A-Fib and Ablation

Training
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As promised, just following up with a few details and pertinent milestones.

I did my first ride two weeks ago, which was exactly 2 weeks after my ablation. The ride felt absolutely amazing, although I did keep things very, very relaxed. Nonetheless, it honestly felt more fun than it has in years and years. My friends were gassed and I seemed to feel totally fine and I was taking it easy!

Then I did Lazy Mountain on the trainer 3 times during the week - this all felt great and my HR hovered around 112.

Then on week 3, I did my first road ride. A friend and I - he being the same age, much stronger, and lighter than me - road side by side for 30 miles, just taking it easy and watching the landscape roll by. We had a great ride, but what totally struck me was that my AVG HR was 133 compared to his 146, and I’m on Eliquis still, which is supposed to slightly elevate my HR. I didn’t need a nap that afternoon, per usual, and had a super mountain bike ride the following morning.

As of today, I did my one month follow up with my doctor and he gave me the green light to go as absolutely hard as I can stand. He said it would simply serve as a stress test, but it won’t mess up my future or recovery. Regardless, I’m not jumping straight back into intervals, since with a broken rib and the ablation, I was off the bike for a while. Best to get some miles in my legs first. (The old Eddy B lessons in me will never die)

More importantly than anything, however, is just how bloody great I feel all the time now. Each time I ride, walk or exercise in some fashion, I feel EXCPETIONAL.

It’s too early to say whether or not I have unlocked a new level of speed, but I have for certain unlocked a new level of enjoyment, which honestly, is way cooler.

Keep the rubber side down, y’all!

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This and search Allan Hovda’s posts on this for probably interesting and relevant readings.

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Weird timing to see this thread pop up… I went to the ER a couple days ago for an unexplained discomfort in my chest. Spoiler alert: a-fib. They zapped my heart back into rhythm and sent me on my way with a referral to a cardiologist.

By sheer luck, I was able to see a cardiologist yesterday morning. Next steps are echocardiogram and discussion with an electro-physiologist, hoping I can get ablation.

The cardiologist and ER docs were a bit perplexed though… I’m in my low 30s, no smoking or drinking, in pretty decent health overall. Not the ideal “candidate” for a-fib.

Anyway, I’ll keep y’all updated if it rears its ugly head again and any progress to curb it.

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My first AFIB attack happened like this…

Got on trainer first thing in the morning, HR was 150. Pedalled for a bit, stopped, swapped to backup HR monitor. Still readnig 150, hmm. Not feeling the best but I’ll try a bit of an interval and see how I go - wow HR seems to be spiking was my last thought. Wake up on the concrete garage floor one shoe still clipped in :confused:(see pic). Drove myself to hospital for a checkup (should have really called an ambulance). Cardioversion then ablation later that day!

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Was fine for 2 years then I had it again. This time i knew what to look for an went straight in when HR wouldn’t go down. Again ablation touch up the same day.

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Hey CincoBoy - I would have said the same about my myself the first time I experience an irregular HR. I was somewhere around 35-37 years old.

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Yikes! Glad you got it sorted!

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Do you have a history of doing endurance sports?

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Just cycling as a hobby for the last 8 or so years.

I try to ride 3-5 hours per week.

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Best of luck with it, hopefully just a blip!

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That’s some seriously shitty doctoring. Glad you finally got a diagnosis and treatment. With some luck, the ablation will fix it for good and you’ll be back to riding normally in short order.

I had ablation about 9 years ago. Similar symptoms - crazy high HR reported by a Garmin HR strap, feeling of butterflies/adrenaline, and loss of power (though not by much). My arrhythmia usually resolved itself in a few minutes. Finally went to the cardiologist, had a diagnosis within 2 weeks, ablation on week 4, and back to riding normally week 6.

Mine wasn’t a-fib, instead “just” an AVNRT.

Cardiologists (maybe doctors in general) can be weird… First appointment, with a general cardiologist, he walks in, sees a normal EKG, and tell me “well, if it was the type of problem to kill you, you’d be dead, so that’s good.” Later, I go to see the electrophysiologist. He walks in, chart in hand, with a shit-eating grin, bouncing like a toddler. “DO YOU KNOW HOW HIGH YOUR HR WAS!!! And you didn’t pass out or anything!!!” Too funny.

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This thread has been an interesting read for me, dealing with various palpitations for the last couple years and having been through several rounds of testing without ever finding anything alarming.

A couple months ago I woke up in the middle of the night to a frighteningly irregular rhythm and apple watch afib notifications. It self-resolved after a few hours, and after a month of follow-up testing my cardiologist believes it was a false positive. He saw lots of premature atrial contractions on my Holter results, but no sign of afib, and his conclusion was the “episode” was more likely a particularly alarming series of recurrent PACs and not actually Afib.

I feel frequent palpitations during both rest and exercise, but for me they come with no loss of power and generally only last a moment or two. At rest when my HR is in the low 40s they seem to make me very briefly and slightly lightheaded, but during a workout they have absolutely no effect I can discern other than the momentary terror that naturally comes with such a feeling. I’ll admit, I part of me was hoping for a diagnosis that would ultimately warrant ablation and a cessation to the feeling I’ve grown all too used to over the last few years. But in the end it seems my palpitations are annoying, but not worth intervention in my doctor’s opinion.

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Same sort of thing here, feel the heart do its flutter but nothing else changes ( power output etc.) but my HR track shows a BPM dip guess the algorithm doesn’t know how to handle it…
Just had a followup with my PCP and 48 hour Holter for palpatations,… Not AFib but Ventricular premature complex and “we will watch it” and maybe some Beta Blockers if it continues/worsens… not sure if it is related to the DM2 diagnosis recently but that is now controlled. and dwon to pre-diabetes with Metfromin,… Mom has Afib and HTN so probably genetic in my case,…agree kinda freaky the first few times you experience it or at night when your heart skips a beat a few times…
Doc said keep riding and eating healthy, and try to lose a few pounds
nice to know I’m not alone in this,

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One option you could consider would be get something like a kardia 6l ekg. A holter is great, if you happen to be wearing at the time of the episode. In my case the episodes aren’t very common, but I definitely know when they’re happening, so I can take my own ekg and share the pdf it creates with my doctor. It’s not quite as good as having a full ekg in a dr office, but it’s still useful in that you can use it anytime, it can detect afib (and other anomalies) and is pretty inexpensive for what it does. And as amazing as the apple watch is, I’m sure a 6 lead ekg would be more accurate than it could ever be.

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@cleask wanted to see how things are turning out for you now? I just had my ablation Jan 16 2024 and have been feeling good and no afib episodes so far (even though they are to be expected during the blanking period). One week full rest then started w walking the dogs a few miles each day, light weights and easy 30 min on the trainer every other day. Mixing in some yoga and mobility work to stay loose. This summer I am hoping to return to at least 60-70% of what I was doing last summer (~9-10 hrs/week of gravel and mtb). Still on meds and hoping to be able to drop them soon (12.5 metoprolol, 50mg flec 2x, eliquis 5mg 2x). I don’t want to rush it but just hoping to hear your experience almost a year out from your ablation. Thanks!

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Hey @bdrucis - happy to respond! Just under 10 months out from my ablation, and I’m still pinching myself over the fact that I essentially got a second chance to enjoy the sport I’m so passionate about. You have an exciting journey ahead of you!!!

I haven’t had a single episode of a-fib since my procedure and I have done 3 month, 6 month and 9 month check ups with my doc and he says that things can’t be any better. I’ve also had my Apple Watch on every day, every minute, and it has made no observations either.

Sounds like you are taking your recovery conservatively and smartly, I recommend the same. While my doc told me I could give it full stick easily within 2 weeks, I gave it a full month.

Come summer, sooner actually, you’ll be back to full flight and you will really enjoy how much more you’ll be able to enjoy the rides, as well as recover, more than you can probably imagine. Sleep improved enormously for me. I still drink half the coffee that I used to.

Last August, I did SBT GRVL and blew myself to shreds because I still hadn’t fully learned my new parameters, but finishing the distance was no issue, and 100 milers have always been an issue for me for my entire career. Then, last fall, I did the Big Sugar 100 gravel event and for the first time in I don’t know how many years, I was able to pace myself where I was comfortable, but making progress, and with good nutrition, I crossed the finish line feeling GOOD, not like a cratered husk. But it took me some failed experiments (SBT GRVL) to get there.

I noticed three things about myself that I had to re-wire.

  1. I was so accustomed to feeling like I was going so hard all the time, that I thought I was now going to be invincible and be able to do that again, but without my heart going haywire. Not quite the case. What I learned was that I was in fact able to go harder - too hard - but not be able to recognize it in my new, normal HR, so I was blowing my legs to smithereens. My muscular endurance had not been the issue for so long that I didn’t know what that limit looked like.
  2. Anyone’s mileage will vary here, but I found that my HR zones had dropped considerably. Thus, when I would go out for a ride and think (based on pre-ablation numbers) that I was cruising along at healthy Tempo, I was actually well into Threshold, if not near the top. I secretly began to use a power meter (I loathe them, but I recommend them) and re-baselined everything. Now that I’ve learned to look down at my HRM and see a much lower HR, but know that I’m still in Z2 or Tempo, that has been an amazing help. I’m so stubborn and dogged in my ways, I had to use the Garmin Power Guide to re-train my perception. That worked extremely well for me.
  3. If you have a spouse that wishes you maybe focus a little bit less on rides and events, you have a lot of wood to chop in front of you as you may find yourself so excited and pumped to ride, that you’ll sign yourself up for more events than you have ever had and your other half may not be as impressed with you as you will be yourself!

Best of luck, and do please keep us updated!

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Afib in endurance athletes is often vagal-mediated, so the situation you’re describing is fairly common.

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@cleask This is great info and I hope I am feeling that good this summer! If you don’t mind, I have a couple more questions. Are you still taking any meds since the ablation? These are a big limiter for me, especially the Metoprolol and Flecainide. Obv the eliquis is a concern as well. Also, how much lower is your target HR now? Prior to the ablation and on the meds, I was finding mine would be ~10-15bpm lower. After the ablation, my RHR is higher by about 10-15bpm (55-59bpm). My target based on age (52) is 168, but I feel i should be adjusting it down for a bit so I don’t push it too soon. Also, I am 6’3" 205lbs, so we are close in weight so I know we need to put in more effort on the climbs :slight_smile: Thanks for your openness about this topic!!

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The bruising is spectacular!

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You bet! Open book here, anything you need.

They had me on Eliquis for one month, which was really no big deal at all. All I did that month was walk, yoga, and super easy rides (starting at week 2). And now I’ve forgotten, but there was some pill for my esophagus for two weeks because of another exploratory procedure they did at the same time to ensure things were in the right places. Supposedly that scratches you up, so it helps the tissue heal. Otherwise, no other meds going forward.

My target heart rate is generally 12-15bpm lower for a given power now than it was before. But interestingly, my resting heart rate is way up! Historically, it has been 40-42bpm. When I was younger and quite fit (oh youth how I miss you), I was extremely proud of my 37bpm. But now, 10 months post ablation, I’m holding a steady 57-60bpm resting HR.

In terms of max HR when out there ripping it with my pals, I can regularly hit 179 in an all out, long sprint effort, and then come down from it very, very easily. Prior to ablation, if I broke 172bpm, I went straight to a-fib and my day was over.

What is really amazing now is how much better my winter training is going, so I think this year is going to be even better than I could imagine. Yesterday I did 62 miles alone in the cold wind. I stayed zone 2 for almost all of it. Got home feeling plenty good, only to learn I was way faster (I do that route often) than multiple pre-ablation rides where I was HR zone 4/5 for the entire ride thanks to my spastic heart rate. It’s been at least 8 years since I was able to do that.

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@cleask Thanks for the insight on your ablation journey. It’s been 3.5 weeks since my ablation and starting to feel pretty normal and in NSR. Slowly picking up the efforts and have been able to get outside for a couple casual gravel rides with the warmer weather here in PA. Will pick up my base training next week, but don’t plan for full gas until I meet with the EP in March. Excited to get the legs, lungs and heart ready for some spring and summer adventures!