Cyclist / runner recent diagnosis - is it going to get worse?

[CyclingRunner]

Afternoon all,

Reaching out to manage my expectations as I start my journey.

Background - 47, always played some kind of sport but got into running seriously 10-15 years ago, while also doing some cycling. Run a few marathons, then in 2018 my marathon running was ended by a pubis ramus stress fracture. So turned into a cyclist. Did about 14000k last year, and do 200-300 a week. Resting HR early to mid 40's.

A year or so ago was chasing a friend in a sprint (5k, up hill) set my record strava time, well and truly red lined - almost vomited at the end 😂. HR was not abnormal - around 170 at the end. Was cooked for the rest of the ride - any slight hill was straight back up to 160+ and I had nothing.

In May I was coming down with a chest infection, and in the final group sprint to the cafe pulled out to take the lead and watched the HR escalate rapidly - felt really uneven and again was cooked for the rest of the ride. Put it down to the chest cold.

About a month ago (there's a theme here) was riding with a group where we ride hard up at 3k hill with a sprint at the end. Won the sprint, no massively abnormal HR but as the ride progressed then hills were a challenge. I'm pretty fit, but hills I would normally do 145bpm in conversation I was dropping off the back doing 160-170. At the lights up the last hill I hit 200 but wasn't breathing overly hard. It drops back down but then any effort is straight back up again. A mate I was riding with is a research medical doctor, felt my pulse and told me that's not normal - don't need to go to hospital as it settled down but was pretty uneven and high.

Then last week running a 14k race called the City to Surf I ran the first 5k at 4.50/k. I'd been running 13k and sub 5/k for the last month or so. Hit the wall up the hill. HR monitor wasn't reading properly but I had to stop and start for the rest of the race, even feeling dizzy. HR was peaking around the 170 mark and would get back down to 140 when walking, felt uneven, skipping beats and pounding. When I finished was back down as per normal.

I had an appointment with a cardiologist booked 3 months ago for a regular check up (5 years since the last) on Friday. Stuck me on the treadmill and after about 10 mins at 12%, holding HR at 150 it ramped up to 175. Stopped the test and after discussion suggested it is more than likely AF.

So I took it easy in my Saturday cycle and Sunday run. Interested to hear your experience - mine currently only rears it's head during very hard efforts, however it got me thinking maybe it's more frequent than I've thought but only becomes noticeable when I continue to push hard. To set my expectations, does it usually progress and you get it at lower thresholds - how quickly? I've got to have a few more tests and then go back in 3 weeks, so I can ask more q's then. Only had a very brief discussion about treatment options (no beta blockers as he said my RHR too low), so ablation was one option or just manage.

Appreciate that everyone's journey is probably different, but this is pretty new to me.

Cheers

[CDreamer]

Hi and welcome - your story is pretty familiar as AF is well known to present in endurance sports. My suggestion - read The Haywire Heart by Dr Mandrola, a cyclist and a cardiologist specialising in AF.

drjohnm.org/my-af-story/

My other suggestion is - The AFib Cure - his website drjohnday.com/reverse-heart...

The short answer is you have excellent observation skills - less (exercise) is more (health) as far as AF is concerned.

[BobD Volunteer]

You are the perfect cadidate for AF as by now I am sure you know. Endurance athletes and fighter pilots are the two groups most likely to give themselves AF due to the over working of their hearts.

I understand the addiction to such things but some moderation is now called for. Excersise is good but over excercise is bad. Whatever you do make sure that you can talk at the same time.

In answer to your prime question, yes, AF is usually a progessive condition but there is some evidence that if you de train and desist from over working your heart then your AF burden may not develop and could even reduce.

[CyclingRunner]

Thanks - appreciate the replies. I've ordered a copy of that book and listened to a few interviews with the authors - concerning that it appears to start with intermittent occurrences which then appear to take longer to calm down as you progress. Dr John is also interesting - I asked my cardiologist the alcohol question and he suggested that in general it's not a good thing but affects different people in different ways.

I also came across some research papers about the correlation with height - forgot to mention that I am almost 6ft 6. The last night at dinner was talking to my dad about it who's had a double bypass (strong family history of CAD) and he mentioned that he also suffers from AFib. So looks like I've got all the risk factors going for me, along with a RHR in the 40's.

Now I've got to work out how to retrain my mind to ride / run easier and still enjoy the time out, assuming that I can avoid triggering at lower BPM's.

[Hidden in reply to CyclingRunner]

Hi,

Must admit that the paternal side of my family have experienced AF, have been treated for AF including strokes from AF. My daughter was diagnosed with AF in her early 30's when pregnant with both my granddaughters. Once she stopped breeding the AF stopped. She now entertains herself with Thai Kick Boxing and resembles a stick insect. Still no more AF. Be interesting to see what happens when she is in her 60's. So, genetics does play a part and so does a dysfunctional Vagal Nerve responding to food and/or drink we consume.

[Rossdkemp]

You seem to be in a similar situation as I was. I suffer from what appears to be exercise enduced AF. I’ve had a few cardio versions and 2 ablations. Continued my same exercise of football throughout this period. First experience at 27/28 now 36. I gave up football last year after a sprint down the wing put me straight in AF. I do a lot of walking now. Had no issues with AF since. Currently alcohol and caffeine cause me no issues. It’s a shame I’ve had to give up on the sport I loved but no point having to go to A&E just because of exercise. Caveat that everyone’s different. Best of luck on your journey.

[Samazeuilh2]

I've been told by EPs that AF is a progressive condition, but its rate of progression cannot be predicted. Some people might progress to persistent/permanent AF within a year or so, whilst others have the same frequency of episodes for years. If you are lucky you might be able to reduce the frequency of episodes by medication and/or lifestyle changes. Studies show being overweight and alcohol consumption are key factors for progression. As others have noted, your athletic activities are likely an important contributing factor-any approach to treatment needs to take this into account. Imo the best thing you could do would be to see a really top EP for a second opinion and discussion (including discussion of whether an ablation would be appropriate).

[RoyMacDonald]

Sounds like my SVT.

I rarely have any episodes at all nowadays since I avoided any triggers like foods I don't tolerate well, stress, develop good habits like having the same bed time and waking up at the same time every day. Avoid alcohol under any circumstances. Caffeine is OK for me and I take two cups of green tea every day and one cup of decaf filter coffee in the late afternoon. Beetroot juice in the morning before I take my regular training ride. I don't do high miles though but I never have as I've always found about an hour works best for me. But my races are usually an hour long so that has always fitted in well anyway. I'm 78 now and still racing. I'm only taking Apixaban and the hospital heart unit discharged me last year.

All the best.

Roy

[CyclingRunner]

Thanks again for the replies. Got a CTCA on Friday to check on the family heart disease side of things then a follow up with the cardiologist. He's a cyclist / runner himself. My GP is also a past triathlete so I've got a few people to seek opinions from. I'm resigned to reducing alcohol down to minimal amounts as a couple of the afib moments were after bigger nights (probably 8 standard drinks or so). Having said that I didn't drink for 4 days prior to the test last Friday, but it seems like it's a risk factor that I don't need.

Was also thinking about an ECG watch to be able to better test to see if I am pushing marginally into afib at different points of running / riding, as my garmin doesn't see to have that functionally and couldn't pick it up a few weeks ago.

Hopefully I can keep the distance and reduce the intensity - got a ride called 3 Peaks Challenge in March next year which is 240k and 4000+m elevation in one day - would really like to do it if I could.