Thanks for sharing OP. At 50 now I’ve been living with this my entire adult life, and I’ve learned that there are three factors for me: hydration (number 1 with a bullet), alcohol, and sleep. Exercise is not really a trigger but it is a heart stressor and so various combinations of the other factors makes AFib more likely. Drink too much alcohol and too late in the evening so that my sleep is disrupted, don’t drink enough water, and then go hard on the bike the next day and I am pretty guaranteed to have flutters, on the bike or off. For years now I have started my day with a pint of room temperature water and I always have water within reach during the day. If I’m going out for a long ride and am uncertain about water availability I take my camelbak, fashion be damned.
The back story: I’ve had heart flutters since I was a teen, at least. It wasn’t until I was in my 20s, sitting quietly, that I had a longer episode and thought that this is not normal. (People talked about hearts skipping a beat so I never thought anything of it). I usually only feel the sensations for seconds so I have a hard time picking it up on my Apple Watch. I did not see a doctor until my early 30s when for the first time I had an episode that lasted more than a few minutes–it lasted hours and I went to urgent care. Fluids and magnesium eventually got me to snap back into rhythm. EKG confirmed and I was prescribed beta blockers which I never took because they would affect my athletic limits. I wonder whether I should have just had the ablation rather than manage it, but maybe it’s coming…
My dad was diagnosed with A-Fib due to his Apple Watch. He’s not the best with technology but I set it up for him and that same night he got highly heart rate alerts and did the ECG reading that alerted for A-Fib. I was a little suspicious that maybe it was faulty, so I had him trade watches with my mom (who also just got one) and same thing.
He went to the ER and they confirmed it. Definitely worth the money just for that. For the record my dad’s a life long athlete and had no idea he had a-fib, just thought he was feeling tired due to possibly being sick.
I have heard good things about the Kardia Mobile 6L from my friend that has one and has A-Fib. For anyone that is having trouble getting the data to show your issue to the cardiologist, I highly recommend getting one because it’s FDA approved for detecting A-fib and has 6 leads to provide copious data.
From what I have come to understand, the viability of an ablation has increased exponentially over the last 10 or so years. It may not have been a viable, reliable, accessible, or even affordable option 20 years ago…
Can confirm that the Kardia is a great device. I used one often, but I always had to remember to pull it out and use it. I think the Apple Watch is helpful in that it is essentially always on you.
Everyone deserves a chance at sinus rhythm. You sound like a great candidate for an ablation. These days, rate control (beta blockers) would not be the first choice of management for you. You may benefit from seeing a sports cardiologist to discuss optimal management of your afib with your athletic proclivities.
Agreed. Apple Watch is best as an always watching monitor to flag unusual activity, even if you don’t suspect anything. My dad’s A-Fib episodes were presumably happening quite often before we found it, given the small likelihood that we’re would find it the same day he got one.
If you can get to the ER and get measured before your episode ends, then that’s great. But for those people that are having trouble with the doctors not trusting the watch and you’re not able to get hooked up to a hospital ECG before the episode ends, then the Kardia is a cheap but FDA certified medical device for taking 6 lead EKGs, which gives a better picture of what is going on versus a single lead (like the Apple Watch or HRMs). A cardiologist should respect that data and be able to conclude a lot from it.
Also I forgot to mention that dehydration and alcohol (either, by themselves) are triggers for my dad’s afib. That correlates with others here.
Totally agree. Alcohol and dehydration certainly were factors in my earlier part of this journey. Eliminating one and managing the other were big helps.
I ditched my Kardia as kept giving me unknown readings, I switched to a Wellue device that does AI analysis of the ECGs. I got the model you can wear for 24 hours ( 24-Hour ECG Monitor with AI Analysis, Continuous ECG/EKG Monitoring at Home – Wellue (getwellue.com)), been really impressed with it. I’m considering a 3rd ablation as I seem to get exercise induced Afib at the moment. Trying a different beta blocker for a bit before deciding. I also figured out I’ve been training too hard so going to back that off to the 80/20 rule.
Wow, that’s a pretty impressive looking tool. I was not aware of it. A good friend of mine is seeing bigeminy patterns on his apple watch right now. I’ll recommend this to him.
It seems pretty accurate, when I jump around the raw ECG what it shows matches what the tool flags. I could also see, for example, PACS on my Kardia, but the Kardia, even when I paid for Advanced Determinations kept telling me my 30 sec trace was unclassified. Kardia were very good and allowed me to cancel and paid back the remaining months of the Advanced Determinations subscription. Their support said the following, which I guess is a shortfall of the 30 sec trace. With my Wellue device I’ve been wearing it for hours.
In order for the Kardia app to read the Advanced Determinations for PACs, there have to be 4 or more PACs present in the first 30 seconds of the EKG for the result screen to show Sinus Rhythm with PACs. For the Advanced Determinations to read Sinus Rhythm with PVCs, there has to be
2 or more PVCs within that 30-second recording.
ER doc here. This has been a good thread to follow. I don’t recall when the apple watch added the a-fib functionality, but I have definitely seen a good handful of patients presenting with the complaint of “my watch told me I’m in a-fib”. I would say everyone who I have seen was symptomatic at some point. Like “wow, my heart is racing, crap my watch is telling me I’m in a-fib, I should go to the ER”. I think the person who gets the message but isn’t having symptoms may tend to self select themselves to their PCP or cardiologist (if they have one). For the non-afib familiar crowd, one of three things would happen if you came to the ED: 1. if really symptomatic and with rapid rate, probably admission to the hospital 2. minimal symptoms, normal-ish heart rate, potentially home with cardiology follow up 3. If converted to sinus rhythm (the normal way the heart beats) w/o confirmed a-fib probably home with a monitor for days to weeks to try to capture the a-fib (or other arrhythmia)
As a minor point of clarification, what’s going to happen if they go to the ED is highly variable depending on local medical practice when it comes to afib. This is because the management of afib acutely is highly variable across the world.
For contrast, locally, essentially none of these people are going to be admitted to hospital, and almost everyone who’s symptomatic (even minimal symptoms) will be electrically cardioverted and sent home for outpatient follow up.
*electrical cardioversion is chosen locally for basically everyone as it’s felt to be the fastest and most effective option to treat patients symptomatically, uses the least resources/$, and has highest patient satisfaction. We are also all very comfortable with procedurally sedating basically anyone. *
Appreciate the insights on the product. I’m curious; about halfway down the linked page is this caveat " Please do not use this product during strenuous exercise." Seems like those of us who want to see what happens while we’re working out are cautioned by the manufacturer not to do so?
FYI, I’m now three months post open-heart surgery with a composite procedure which replaced a severely dilated aortic root and ascending aortic aneurysm (which had resulted in severe regurgitation/aortic insufficiency) with a graft of my ascending aorta and bovine tissue aortic valve. Have had a history of SVT as well as a couple bouts of afib/aflutter early in my recovery. From my reading it appears 30-40% of surgical patients experience afib; good new is that 90% of them see it resolved and that appears to be independent of the mode of treatment. Best news for me is that my surgeon says I’m back to 100% capability and have no restrictions or limitations on any activity now!
