Atrial Fibrillation PSA To Fast OFs

Al Truscott

My wife, who, bless her, seems to care about my long-term health, sent me some articles this morning about athletes and atrial fibrillation. Now, most of us know that runners and other endurance athletes are at higher risk as they get older for developing atrial fibrillation (rapid heart rate triggered within the upper chamber of the heart receiving blood from the lungs), but these articles go a bit deeper into both why this might happen, and what to do about it. I was intrigued to read them after I saw this introduction:

"The endurance athlete is special. These are not the people who run a marathon; they are the types who ride their bike to the marathon, run the 26.2 miles, then ride home.

The normal exerciser sweats, breathes hard, and occasionally pushes his heart rate close to maximum. The competitive chronic endurance athlete pushes well past that threshold on a regular basis—for years and decades. Going over the limit—in dose and intensity—is what defines these individuals.

Endurance athletes endure fluid shifts, changes in pH and electrolytes, and fluctuations in blood pressure. Their atria are exposed to chronic volume and pressure overload. Athletes live in a disordered autonomic milieu—spikes of sympathetic outflow interrupt a persistently high parasympathetic tone. The athletic heart is exposed to extreme tachycardia and long periods of profound bradycardia.

And it is not only the physical effects. Endurance athletes who compete may also develop mental and emotional stressors. Although the incidence is not known, some athletes use substances to enhance performance or promote rest—many of which are arrhythmogenic. In addition, those who exercise as a vocation rather than a hobby may endure self-esteem issues, which have been correlated ^[3] with greater inflammatory responses to stress."

I shuddered with a recognition - every sentence in that applies to me, except for the one about PEDs. So I read on. (I'll provide the link to the article, but, caution, it is written mostly in medical/cardiologese. Even as an MD, I can can understand the words used, but it's a bit more difficult than deciphering James Joyce or Thomas Pynchon. EG, this sentence: "Vagal stimulation further shortens AP duration, then sympathetic stimulation enhances Ca-current, which has a net depolarizing effect and can lead to rapid repetitive firing.") Article (you'll need a Medscape account to read, I think.)

Anyway, this gist of it seems to be a theory that some of us have the advantage of conduction pathways near the top of our heart, where the veins from the lungs are bringing blood back, which work a bit differently, along with some structural differences in the atrium itself, which help reduce the risk that all that chaos during intense and/or prolonged exercise described above will trigger a bout of arrhythmia in our heart. Others who don't have these variations might develop AF. The older you are, the longer you've put yourself through the ringer, and the faster you are, the more likely you will experience AF.

So what to do if you develop AF with no discernible cause other than you are a "competitive chronic endurance athlete [who] pushes well past that threshold on a regular basis—for years and decades."? Apparently, you have three choices: medication, which would significantly inhibit the quality of your training, surgery, which, in addition to its inherent risks, fails 15-35% of the time, or simply stop being a competitive endurance athlete, as defined above.

The good news is, AF is not really life threatening. But it's still worth being aware of the symptoms: Heart palpitations (feeling that your heart is racing or fluttering) • Awareness that the heart is beating • Chest pain, pressure, or discomfort • Abdominal pain • Shortness of breath • Lightheadedness • Fatigue or lack of energy • Exercise intolerance

Bob Irwin

I've had afib for 10 years - the first episode was at mile 10 on the bike of vineman. My heart rate went to 250bpm and I got so light headed I almost fell off the bike. I kept going for a while, but stopped when I got to the bottom of chalk hill - i knew I couldn't make it to the top. I take two kinds of medications. A calcium channel blocker every day to control my heart rate if I have an episode and an antiarythmic which I take when I have an episode that lasts longer than about 15 minutes. The calcium channel blocker doesn't seem to keep my heart from getting up to where it needs to be, but it does take longer to get there. When I was ferst diagonsed, I took a beta blocker. That made me tired all the time and I couldn't get my heart rate above 130. Switching to the ccb fixed that. My cardiologist says its fine to train and race up to the IM distance. Three or four days before a race I stop taking the ccb so that my heart rate will fluctuate more normally, and carry both the ccb and the antiarythic in my singlet pocket. Luckily, I don't have episodes that often, and they don't usually occur during exercise. The cardiologist said that if I have an episode that requires medication during a race, then I have to call it a day. I don't believe that my cardiologist would agree that afib is not life threatening. My understanding is that the heart beats so fast, and is so out of synch that it does not pump blood effectively. This leads to pooling of blood in the heart and clotting, and possible stroke. I'm not a doctor, but that's how my cardiologist explained it to me. The good news it can the managed.

Paul Hough

I'll be 58 this year and have been running since elementary school and running hard since 9th grade track. I don't have AF but I guess I'm at risk according to the medical literature. I met my primary goals as a runner so now as a triathlete I want to do well, but it doesn't define me the way running did. In that sense, I may have reduced the risk.

What does bother me more as I get older is catching my FIRST wind. Sometimes when I start out running or swimming, I'll be gasping for breath before I hit 100 yards. It's like my system hasn't opened up and can't get enough air even if I'm moving at an aerobic pace. If I slow waaaay up, then ease back into it, then catch my breath and within 5-10 mins I can be hammering like nothing. This is something that never happened when I was younger but seems to bother me even more as I age. I'm not sure, but warming up is becoming more and more important. Or is this a precursor to AF??

Mark Maurer

@ Paul, I'll be 59 this year and it takes me a while to warm up as well. When I head out running I'm winded by the time I hit the end of the block. However, 15 minutes into it I can hammer the run. I've also noticed that when I'm climbing stairs at work that I start breathing deeply after climbing a couple of flights, but I catch my breath really quickly once I hit the level floor.

Al Truscott

I think I started noticing this thing with warm ups being longer about age 55. It goes in three stages. About 45-60 seconds in, I suddenly feel like I just dont want to be working, and that just as quickly dissipates, as if my body is flipping a switch into ,"OK, we' re gonna do THAT again". Then, the next 5-10 minutes, I'm able to be moving along, but no way I'm gonna be able to put any real effort into. Then, after 15 minutes, I'm ready to hammer. When I was "younger", I could start slamming within five minutes. I bet its more wisdom/experience than actual age related physiology, an internal injury prevention mechanism. Notice how much warming up the 20-somethings at the top levels,do before the all,out effort of a big race. As we mortal athletes get older, our brains and bodies have learned from experience the value of the warm up which the Olympian already values. Or maybe its just that lower testosterone levels allow the innate rationality to dominate, instead of warrior instincts.

So, no, Paul, I dont think those are signs of AF.

robin sarner

not mentioned is maybe the biggest problem with afib.       whether chronic or intermittent (paroxysmal).    and that is stroke.        clots form in the heart and then go to the head.     

risk factors for stroke with afib include : heart failure, hypertension, vascular disease, diabetes, stroke or clot history, being female, and age over 64.   

for instance, if you are a male with hypertension over 64, you probably should be on warfarin (Coumadin) or one of the newer thinners.

Bob, how old are you and are you on a blood thinner more potent then aspirin?     

Tim Dunnahoo

I'm 59 and was recently diagnosed with A-Fib after wearing an ECAT device for a week in September. My episodes are short (10 seconds or less) and at random times (night, day, while training or not) but silent (no pain detected) although the risk of stroke was present. My cardiologist put me on prescription Niacin and Flecainide, and I continued to wear the monitor for four additional weeks. Last week I received his approval to race IMAZ - a week from today (and I previously received approval from the electrophysiologist that will perform my ablation in December). These meds corrected the wacky HR I initially detected nearly a year ago, and eliminated A-Fib episodes. In fact, my HR dropped back to training ranges I experienced several years ago. My morning HR is once again rhythmic with a consistent cadence, but no longer too low (30's-40's). I have (and still) experience labored breathing for the first 10 minutes of cardio (and sometimes HR somewhat elevated), before settling in to normal breathing rates and HR. At least all the tests I have endured this past year show that otherwise my heart is strong and healthy; no myopathy or heart failure. Being healthy, active, and "young" I understand my ablation has an 85% first time success rate. It's good to know that if it isn't, I could continue with the effective meds.

Paul Hough

I read the Haywire Heart earlier this year.  I highly recommend it for lifelong endurance junkies.