Fibrillation in cyclist's?

I had paroxysmal atrial tachycardia from 18yo to 30yo. It was exercise induced and quite annoying. I could keep riding but would have to drop back my effort. To stop it, I'd generally have to stop riding and do things to increase vagal tone (eg. controlled breathing, cold water to drink, lying down +/- legs up). Obviously not great options during a race! Twice when I pushed hard despite the PAT, it went into atrial fibrillation.

I never wanted to take the drugs. It happened less the fitter I was so I tried to stay fit, well hydrated and avoid caffeine before riding. At 30, I had the accessory pathway ablated and have never had it since so I would certainly recommend getting EPS done.

As to the underlying cause, it is not really clear. Underlying accessory pathways and re-entry of the heart's electrical rhythm are usually found but why those are happening is not clear from my reading.

I've been cycling regularly (2+/wk) for about 9 years now. I consider my sessions to be at high intensity but not to the point of total exhaustion...at least not on average anyway. I am 21 and have experienced arrithmyia intermittently since i was about 16. I went to the doctor about that time and didnt find a problem. Two months ago the duration and onset increased to the point where i was really concerned about what was happening. So i went back to another doctor and he gave me ECG, Lung X-ray and blood tests only to find nothing wrong.

My condition has improved somewhat since then....I am still pounding away on the bike, aswell as surf ski and going to the gym, but occasionally i still get the flutter.

I remember one website i went to when i was trying to find out for myself what the problem was, talked of this condition in relation to some professional athletes, basically concluded that the benefit of exercise outweighed the negatives and you can go as hard as you want without fear of doing damage. I am interested to see if any more messages surface similar to the postings here.

Quoted post said:

Originally posted by tech.racer
I've been cycling regularly (2+/wk) for about 9 years now. I consider my sessions to be at high intensity but not to the point of total exhaustion...at least not on average anyway. I am 21 and have experienced arrithmyia intermittently since i was about 16. I went to the doctor about that time and didnt find a problem. Two months ago the duration and onset increased to the point where i was really concerned about what was happening. So i went back to another doctor and he gave me ECG, Lung X-ray and blood tests only to find nothing wrong.

My condition has improved somewhat since then....I am still pounding away on the bike, aswell as surf ski and going to the gym, but occasionally i still get the flutter.

I remember one website i went to when i was trying to find out for myself what the problem was, talked of this condition in relation to some professional athletes, basically concluded that the benefit of exercise outweighed the negatives and you can go as hard as you want without fear of doing damage. I am interested to see if any more messages surface similar to the postings here.

Hi GC racer,

I am in brisbane e-mail me at : [email hidden]
and I can give you some handy url's and forums to help David S

I get paroxysmal atrial fibrillation every 2-3 days. It lasts for about 12-24 hours. I do a fair bit of cycling (2* per week) but also play hockey. I'm 52 and have had it for 10 years or more. According to my cardio it's more common in athletes.
I used to row and I can remember some occasions where I really pushed it, to the extent of nearly blacking out. This may possibly have been an original trigger.
It is possible that it's only athletes who are aware of the reduction in performance.
Triggers include caffeine and stress.
It try not to let it affect me too much. I carry on cycling and it doesn't seem to affect me too much. I did the South Downs Way in the summer and got AF half way through. I was able to carry on with little reduction in pace, and it actually went off after a few hours. However, it affects me more playing hockey, possibly because it's more anaerobic and spamodic and the recovery period from a burst of running is extended.
Drugs don't have a great affect, I've tried quite a few and flacainide appears to work best, reducing frequency to every 5 days. I might try ablation in a few years once it's got a 95%+ success rate.
My wife's a doctor and I came across the following article on lone AF in athlete's through one of her CDROM's:
http://www.westhertshospitals.nhs.uk/whc/archive/evidence/07%20arrhythmias/Lone%20AF%20in%20exercising%20men-EHJ%202002.pdf.
The conclusion is that "long term vigorous exercise predisposes to AF".
I would appreciate any views on good long term fixes!

Hi Seadog,
As you can see from above I have quite a bit of info via postings and web URL's and attachments from my Words doc files. So if you don't mind e-mailing me I will send them on as they do take up quite a bit of space. I have a fire wall and virus protection in-out from me, so should be OK

What part of the UK are you in? I am a part time cyclist 66 yo and live in Brisbane, Qld. ex London, Uk. Use to race with a north London club.

Hi David
I've emailed you separately. I live in Hampshire and go cycling recreationaly in the South Downs, on tracks when it's dry but on road at the moment as it's so wet!
The funny thing is my cardio had AF when I last saw him! It had just started for the first time and he was on flecainide. We spent most of the session discussing his symptoms and feeling his pulse!

Hi Tech racer and Seadog,

How have been with any of the info mailed? and have you's found anything else in your research into LAF etc?

How is this heat with you Tech racer? I am only getting a few PAC's with it so far. David S

Hi David

Sorry I haven't replied sooner but I've been out this week abd it's taken me ages to read all the really useful stuff you sent me!
On the one hand it's good to see there are other in my position who are coping with their condition, but on the other hand there doesn't seem to be an easy cure-all!
I've got some magnesium orotate which I will be trying once I can give it a fair test and not trying out various drugs as I am at the moment.
One thing I don't understand - how do you work out whether you're vagal or adrenergic type LAF?

Hi there,

I apologise for taking so long to reply but i have been very busy and the information you gave David was not an easy read but worthwhile nevertheless.

My condition has improved significantly now and im trying to evaluate the conditions that have changed to determine if there is anything in particular that is promoting such a response. Three things i think that seem to promote the onset of AFB in myself:

Long periods stationary - at the computer!! - followed by :
Lack of sleep
Stress - intensive physical and emotional
Caffeine

With the UW_Wformular.doc you sent Dave, it has this statement:
"It makes no sense to drink so much alkaline (bicarbonate-rich) water that the body suffers the loss of potassium as a consequence since this could contribute to afib in addition to lack of magnesium"

In Laymans terms I have taken this to mean that drinking too much water can flush out the minerals that are necessary for proper operation. If this is correct, it would make sense in my case. I have been using MAX's weight gainer and i'm wondering if the nutrients in this have been one of the causes of the beneficial effect i have had of late.

I'm in the US, I am 62, have exercised very vigorously and for long periods of time my entire life. A year or so ago, I noticed that during or post exercise, I would go into periods of atrial fibrillation for periods of 4-24 hours at a time every few days in very random pattern. Hard or long efforts seemed to trigger it, sometimes a few hours after stopping.

On July 23 of last year I had a catheter ablation performed by Dr. Hugh Calkins at Johns Hopkins University in Baltimore, MD, USA. The bottom line is that I have been a-fib free since a month after the procedure (it takes a little time for the procedure to "cure"😉 and significantly, I have returned for several months to very hard workouts (for example, two hour duration with multiple maximum efforts) without any incidents. This would have been totally impossible before. No one will guarantee that catheter ablation (which is a significant procedure, but can be done on a day-stay basis) will cure everyone, but good doctors are getting very good cure percentages for patients who are fit and otherwise don't have significant issues.

If it came to it, it would be well worth a trip to the US to have this done. However, I would find it hard to believe that there aren't good doctors in Australia that could be as effective. Be sure that you go to someone who is very experienced and is sympathetic to endurance exercise. Dr. Calkins is certainly in that category, and in addition to being a world expert, is very personable and very reachable by email.

I last posted on this topic 7 years ago! Here's an update:

Like Donald I've had a PVI ablation. Mine was last year at the London AF Centre and carried out by Prof Schilling - combined RF and cryo. It was successful with no AF after about a month after the procedure. Before the ablation, my AF had been increasing in frequency up to about 80% of the time. However I was not very symptomatic - I think I just got more used to it as the amount of AF went up. I could carry on cycling without majoe problems.

However an ablation becomes a lot more difficult once you become persistent/permanent, and I was well on the way to that. So I decided to go ahead as it could be my last chance of a decent outcome. I've been very pleased with the results. I can get straight up from sitting down without feeling dizzy and I generally feel better.

However it hasn't had much impact on my bike times on the standard circuits I do. I have improved on one of my times by a few seconds but that's it. I find it difficult to get my heart rate up really high - i.e. above about 130 (and I'm off all meds other than warfarin). I think before, even when in AF, my heart was still pumping efficiently even when in AF. The exercise could also have helped reduce the AF.

Generally now I don't push it hard. I think really pushing it was what originally caused my AF, and I don't want to go back to that by causing more inflammation in my heart.

I agree that the fitter you are the better outcome you are likely to get from an ablation.

Mark

hmmm, I just stumbled across this thread and I am wondering if there are times that I am not having this issue as well. I am 28 and an avid cyclist and race, so there are times that I am pushed to the max. I spend 8-10hrs on the trainer during the off season doing various types of workouts and then am on the bike as much as 20+ hrs a week during the season. I don't really notice to much on the bike except that there are times when worked really hard I feel absolutely awful (head ache, nausea, dizziness). Honestly, as hard as I go I have chalked this up to the normal result of putting my body through what I do, but I guess it could be a symptom.

What I have noticed as a of late is that if I stand up to quick I get extremely dizzy and it has seemed to progress to the point where it drags on and intensifies for up to 15-20 seconds. About a week ago after my a.m. workout, when I took the first drink of my protein shake my heart seemed to "flutter". It was a really noticeable sensation and continued throughout the day. After it continued throughout the day, I did look at my resting HR, and it was high (70-80 bpm when it is typically around 47-50), but I had just completed a workout at the gym an hour prior. I would not describe my sensation as being a really elevated HR, maybe a touch faster, but more of an odd "flutter".

You would be at increased risk of atrial fibrillation due to the amount of endurance exercise you have. If you do get AF it's more likely to be what is called "vagal" AF, which occurs usually after intense exercise during the warm down period or after eating/when relaxing.

It's worth feeling the pulse in your wrist - is it regular or irregular? You should get a pretty steady rhythm with little variation. With AF the pulse can pause for 2 beats, or sometimes get 2 beats close together, and the rhythm is generally very irregular. At the same time I get a funny flutter feeling in my chest.

It can cause dizziness on suddenly standing up. I used to get this, I had to pause for a few seconds on standing up, and I would get a bit puiffed just going up the stairs. Once I was going it was no problem. I could carry on cycling or whatever but just had to warm up a bit more. Now I've had a successful ablation, I don't get that anymore. Disappointingly my bike times have not improved however!

If you get the symptoms over an extended period it might be worthwhile getting an ECG. Your local GP's surgery should be able to carry that out. Don't ignore it however, it does need diagnosing and treating.

Mark

Hello all:

I am new to this. So here is a little about me. My first episode of AFiv was at 22yrs old, I am 33 now. I remember that I was laying on the couch watching tv when my heart rate took off for about 40 seconds and all of the sudden it stopped. I started cycling when I was 10 years old and I started to get serious about cycling when I turned 18 (which is when I got my first heart rate monitor). I would ride in the mornings for about 3 hours and I would always go hard, I would hit the mountains and would pretty much timetrial all the way to the top with my heart rate always staying way over 210bpm. In the afternoons I would go riding with my teammates for another three hour ride. My resting heartrate was pretty low, between 30-35 bpm. My AFiv isn't that bad, I get an episode about once every two or three months. I tried to keep on cycling but it kinda sucked that my heart would skip beats during sprints which used to freak me out. I just ride recreationally now. My cardiologists says that it was probably the long hours of hard training that probably caused my AFiv.

Oscar.

Hi Oscar,

It's good to hear your story - you sound a pretty hard core cyclist and just the sort that would develop AF! Getting an episode every 2-3 months is not that bad. If/when it gets more frequent you might want to consider an ablation, but it's probably worth waiting for now, as techniques improve all the time. Are you very symptomatic now or can you handle it fine if you're not cycling?

You're probably deconditioning your heart now, which, funnily enough, is a good thing. An athlete's heart can be too large and the low heart rate can precipitate the irregular beats. Some people find it improves when they are not quite so hyper fit. In any case follow your cardio's advice. Do you also see an EP who specialises in irregular heart rhythm?

There is a website for those of us who have "lone" AF (i.e. AF without a known cause, no other heart problems etc.) - www.afibbers.org - which is very useful.

Mark

Hey Mark, nice to meet you and thanks for the link.

Well, I used to be pretty hard core back in the day. Not any more. The AFiv pretty much killed it for me. I just go on rides now, but just for exercise. No more motor pacing at 4am 🙂.. My cardio told me about the ablation procedure, he also said that it wasn't worth it to get it now since i hardly ever get episodes of Afiv. I kinda would like to get it now just so that I could race and be competitive, but I guess that it's not really worth it.

As I get older, I have notices that my episodes have changed. My heart used to beat really fast, and hard. It was a super strong beat. I used to think my heart was going to burst out of my chest. But I guess that is also due to having a pretty strong heart back then. Not any more, now my heart just beats fast, but it doesn't feel as strong. My doc says it's due to me getting old (thanks doc)...

I never knew that there were so many cyclists with this condition.

Hi Oscar,

I bet there are lots of cyclists on this board who have AF and are not aware of it. Cyclists have 3 or 4 times the risk (as do other endurance sports participants).

If you don't get AF much then an ablation probably isn't worth it. However it is worth watching in case it becomes more frequent. You wouldn't necessarily be able to go back to the same intensity as before anyway, even if it's successful - and only about 60% of ablations are successful.

Cheers
Mark

I'm an alternative medicine practitioner and Registered Nurse and had extensive experience as an ICU nurse in Cardiovascular care. I pretty frequently help people to overcome atrial fibrillation and chronic heart palpitations and the answer, in many cases and especially in athletes, is fairly simple and straightforward as long as you've otherwise been given a clean bill of health.

First: Get off of ALL artificial sweeteners. These are very well known to cause heart palpitations and arrhythmias and anyone who has an abnormal heart rhythm needs to eliminate them completely.
Next: Magnesium and Vitamin B6 supplements. Most athletes are slightly magnesium deficient from chronic sweat losses and the paucity of magnesium in modern diets. Taking HIGH doses of magnesium can often eliminate these problems completely. Since Vitamin B6 is required to absorb magnesium, there are some people who don't benefit from magnesium alone and need to also take B6. It really can be as simple as taking high dose magnesium and a couple of B complex vitamins every day to eliminate those stray beats. Oh, you can still be moderately to severely magnesium deficient even if your doctor did a magnesium level and it was normal. Blood magnesium levels are useless and I have no idea why the medical community uses them, so unless you had a HIGH magnesium level, you can completely ignore a normal magnesium level.

Two cautions, though. If you have kidney DISEASE (not including kidney STONES) then ignore this advice completely. You will know if you have kidney disease because you will have a kidney doctor (or you've had one in the past). If you have a kidney doctor, then you must talk to your kidney doctor before taking magnesium. No exceptions.

Second: If you currently have atrial fibrillation, you could 'convert' to a normal rhythm. While this sounds good, unfortunately it's not because atrial fibrillation tends to pool blood in the atria, causing tiny blood clots. If you have atrial fibrillation and you suddenly convert to a normal rhythm, those clots could go into your system and cause BAD things to happen. If you currently have atrial fibrillation, you must speak with your doctor before taking magnesium as well.

Hi Kerry,

Unfortunately I tried all that - Magnesium supplement every day, no sweetner (I don't have sugar anyway) and a high dose B complex vitamin tablet and it still did no good!

There were a lot of other supplements I tried as well - L-arginine & fish oil to name but 2. In the end I had an ablation which fortunately does seem to have fixed it.

Cheers
Mark