A Fib in an athlete?

[Lewyn]

History:  35 y/o Male. Five years ago in hospital with terrible "viral stomach thing" and went into A Fib.  Heart converted itself within twenty minutes.  Five years later (Summer 08), I had an erratic heartbeat and went to hospital were I was in A Fib.  They converted me with medication.  Nothing for three months and then the third episode.  I did nothing and it converted itself within an hour or so.  I saw a cardiologist after the second adn third episodes which have been the only ones to date (3 in five and a half years), and he did EKG and Echo.  Both normal across the board.  All blood work is fine.  Was told I am unrestricted in my abilities.  Here is the kicker.... I have run every distance race from 5-K to the marathon.  My hobby is triathlon.  I just finished the fall season with my second Half-ironman.  I was in the top 25 % of 2000 people, so I am not walking these things!  Resting heart rate in the high forties. Even during my episode I was told it was rate controlled because my heart rate was still only in the eighties. Not trying to post a resume, but I am rather frustrated!  My questions:  Is this normal?  This has had a huge mental impact on the way I live my day to day life.  The doctor said these things can't always be explained and to "drive on."  I suppose this is just a tough pill to swallow.  Are there ways that an athlete is doing this to himself?  Improper balance of some mineral or something?  Thanks for listening.  

[AnthonyF1500]

Hello, I read your story and it is very similar to mine. When I was 40 I had a bout of severe food poisoning. Shortly there after my wife and myself were trying to get pregnant, she has 2 miss carraiges and we finally succeeded. During these issues we moved to another state, quit our jobs and started a new business. It has been successful but the stress I endured with all this was tremendous! I was training, running, biking and stairmaster about 2 hours a day because I was always told it was a great stress relief. I had my first Afib episode about 1.5 years ago. I had 6 in 3 months during the high stress level time. Our business really took off and my stress level decreased quite abit and I went 1 year without another afib episode. I do have PVC's from time to time and they too seem to be brought on by stress. I just opened a second business + my wife and I have been having arguments for months + we have our son who is an angel but any child adds frustration. During this business opening the afib episodes came back, but this time during exercise. (Echo + stress test all good) The shorset episode has been 1 minute the longest 22hrs, I always convert on my own. My cardiologist decided since the exercise seemed to induce the last few episodes that I should try a beta blocker to lower the HR/ adrenaline rush. I have been on it for 2 weeks and only a few minor/very short irregular beats. BUT, I have cut back on my workouts immensly. I am afraid to go running for fear the stress will bring about an episode. I know I have to do it, and I will. I truly believe the STRESS has had a major affect. I am a "Lone" afib person. I have NO risk factors that I can see for Afib other than stress and physical exertion. At my peak I can workout 2 hrs a day.I hope this helps...Anthony

[Der_Kaiser]

Hi,
I recently entered the club of A-fibs. You story sounds exactly like mine: fatigue plus dehydration. Had also 1 week of stomach bug, since then in and out of A-fib, esp. as I start riding (easy, that is!)
Stress can definetely "help" the onset, esp. when sleep is crappy (vicious cycle: stress, bad sleep, more fatigue, more stress, less sleep etc).
BTW, sleep apnea (yes, even in a healthy lean person) is a major contributor. It's worthwhile getting it checked.
Cheers, Alex

[smconorm]

I think that for endurance athelets one of the best cases of complete recovery is pro cyclist Bobby Julich formally with Team CSC who retired this year at 36.  Bobby was diognosed with RSVT in 1996 and was treated with radio frequency abblation.   Bobby went on to place 3rd in the 1998 Tour De France, win a Bronze metal in the Cycling Time Trial in the 2004 Olympics and win the 2005 Paris-Nice Criterium International.  

I attached a link below to the story.  

I think I would like to have an ablation but my EP is reluctant ....claims there is not much data on long term success and that the procedure is new and evolving.   The preference is to use drugs which would be fine for anyone but an endurance athelete.  Also these procedures are expensive $30K to $50K and there may be pressure from insurance companies to stop "quality of life" expenses.

Anyway there is hope and every year the technology improves so I may take my time to find the best doctors .




http://www.bobbyjulich.com/?p=46

[cm11599ps]

I was going to bring up the Lemiuex point too.  That's what my doctor  told me the first time I had Afib.  FWIW, **** Cheney has it too.

[Lewyn]

I am so sorry to hear about your wife.  You have given me some great insight and inspiration and I hope to keep plugging away at it!  I will keep trying!  I hope I can return the favor someday.  Lewyn

[Lewyn]

That is so cool.  This place is such an awesome resource for information.  I did not know that about Lemeiux.  I am still having some great times on some runs and bikes but, it's trying to work past the mental aspect that's tough!  Thank you so much for the information!

[Wisconsin2007]

First, to smconorm, I'm so sorry to hear about your wife.  I can't imagine what that must be like.  Thoughts and prayers are with you.

But to Lewyn - I get PVC/PAC and some other paroxysmal arrhythmia that is relatively new and needs checking on.  That's not the reason for my note -  the reason for my note was to point out the case of the hockey star Mario Lemeiux - At the end of his career he was going into (and playing through) afib while on the ice.  Not to suggest you should do the same, just that there have been professional athletes with similar conditions.

In the end, Lemeiux ended up retiring (at age 40, I believe), and shortly thereafter had an ablation done which resolved his issues.

[smconorm]

It is hard to deal with the news that is a threat to our lifestyle of running and cycling but this condition is not life threatening.  Sometimes we need to keep the big picture in mind.    In my case, I had over 25 good years of racing both running and cycling that I am greatful for.  At this time I am glad that at least I can still participate with the "B group" -- not at a competitive level.  I am converting my bikes to a lower gearing for hills (34 -27 compact gearing) and my running is more like jogging.  

As far as stress, the EP told me it wasn't anything I drank (coffee) or did but a latent condition that gets worse and more apparenet with age.  However, in my case I was also dealing with a great deal of stress since my wive was diognosed with stage 4 cancer and I watched my 401k lose half its value.  Apparently stess, coffee, and other things just bring out the symptoms.

[Lewyn]

   Thanks as always.  The funny (not really) part of all this is that I am able to train harder than ever now.  It's just the sitting around waiting for the next one that stinks!  The Cardiologist did explain that the AFIB is not the concern, but rather long term effects with things such as stroke.
   I think he understood that physical exertion was part of my routine and that's why he said "have at it."   For instance, I specifically asked him if I should do the 70 mile ride on my schedule the next day, and he said "absolutely, if you feel like it."  So I did. I don't have a sedintary lifestyle.  My job in and of itself is very physical and stressful.  As for the oversized heart, he said the echocardiogram showed no abnormalities.  Wouldn't that have shown there?
    I certainly do understand the stress (and probably insane amounts of cortisol that must be going through me at times) that the prolonged workouts are having on my body.  I am trying to adjust some dietary issues and continue to try. Thanks again.  Lewyn

[outofrhythm]

Certainly stress could play a role in your heart issues. I am a physiologist and study the effects of diet, stress, exercise, environmental exposure, etc... on animals and they all have significant effects on the progression of almost all disease states.

Also, exercise can have both beneficial and negative effects on your body. Excessive exercise has been reported to elevate body free radical (toxin)) levels due to high oxidation levels. Athletes are prone to over-sized hearts and problems associated with vagal toning. It appears as though moderation, or calorie and energy restriction are the only proven means to increase chances of a healthy life.

I would suggest finding a cardiologist or EP who understands that exercise is a very important factor in your quality of life, and one that should be considered in any treatment course.  

[Lewyn]

Thanks for the information.  It's seems so hard to swallow this.  I mean we are told our whole lives that exercise is the way to maintain a healthy body and function and then this. I never imagined I would be posting on a heart rythym forum and certainly not at 35 years old.  I am trying to keep this in perspective but it's hard.  Have you or anyone else out there heard of stress causing these things?  That seems to be a very popular question when discussing these things with physicians. I mean I have endured some heavy loads of stress, but enough to cause a heart issue!?! Seems odd but I will investigate every avenue. Thanks again for your time.

[Lewyn]

Thanks again for the information.  I have not gotten to the medication stage and God willing it won't happen!  I did visit the letsrun website last night briefly, and I intend to continue researching everything I can.  Lewyn

[outofrhythm]

Most anti-arrhythmia medications--especially beta blockers--will slow your HR which will limit your ability to train. It feels somewhat like having a governor on your heart which doesn't allow you to reach full throttle.  

[smco]

I am also an endurance athlete and was diagnosed with arrhythmia last fall and have been taking a beta blocker, metoprolol, and rythmol, a channel blocker, for the last two months.  So far the main side effect has been to lower my max heart rate by about 30 beats.   My tempo was in the mid 150's and now I suspect it would be around 125.  It seems that my power output is reduced but not by  an amount proportional to the reduction in heart  rate.  Perhaps this is due to some sort of inefficiency that occurs with higher heart rate.  

I have seen both a cardiologist and an electro physiologist and both told not to go "all out" in exercising.  However, neither of these people seemed to understand the unique condition of a runner's heart.  I would like to find a medical professional that could help with advise regarding ablation and medication.  

I have two friends who went into a-fib while exercising and both are doing well .  One is in permanent a-fib and has learned to compensate.  The other has completed two ablations and is doing well.   It does seem that the onset of arrhythmia is more common among endurance athletes or those with low heart rates especially for older ath letes .

[Lewyn]

Very interesting comment.  The first ever episode I was violently ill and depleted.  The second and third episode were both post run.  Not immediately.  One was two hours later and one was four hours later.  I am a big guy and have a high sweat rate.  I read somewhere that an electrolyte imbalance could be the issue but it was not indicated on blood work that day.  I have often wondered if it wasn't/isn't something dietary post run.  In both cases I do recall going too long before replenishing, with one almost to the point of nausea and dizziness. When you say you could not get you HR up on medication, is that because that is the protocol you were given or the medicine won't allow it?  Thank you very much for the support.  It's tough, as you know, trying to deal with the mental aspect of this.  Very easy for someone to say "forget it, it's ok" when it's not them!

[outofrhythm]

Well, if you can get your HR rate that high without abnormal rhythms and you convert out of a fib on your own, I don't think you should have major concerns. The problem I had was that at age 32-33 I started having similar issues and as I got older they got more frequent and problematic so finally at age 42 I turned to ablation. My a fib was similar to yours in that it was only about 70-70 B/M, but it was irregular with skipped beats and no pattern.

I trained on Norpace, Flecanaid and Rhthmol, but I could only get my HR to about 85-90% max. and my training and times reflected that. Every once in a while I could pop off a good race, but the a fib was a constant issue. Similar to your situation, I would get abnormal beats so I would go out on runs to race my HR up and them it would normalize.

As long as you can train with a high HR you will maintain fitness and should perform well. If your PVCs/PACs lead to more frequent a fib episodes you will probably need to get them under control. If you are training a lot you should also keep an eye on your electrolyte intake as low mineral levels (K, Ca, Mg)  may cause problems that may not be detected on a blood test days or hrs later.


There are some good discussions on athletes and a fib on some running forums if you are interested. You will be surprised how common afib is in endurance athletes.

http://www.letsrun.com/forum/forum.php?board=1
Just search afib or atrial fibrillation

[Lewyn]

outofrythym: I have PVC's and PAC's but when I was given the treadmill test, I was told that they resolved and stopped with exercise.  If I go run now I will have PVC/PAC at lower HR's (140-150ish), but if I get to a tempo effort (160-170ish) they are not there!  My resting HR is about 48 when I am sitting ar resting for a while.  As for meds?  I have never used except the one time they used to convert.  The weird thing (knock on wood!) is that I had my first episode and went on to do a decent first half-iron. Then, three months later had another episode and did nothing about it and did my final race of the year (another half-iron) and went 26 minutes faster.  So I have actually seen improvement in all my times!  The doctor told me that PVC/PAC are very common in people, but being an athlete and more "in tune" with my body, I just feel or notice them.  Are you guys still able to train, if you can get past the mental road blocks?

[bundleblocker]

I am also a runner (though not at your level)  and have "lone" Afibs and also PVC's.  After jogging a half marathon last year I had several episodes of Afibs, but it doesn't always happen after jogging or after racing (usually after eating fatty foods)

The doctor told me to keep running, but as you said it is very frustrating because being on Metoprolol I can't get my heart rate up past 150.

I've been told the body will eventually adjust to the medications and the dizziness has now gone. But I'm still very tired and miss the adrenaline a lot.

I do know other marathoners who have Afib, but nobody (including the doctors) know what really causes them it seems.

I'm a lot older than you two, 72, and my cardiologist just said when I asked him what caused them "You're entitled!"  

My internist said palpitations (of any kind) are common, in people over 60.

But it must be especially frustrating for you two.  I had NO palpitations of any kind until age 60 or so.

[outofrhythm]

Your history is very similar to mine. I was a top triathlete and sub 2:40 marathon runner but started having episodes of a fib. It seems to be somewhat common in endurance athletes. Anyway, I had 4 cardioversions and then decided to try meds. I used Norpace and flecanaid for a while but neither worked well and they had terrible side effects. I ended up getting an ablation 5 weeks ago so the jury is still out on whether that will fix it.

What is your resting rate now, and can you describe your rhythm when you go into a fib? Do you PVC's/PAC's. What meds have you tried? I might be able to offer some suggestions. Meds and threat of afib made it very difficult to train and it is hard to deal with mentally.

[Jerry_NJ]

I have read somewhere (maybe on this community) that high stress aerobic activity can cause AFib.  This post may attract some other input on this point.

The bigest risk with AFib is clot formation, so you may want to consider taking an aspirin a day to help reduce that possibility.  Said another way, AFib is not in itself a high risk heart condition, but it can (will?) cut into your stamina - it has for me.