Thanks Matt, I am just looking at the indoor training side of things as I train there and just do my own thing when outside, not racing. I haven’t heard of diltiazem but I am also on flecainide. Sorry to hear about the ablations not working so far, I’m hoping mine will when I eventually get there, in the meantime I have no chance of getting anywhere near 150 bpm, my original mhr was 180, more around the 125 / 130 mark now.
I was recently diagnosed with Afib 
. Mine is very intermittent so far (two short epsiodes in the last 3 years) and both were self-resolving and not induced by exercise, so at the moment my doctors have not prescribed any medication nor any change in behavior. The doctors believe it is caused by a minor congenital valve issue, aggravated by decades of endurance sports. I have my first consultation with an electrophysiologist next week. I don’t have any advice to offer, but I appreciate the camaraderie here!
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My understanding is that ablations work for the vast majority of people. Don’t be put off by my response to it. Even though it isn’t 100% I can still compete in MTB marathons 14hr+ when previously I could barely climb a flight of stairs without feeling dizzy and short of breath. So it was definitely still worthwhile.
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Sean - I know this is stressful. We are all different, but wanted to share my situation given my good outcome. I had intermittent atrial flutter, and then some intermittent Afib, that kicked in after my COVID shot in early 2022. I never could feel its effects, even working out, but could see it on the HR monitor and then my Kardia device. No meds. I had 2 ablations, one for flutter and one more in 2023 to address the Afib. I’ve been great ever since. Dr. says no limits. I train on TR (love the new AI), and am approaching an FTP high for me. I do avoid longer VO2 max intervals as a matter of choice - I want to avoid max-ing my HR - but do everything else in training. I don’t race but am looking forward to a week long bike travel event that will be spicey. My biking is in no way limited by past arrhythmia. I was worried it would be before. I wish you the best of luck and results on this.
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Thanks for sharing. Out of curiosity, what were the recoveries like for your ablations? Did you schedule them electively at a time that was convenient to your training/life schedule, or did your doctors want to do it as soon as possible?
Hi Sean, I’ve not had one yet and I’m NHS, told that I’m on a 52 week waiting list jusr for a consultation!
First week I was pretty knackered the first 4 days. Then I started doing some walks - easy, slow and short to start with. First indoor ride 2 weeks after. Took it easy to start with and then started to gradually push harder. This was all with the blessing of my cardiologist - as he said, nothing wrong with your plumbing, just the electrics which were a bit wonky. Everyone is different though.
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A few thoughts from my journey that might help others…
I had an exercise induced arrhythmia but didn’t have any symptoms. It was only odd Garmin readings that got me to see a Dr. Initially thought it was an SVT, then moved towards a fib. Initial ablation / mapping couldn’t see it… in the right atria.. Went away with drugs stopped … and managed to get a trace with a Kardia device that the Consultant thought was a fib. Second ablation left atria was cryo PVI.. which touchwood has fixed me for several years..
I asked for a different beta blocker as I didn t tolerate the first one I was given. ( think it was propanolol but it was a few yrs ago) I also had Flecainide too.
I did some googling and it seemed that “Atenolol” was tolerated a little better by endurance folks. My cardiologist was happy and I swapped. I was still governed but I felt better generally. I found the medication overall made me feel “off”, lethargic. I tried to continue with my riding but didn’t enjoy it as it felt so hard.
The ablation recovery was more about the wounds in my groin. I recall they were healing in a few days.
the first ablation/mapping I was awake and that was pretty uncomfortable with the drugs making my heart feel like it was going to come out of my chest.. They didn’t do any burning as they couldn’t trigger the arrhythmia but I still felt a bit knocked about after.
the second session about a year later I was awake for part of it then there are bits I don’t remember where I they put me out. I felt quite sore afterward. I was in overnight but the procedure was in the afternoon.
I did a slow resume to exercise as I had read that can help make the repair “stick” - who knows.
I didn’t do any hard efforts for sometime. Partly as I was so happy to be drug free and didn’t want to risk it coming back! As time has gone by I do push a bit more but not like I used to…
Good luck with your journey..
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How was it diagnosed? During 24hour Holter monitoring when you had some intensive workout which caused high HR?
It’s very difficult to diagnose during ordinary 30 second cardiogram check.
Initially I had a 7day “bardy “ monitor stuck on my chest. I went riding and triggered it a few times. I was getting worse too, which is normal my Dr said and I tried to ride around it with little success!!
I would see a 15-20 beat jump on the Garmin which may have been to say 190 bpm…. The reality from the bardy report was 238 
!! That was quite a shock to me as I didn’t have any symptoms.
Note.. the bardy had a button to press if you thought something was going on, it put a marker in their file. I sent the Dr the Garmin HR plots to match up to the events I had flagged.
I always reset ok if I soft pedaled for a bit but the trigger HR got lower as time progressed. I cut out caffeine and started taking magnesium which was supposed to,help,with electrical stuff. I don’t drink anyway but for some people that can be a trigger I believe.
As I said above the Kardia device helped get my final ablation as the Dr had enough info to suggest AF and the need to poke through into the left atria.
I got quite handy at jumping off my bike on hills when I saw a jump… sitting on the verge with my phone app and the Kardia device to get a trace…
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In USA so I could schedule whenever. I had no physical effects other than HR variance. I scheduled them around life not bike events, as I had dialed back training intensity. Procedure very easy, walked out. Walking next days. I ramped up non-biking activities like hiking - some intense - in a few weeks. I did not return to biking for 3 months. That was my decision to get maximal healing time. I was hoping to get back to biking with no arrhythmia issues so felt the down time to heal was a good investment. I am an older cyclist and was not racing, so under no event pressure. Everyone and their situation is different; best to follow your doctor’s advice.
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No, unrelated to exercise or high heart rate. I woke up from sleeping with my heart going nuts, apple watch said it was Afib. I went to the urgent care and it was confirmed, within a couple hours it self-resolved. The cardiologist said it’s fairly common for endurance athletes that it appears during times of rest, rather than at intensity. I’ve trained and raced normally since (with doctor’s ok) and had no issues.
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The one thing that’s hard to explain to the doctors, GP or Cardio, is the feeling of fatigue after an extended tachy/afib episode. It’s not that my heart hurts, more like DOMS because at 58, running in the 190s is way more work than my heart is used to even at the end of threshold intervals.
I’ll be getting my 3rd Ziio patch the day before Sea Otter.
I have a Frontier x2 and shared last weekends “incident” with my Cardio at the VA. It’s the second time I’ve had afib/tachy triggered during a downhill. The incident started at roughly 11:30 AM and didn’t fully abate until 1:30 AM when I was asleep. On the plus side it did chill out to below 100 bpm (that’s metric right?) by the time I got home.
I did have a GP appointment an they talked about a “pill in pocket” scenario in that keeping me off beta blockers, but having a Flecainide pill on hand to take if things got weird.
I had an echo cardiogram earlier this year and it was deemed excellent. An ejection factor of 69 is as good as it gets for normals, and 70 or higher is either elite athletes or something is very wrong. I’d like to think I was closer to the former than the latter.
In the meantime the orders are the same. Moderate effort. Ride in the 140s without issue, 150s (I have a haptic alarm on my Frontier that goes off at 152, and again above 161) for short efforts but always bring it back down. When I’m off mtb in the boonies all I can do is soft pedal my way back to the car while keeping an eye on things. ¯\_(ツ)_/¯
When I first was diagnosed Afib I was also fatigued. My cardiologist described it as running a marathon every day.
FWIW I’ve been on an Afib journey since 2019, I’ve tried to document all my experiences on my website. Part 1 is here, there are 5 parts in total (I should probably update it !)
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Checking in to say “same”. Last episode requiring any intervention was 20+ months ago. I get a hiccup here and there, but I know my trigger really well and avoid it to the best of my ability (fatigue and chugging ice-cold water at the same time).
While I use power to train, I race with HR data. I remember I took the meds for a period of a week to see how my body would react and found myself unable to get over 150bpm, where my normal workouts were around 175bpm. It was WEIRD.
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