A-Fib and Ablation

Hey everyone - I’m writing this down and sharing it so that someone can potentially benefit from it one day, much like I’ve benefited from reading what others have posted. A bit of a long post, but hopefully useful if you are at the beginning of your journey. Hopefully one day someone will read this, recognize a pattern where I went wrong and they can get on a better course. Either way, I appreciate the support of this community.

Here it goes.

I was pretty competitive, but by no means special, for about 15 years. I won my share of Category 3 road races, criteriums, an occasional TT, and quite a few Expert/Cat 1 mountain bike races. By no means was I ever going to become a Cat 1 on the road - I could have been a 2, but all those points were earned in criteriums, so I didn’t think a fair measure. This is all to say that I was a racing cyclist, in the mix, but not talented or special. Just a regular dude that likes to suffer and really enjoys riding a bike. I was sorta kinda known for my sprint in an extremely small circle inside of an extremely shallow pond.

After getting away from racing for a couple of years and trying to be a good husband and full-time worker (still haven’t cracked that nut, btw), I spun out some, got into heavy, fancy beers and heavier foods and went from 185lb to 255lbs. I found my way out of that, got away from alcohol and unhealthy foods with hopes to returning to just being a good cyclist, a healthy middle-ager and a really good exerciser. I’m long past racing, but every Saturday I pine for the opportunity to go hard for 3 hours with my pals, I VERY much enjoy the pain cave I find on 100 miler gravel events, and I love a burly 50-60mile MTB race. There’s something about hour 4, where everything comes apart, that I love so much.

Now we are in the year 2016. I lined up for Singletrack6, hosted by the TransRockies group, in the Canadian Rockies, still very heavy, but one month sober and getting leaner. The course (my hubris) annihilated me, and I went into severe dehydration on the third day. A course sweeper found me and guided me down the mountain to the medical tent. If you’re unfamiliar with the TransRockies organization, their medical care is first rate (better than any hospital or clinic service I’ve received anywhere in the US in my entire life). Ken, their amazing doctor, pronounced me A-Fib and drove me to the ER. I had no idea what he was talking about. I sat in the ER waiting room for hours, but tragically, some teens had been in a life-threatening car accident and the small-town medical center was fully focused on them. After some 6 hours waiting, I felt fine, so I left.

I dabbled in a few remaining stages of the event – in each one, Dr. Ken would jump out of nowhere, check my pulse and give a go/no-go to proceed. I’ll never forget how good they were.

Ever since that day, I would intermittently, but not regularly, see my Heart Rate go to 220bpm on rides, however I was breathing through my nose and barely pushing any more than 180w. As someone who was known for his sprinting ability, I knew this didn’t make sense. I bought every HRM strap that had a decent reputation - Wahoo, Garmin, Polar - and they all seemed to do the same thing.

Each time my HR would go that high (anything north of say 190), my power would completely and totally vanish. I would come to an almost stop on the ride, unable to produce any effort, but also not breathing hard at all. After a few minutes, it would just go away, and I could give it stick again.

With multiple ride files with 220bpm evidence over the course of a few months, I stormed into the cardiologist’s office and begged for an explanation. They did an ECG and couldn’t find a single thing wrong, so they sent me packing.

Months later, with even more evidence, I returned to the cardiologist, but asked for a different doctor. He understandably discounted my Strava files, I can concede that a Garmin strap is not an FDA approved device, administered an ECG, ultrasound, and a stress test. All tests were negative for A-Fib, although when I was at the max level of the stress test, comfortably at 167bpm, I watched my HR jump to 198bpm (which I can’t do). Despite seeing that, they discounted me and sent me packing again.

Nobody at this cardiology office took me serious because I’m young, strong and fit.

At this point, I resigned myself to assuming that I was paranoid and/or I was just going have a heart attack on the side of the road one day and I kept on with my life. For about a year, I just navigated around it – whenever I felt my heart doing the thing that the doctors said it wasn’t, I would just soft pedal for a while. Usually within 30-45 minutes, I felt like a lion again and I could get back to pace. I still ride with an HRM, but I don’t have the data field showing on my computer – it ends up controlling me.

Seems like heat doesn’t help either. I live in North Mississippi, which is inexplicably miserable, hot and humid in the summer.

It seemed to me that the symptoms were associated with my level of fitness and weight. Like many people, I fluctuate a few pounds every couple of years, tending to range from 210-224lbs (seriously, why the hell do I chose cycling if I weigh this much?!?!). When I’m on the lower end of that range, I don’t tend to have symptoms, which is coincidentally when I’m in better shape and able to manage a solid 9-10 hours a week.

This winter (2023), I’m at the upper end of my weight range.

Fast forward to March 10, 2023 – Mid South Gravel. I was actually having a pretty good day considering I was not in good shape. Despite that, check out my Strava file– see that crazy HR at the beginning? Yowza!

Unfortunately, my day was cut short by a crash and a couple broken ribs.

When I got home, I realized I couldn’t move enough to deal with my bedside alarm clock, so I began wearing an Apple Watch at night and using that as my alarm clock. Prior to that, I only wore it when riding since I thought they were extremely dorky and I cannot stand any more notifications in my life. But I loathe riding with a phone, the watch stores music on it, and it was a gift from my wife, so I went through the motions.

I quickly started receiving A-Fib notifications around the clock, despite not being able to feel it at all. The only indication that I had was that my Whoop was seeing my resting HR in the morning as 80-90bpm, as opposed to the 40bpm it has been forever. I was beginning to think that this was just normal recovery, but I was getting A-Fib alerts while napping, while eating dinner, while sitting on the sofa, you name it.

I went to my general care provider on March 29 for my bi-annual checkup, he ran a 12 lead ECG on me and could see that I was in A-Fib, despite not feeling any symptoms. He referred me to another cardiologist with a focus in Cardiac Electrophysiology who saw me on April 6. The cardiologist ran an ECG on me, and again, I was in A-Fib, and again, I was feeling perfectly normal.

I’m getting an ablation in two days – April 12. I’ll follow up with details and experiences around the procedure. I’m really hoping this leads somewhere positive, because I love riding more than anything else in the world and I’m only getting so much worse at it that I fee like I’ll have to stop forever. Hopefully this gives me a little more runway to end my riding chapter on my own terms.

In the meantime, some salient points.

-GET AN APPLE WATCH
-Don’t be a meathead and keep ignoring it
-GET AN APPLE WATCH
-I’m suspicious that the extremely high HR rates on Strava and the like are because the HRMs have a difficult time sampling the extremely irregular rhythms.
-GET AN APPLE WATCH
-Apparently, the younger you are, the more successful the procedure will be, so get off the fence if you’re on it.
-And don’t forget to go get an Apple Watch.

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What I for the life of me can’t understand from your story is:

  1. You had a known history of paroxysmal atrial fibrillation, diagnosed by a physician.
  2. You were having random documented episodes of paroxysmal inappropriate tachycardia that were associated with objective abnormalities (inability to maintain METs).
  3. Multiple cardiologists did nothing about this.
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I had a pretty similar condition, tachycardia. For years I thought it was just anxiety making the heart beat fast, ignored it until I started cycling more and monitoring my heart rate.
My max is around 190 but my hr could rise from 130 to 210 in seconds and stay high for minutes.

First I thought it was a faulty hr monitor, but I could feel whenever it was going to happen so I finally went to the doctor.
Pretty much same thing as you they said I was young fit and fine, sent me back home many times.

Probably 3rd time I complained about it they gave me a holter monitor to wear for a few days and finally captured the tachycardia.
After that I finally got some treatment. It took me 3 ablations to get it fixed.

Sometimes I still I get some funky heart beats but nothing lasting more than few seconds.
Cycling is much more fun now when I don’t have to worry about my heart.

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Hi cnidos - I will only argue against your first point. It was never diagnosed by a physician until 03/29/2023. Spare the in-the-field holding my wrist and watching the lock test that Singletrack 6 Dr Ken did. Outside of that, every time I went to the doctor at home, they were unable to diagnose/verify. However, I will never be satisfied with how seriously I was never taken.

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Ouch, hard to believe none of your doc’s never got to this sooner. On the good news front, I too had atrial fibrilation for a long time, got the Apple watch with same outcome. Had the ablation about Sept 2020, was back on the bike in about a month, fitter and faster than ever by May of 2021. So, take heart, if you’ll pardon the pun, this can work out well, as least it did for me. I was lucky to have a great internist, a highly competitive rider actually, but a great guide thru the entire process, specialists etc. Good luck!

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Hey, thanks for those good wishes! I really appreciate that. I was wondering about the time frame. Obviously I won’t be doing Garmin Unbound in June, and likely not SBT GRVL in August, I suppose. I wonder - when did you start to feel more normal and like you could give it a real go on the bike after your procedure?

so the ablation was Sept 8, and from my TrainingPeaks Perf management chart it looks like I started to give it a go around mid November (5 weeks) and was back to snuff at th end of Nov, so about 8 weeks. Fair warning though, as my family can attest, I had convinced myself this was just a “procedure” and no big deal – for a week it really took everything out of me. Then, back on the indoor trainer after about 10 days then slowly increasing intensity and time. Also decided to take my normal end of season break before getting back at it for real at the beginning of November. You can see my returning, taking a break and then back to previous levels here:
image

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Jeez, that’s bad. I have been very lucky that I had a couple run-ins with 2 different cardiology groups at different times and my PCP, and all took it very seriously (was only 42, but not in good fitness). 1st time they didn’t find anything, but they kept me for a couple days and ran all the tests (I have really bad anxiety, so that was decided to probably be the cause).

Couple years later, I had quit smoking and was trying to get into shape on my stationary bike and the HR meter went from 120 to 209 and I got dizzy, left arm & hand went cold (for 4 hours), but everything settled down quickly (except the cold arm). Same deal, after all the tests and me agreeing, they decided that episode was a panic attack. But in the meantime, they found a blockage and stented it, and explored all my pvcs and Brugada Type 1 & 2 arrhythmias they had seen during testing.

Of course, 11 years later, trying to get prescriptions and appointments, and cycling related guidance, is next to impossible.

Holy sh!t man! That sounds brutal. It sure seems scary how common A-Fib is and how hard it is to get a clear diagnosis.

A Fib can be a sneaky booger. It can be super unpredictable. I worked as an Electrophysiology RN for several years but have been out of the field for a few years. At the time Medtronic made a simple device that was implanted under the skin called a Linq. It continuously measured heart rate and rhythm data for approximately 3 years. It is FDA approved although probably a little more costly than an Apple Watch. I am rambling but yes, you are correct, A Fib can be super unpredictable.

Agree with some of the comments above. ER doc here, A-Fib can be tough to diagnose, if no one has an ekg or holster monitor on you when you’re in it it will never get found. A lot of people with paroxysmal fib are only in it rarely so it can be easy to miss. I have definitely seen a handful of people come to the ER with their chief complaint being “my Apple Watch told me I’m in a fib”. I doubt anyone would start you on meds based on an Apple Watch, but it should prompt monitoring to try and catch it. I always hate to Monday morning quarterback, but I am surprised you were never placed on a holter monitor at some point.

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The first time this happened to me, and largely because I had no idea what was happening other than the fear of death, I ended up in the ER with an EKG. Took me overnight with some heavy meds before I inverted.

I wore a Holter monitor for two weeks, and it observed nothing. I started wearing Frontier X2: Smart Heart ECG Monitor | Real Time Wearable Heart Rate Monitor | Continuous ECG Chest Strap - Fourth Frontier Technologies LLC, and it has good data reporting that my cardiologist was willing to accept, but it also caught nothing.

It’s pretty nuts that I can hop on the bike and do any sort of workout that will spike my HR, yet my HR can return to normal. But then just sitting on the couch doing nothing, and I can flip to a-fib.

Happens maybe once every 18 months but still no fun.

I just got home from my catheter ablation from this morning and according to the doctor, all went textbook-well and he expects I’ll see great results.

Procedure wasn’t difficult for me at all and I’m in no discomfort except for my throat. We will see what the insertion area looks like when I take my bandage off tomorrow. I can feel something in my chest, but I wouldn’t say pain or discomfort. I can just tell that something happened.

First thing I did when I woke up was put my Apple Watch back on and test - sinus rhythm! Forgot what those looked like!

I’ll pop back in from time to time with a reply to the original post to document the recovery/effort/exercise process.

Thanks for everyone’s very helpful replies and encouragement. Keep the rubber side down!

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Good luck! As I mentioned, I worked as an RN that scrubbed in with the cardiologist with these procedures. It is very normal to have somewhat of a sore throat due to being intubated (having a breathing tube). That should subside quickly. Your groin area might be sore for a day or two due to the puncture sites. I wish you the best with everything!

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Here’s my story, in the hopes that it might help someone else. Similar to the OP but in my case it’s persistent atrial fibrillation. When my heart flips into it it stays that way until flipped back again by cardioversion (electrical shock). That makes it much much easier to diagnose. I had ablation 4 weeks ago, so hopefully that’s fixed it. Time will tell.

I’m 71 years old. I compete in veterans’ races during the summer months and during the winter use TrainerRoad and weekend group spins to train.

In October and November 2021 I had a series of respiratory infections (not covid), plus a recurrence of vestibular neuritis (vertigo). Over the following weeks I felt very tired, but still went on the regular Sunday group spins. I struggled to keep up, getting out of breath. I put it down to post-viral effects. At the same time, my heart rate monitor seemed to be acting up, giving readings that were crazy high (200+ for a 70 year old??). Over 4 or 5 weeks I changed strap batteries, and then changed straps, and then tried moistening the pads, but it was still giving crazy values. On 21st December I went to my doctor. She diagnosed a. fib. in about 60 seconds.

On 1st February 2022 I had a cardioversion, which flipped my heart beat back to normal. Almost immediately I felt better, although I was still on the beta blocker medication for a few weeks, which limited my max heart rate to about 115 bpm. Extremely frustrating. I got myself taken off that as soon as I could persuade the cardiologist I didn’t need it.

I got back to training, and resumed veterans’ racing in May 2022. I had a good season, with one win. No heart problems. I put the whole thing out of my mind, marked “fixed”.

On 24th August 2022 I went out on a solo training ride. After the first hard effort up a small rise I noticed my HR didn’t come down and I felt a bit tired. I had got a slight throat infection in the previous few days so I put it down to that (you’d think I’d have learned from the first time…), and I cut the ride short. Over the following day or so it became obvious I was back in persistent a.fib. Within 3 days I’d had another cardioversion and my HR had flipped back to normal.

Over the winter I used TR extensively and went on weekend group rides. All good. The cardiologist started talking about doing an ablation to prevent recurrences of a.fib. That was done on 21st March 2023 (4 weeks ago), a few days after I returned from a 10 day training trip to Spain that was supposed to leave me fit and in form for the 2023 racing season.

Recovering from the ablation took a while. First, the effects of the general anaesthetic and other drugs and stuff they do to you make you very tired for a week or more, and unable to do anything much. I got back on a bike for a TR session after 6 days, but it was only at constant 70% threshold and I could only do 35 minutes before I ran out of energy. A little uncomfortable in the saddle, due to the insertion wounds in my groin, and to irritation in the shaved areas. Over the following 6 days I did 4 TR sessions, upping the power and feeling better each time, and doing a full anaerobic 1-hour session by the last one. At ablation+14 days I did my first outdoor ride with a small group, doing 15 minute laps that included a short hard climb. I felt good, not back to what I had been, but definitely getting there.

I continued to do TR anaerobic and sprint sessions, and a couple of outdoor rides. At ablation+26 days (yesterday) I did my first race of the season, and surprised myself. My objective had been to try to finish with the bunch, but I actually found myself at the front pushing the pace up the short climbs and joining breaks. I was in the front group when the race was stopped 8 km from the finish due to an accident in another race on the same route. I and 20 others claim we would have won.

Time will tell if the ablation fixed my problem. My two episodes of a.fib. were almost a year apart, and were both at times when I had respiratory infections. The lessons I take from all this are first, never assume a crazy HR is just your heart strap - it might be you. And second, there is (cycling) life very soon after ablation, particularly if you use TR.

PS: The bruising after the ablation was spectacular, as if someone had poured a tin of deep purple paint over me. Not sore at all, just looked jaw-droppingly spectacular. Took 2 to 3 weeks to fade. I was just sorry it was in an area I couldn’t go showing off to people!

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Hey, thanks for sharing that!

I’m 5 days post-ablation, in constant sinus, and feeling absolutely fantastic. There’s a low grade fight-or-flight response that I’ve constantly had prior that is just missing now. I’ve been taking it really easy, focusing diligently on a conservative and safe recovery, but I can already tell I’m overdoing it. Just doing nice easy walks, only working up to a brisk pace for 4 miles this morning. No issues at all. For whatever reason - family obligations and work travel really - I’m giving myself a full 2.5 weeks of nothing but walking to make sure I recovery really, really well as I’m feeling confident that I can do a nice 3 week build up for SBT GRVL in Steamboat Springs, CO this August.

I’m getting more and more bullish in my position in that if anyone is feeling anything strange with your heart, please, please, please accept the role of being your own unflinching health advocate and do not stop working the system until you have answers.

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Good luck with it all, I’m a similar story, there are a few AFib discussions on here. I’ve had 2 ablations and Afib kept coming back so on drugs and still training!

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I’m at the point where I wear two HRMs - one on the chest and my Garmin watch - and if both are reporting wild heart rate swings, then I know.

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Thanks for sharing, and I hope the ablation is effective and your recovery is quick!

I’m not far from you (Memphis), so I’ll be sure to say hey if I see you at a race or on the trails.

Right on, dirty dime!