Runners with Atrial Fibrillation................................Diltiazem???

my cardiologist says i have afib, but i don't feel it, the irregular heartbeats...all i know is i run awfully slow now, get tired after 200 meters of running......kind of annoying as i once ran 4:09 mile....what a drag it is getting old.....

all you young runners out there with cardiologists who don't understand, ask for a second opinion with a electro-physiologist who can do a cardiac ablation. I doesn't work for everybody, but it is a great solution for lots of people and gets you off the drugs. If you are young an fit you are a great candidate for an easy procedure.

Afib is no condition for a serious runner to mess with.

the guy i saw is an electro-physiologist who seems to know his stuff. he's just conservative about recommending the ablation for Afib.

however, i think you're right...after trying this diltiazem for a little while, it will be time for a second opinion if it doesnt' work.

thanks!

I thought I was the ONLY one who was triggered by cold liquids or foods(water ice 2x). Every single episode I've had was triggered by cold foods/drinks. Also my potassium levels were 3.4-3.5 .....5.0 is considered optimal. My EP said he had never heard of the cold trigger, but believed it was vagal. Sometimes if I have a sip of something cold I feel mysef getting funky and breathless .Quickly I reach for hot water. Got to be careful! Thanks for sharing.....

mez wrote:

I thought I was the ONLY one who was triggered by cold liquids or foods(water ice 2x). Every single episode I've had was triggered by cold foods/drinks. Also my potassium levels were 3.4-3.5 .....5.0 is considered optimal. My EP said he had never heard of the cold trigger, but believed it was vagal. Sometimes if I have a sip of something cold I feel mysef getting funky and breathless .Quickly I reach for hot water. Got to be careful! Thanks for sharing.....

The first cardiologist I went to told me there was no connection between the Afib and cold substances. After the third time, I found a new MD who said he had seen a few cases where cold had an immediate impact - in fact it was one of the first questions he asked - did you have anything cold to eat or drink. I think it also has to do with ingesting cold stuff on a fairly empty stomach. All three of my cases were the same. I now avoid MDs who say "never heard of it". My retort is "do a little research".

I'm glad this thread came up. I posted a question on this a few days ago but it quickly got lost with the Olympic Trials discussions.

I get atrial fibrillations pretty much every day, though they usually only last for 20 minutes or so. It started about a year ago. I find it a little bit harder to breath, though I have frequently run through it (this is because it seems to come on almost every time I run, or do other serious exercise).

My condition seems to come on primarily from exercise (I can trigger it every time by ramping up to a sub 20 second 100 metres), but also from stress (I work on a trading floor, unfortunately), bending over too deeply, sometimes lying on my right side, and occasionally from injesting really cold liquids.

I was not a great runner, but pretty solid -- 4:11 mile, 2:33 marathon was my spectrum. I am now 30 and just running to stay fit for the past 4 years. I ran seriously from the age of 10 to 26, and generally at a very high intensity relative to my racing performance.

I have had an MRI, a nuclear stress test, plus all of the standard ECG type stuff, and nothing shows any problem with my heart, aside from the a-fib.

I do not want an ablation or drugs if I can help it. I am not even taking aspirin right now. My doctors have no experience with young people or athletes with this condition, though it seems to me that there is a massive correlation between endurance athletes and afib. Research I have stumbled across suggests that some people have cured their a-fib by DETRAINING their heart. I have just recently stopped running to test this out, and after almost 4 weeks, my only bout of a-fib was the one time I had to bicycle somewhere quickly. This suggest my afib stops when I stop exercising. The bigger question is can I get it to stop once I start up again at some point.

Does anyone know how long detraining takes to get the heart back to a sedentary state? I plan on resting for 3 months, but I am hating every day of it. I have also read that many athletes are able to recommence their exercising after detraining, and for whatever reason the heart doesn't go in such a detrimental direction as it is built back up again. Has anyone heard of this or tried this?

Would really like to find a natural solution like this. I have the luxury of not worrying about a racing schedule. I just want to be able to run home from work every day again and to stay trim. Alternately, what exercises can I do that don't work the heart, but that keep the rest of me fit. Aerobic and weight lifting exercises are clearly out. Perhaps yoga?

I've basicaly moved in that direction, sadly. I was in the 75-85 mpw range when all of my stuff started. After each bout initially I would rest for 10 days or so (I felt really washed out and it took this long). But then I went back to normal training. After the 5th one, I took off all summer and into the fall before gradually starting back by running a mile or two with my 12yr old son. Now I just cap most runs at 30 minutes and run according to how I feel. I'm real tempted to ramp back up, but not going back into afib (and getting paddled) is my first priority.

It is so true than there is something in distance training over many years than tend to leave a large # of runners (mostly men) with this condition from their 30's on up. Perhaps it is in the electrolyte balance (or inbalance), increased vagal tone, decreased resting HR, or something directly related to the atria, I don't know. Certainly long time runners suffer from this at a far higher rate than the average person, although their hearts may be technically stronger. Having been through my last bout feeling like death with my wife and kids around me before being put out for the cardioversion makes me think that a few miles a day isn't so bad. Hell ...I even skip a day or two.....or more! Something I never would have considered in the past. Do what's smart. You can enjoy the sport and still remain healthy (i.e. in NSR). Good luck......

Eric, just curious, why are you against the ablation?

I urge you to think twice about the ablation and to find a cardiologist who has some experience with and understanding of runners. My first doc had none and I found him very frustrating to work with. My second was a successful high-school runner and avid athlete himself and that made a huge difference. He was also very conservative and did not push the ablation, just the opposite. He made me try 2 more drugs and made sure I really, really wanted the ablation.

As I have noted before, the ablation procedure itself is easy (though costly, you'll need good insurance). The success rate is good and getting better, complications are now down into the 1-2% range. If the ablation works for you, you go on to a normal life without a lifetime of drug therapy. Quality of life is GREATLY enhanced. This is a condition that seldom goes away on it own (unless it is triggered by caffeine or alcohol and you cut those out). In most cases it continues to worsen with time.

Also interesting to note the connection to long-term endurance activity. I brought this up with my first doctor and he said there was absolutely "no correlation." My second doc said that the literature hadn't positively identified it, but nearly all his a-fib patients under age 45 were or had been endurance athletes. There simply isn't a lot of definitive research done on a-fib and it has been identified as a serious medical issue only for a few years.

I went into A-Fib on a run in late Oct. 2005. I didn't know what the hell was going home but I walked home and laid on my floor and my HR was still in the 140's after several minutes motionless and there was no rhythm at all to the beats. I went to an all-night clinic and they did an EKG and then I was sent to a cardiologist the next day. They let me take aspiring for 4 days and give me a chance to convert on my own and then I was admittted to the hospital and shocked back into sinus rhytm on the third try after two botched attempts - the first did nothing and the second stopped my heart altogether. I awoke with burns on my chest and it felt like I had been hit with a hammer - I couldn't do any bench press for a few weeks. I was told to steer clear of all alcohol and caffeine but I could start running again the next day, which I did, but I was sore as hell for about 10 days as if I had run a marathon. Strangely though, my first workout back was the best workout I had run in a long time and I went on to have the best Spring I had had since I was in my twenties - this after a long slump that was immediately ended by the cardioversion. I have done research on PubMed and they can't find any proof that caffeine has anything to do with Afib despite the common practice-based recommendation to avoid it - there was a big study done recently debunking this view (although alcohol certainly does) - I had drunk about a quart of coffee that morning and had a particularly stressful day at work.

I have been in a bit of a running slump again for about a year and I am starting to feel irregular beats again (generally an extra beat thrown in a few times) and I am starting to worry I may be in for another bout. One thing I noticed after my cardioversion was my resting HR felt really strong and very, very regular and slow and that my HR on runs went down a bit at all paces.

I've been told that this condition is very common in senior citizens and the general treatment is tambocor/flecanaide or some other rate stabilizer and coumadin, or a similar blood thinner. The biggest risk, of course, is if you stay in Afib too long, blood can pool and clot (thus the blood thinners) and then you can have real problems - up to and including stroke.

At this stage of the game, I don't even want to run any more (too many miles, too many years), but sometimes a brisk walk can produce a slight flutter here and there. When I feel it, I immediately slow down and regulate my breathing and heart rate until I feel like I'm in normal sinus rhythm.

I was able to get off the flecanaide three months ago (stopped taking the thinner years ago) and now only take a single aspirin (ecotrin 250mg) per day. I walk for about 20-30 minutes three or four times a week. So far so good. I've pretty much ruled out anything that will push the heart rate above 130-140 or so. It seems like this is the best I can do without the ablation.

Seeing these threads is both reassuring and discouraging to me. Reassuring to read I am not the only one who has had such issues, but discouraging to see so few examples of people getting back to where they were before.

I starting having heart issues 5 years ago (now that I think about it, it has been 5 years this month). I never really figured out what it is was, but I had similar symptoms to a number of you: got fatigued quite easily on runs and my heart rate elevated quickly under exertion. But the symptoms I had/have are not very severe. Bad enough to cause me to no longer be an endurance athlete, but not so bad to impact leading a relatively normal life.

Even now, 5 years later at 30, it still seems to be the same situation. I try going out for a run (which is more of a jog), only to feel the slight discomfort in my chest. I don't even want to try because it isn't the most fun emotional rollercoaster when you want to get back into shape, but the chest discomfort and inability to get any conditioning prevent it.

It's also hard to explaining it to anyone as it comes off as almost a mental sounding thing. "What do you mean, your conditioning just sort of evaporated?", etc.

Anyway, not the most articulate rant.

And when I did go to a cardiologist (went a couple of times to him where they ran tests), it was like he didn't want to diagnose anything. Kept telling me my heart was fine and almost begrudgingly finally diagnosed me with a minor tachycardia. Despite the fact that while doing the stress test I was watching my HR go above 210.

Keep trying and consider switching doctors. I complained of my a-fib symptoms for 15 years and had umpteen EKG's until they finally got a reading. If you are in a-fib, it is real easy to see on the test, no questions, the EKG tech can diagnose.

When you aren't having an episode though, there is nothing, your EKG looks totally normal. So in a sense your cardiologist is right. He needs to see something to diagnose. Certainly your insurance won't pay for anything without a positive diagnosis.

I suppose I am against an ablation procedure because I would rather avoid any sort of invasive procedure if I can possibly help it.

Also, to the extent that the main risk of a-fib relates to an increased risk of stroke, and to the extent that the increased risk of stroke is a function of the a-fib lasting for a long time at each interval, I feel that my brief 20 minute episodes must be rather low risk. Unless my episodes start lasting longer, I imagine my greater mortality risk would be from the procedure itself than from the a-fib. The fact that many ablations don't "stick" makes me even more wary.

I should also note that the doctors I have seen do not seem to be pushing ablation (or drugs, for that matter). They seem to think there is no huge problem. And while my primary heart doctor is a middle-of-the-pack type doctor, I have also visited with one of the world's most renowned cardiologists (and I am the nephew-in-law of another, who I am told is considered by many to be THE biggest heart doctor in the world -- he is now the head of a top US medical school), and those guys seemed even less concerned, and did not suggest any sort of treatment.

Had another episode last night -- was waiting to give a presentation on stage as a keynote speaker and it went wild as I was being introduce (and as my adrenaline no doubt temporarily spiked) - to the degree that I could hardly breath - but then settled down once I started talking.

I live in Canada and have free medicare for these sorts of procedures. Cost is not a concern.

In response to some of the other posters' comments -- I have definitely seen a few studies that identify a several-fold increased incidence of a-fib among endurance athletes. But only for males. Perhaps it isn't firmly established in the literature, but there are a few studies out there. Anecdotally (which isn't worth much), I had a running roommate in university with the same problem, and I have stumbled across several others since then. There have been several threads on this subject recently, with lots of runners posting.

One of the frustrating parts about my situation is that there are not many lifestyle changes I can make aside from stopping serious exercise. I already sleep well, I eat well, I exercise, I have never consumed alcohol, I do not ingest caffeine. Taking a less stressful job is not a good option at this point, and taking life a little slower is also not a good option as I have a new baby at home. It all feels a bit unlucky on my part, though I simultaneously think about all of the wild (and probably unwise) training I did through HS and university, and I can understand how my heart might have ended up somewhat the worse for wear.

PS how many people just have their a-fib manifest as a high heart rate versus an irregular heart rate? Mine is usually an irregular heart rate without any real pattern, though when exercising it can often convert to a regular but unnaturally high rate (and it feels like the heart is pounding really hard, even in relation to how fast it is beating).

When I first experienced afib, I didn't know what the hell was going on. I thought I was dying; my lips and fingers went numb, I was breathless, and my chest felt very funky with lots of pressure. Upon taking my pulse, I was horrified to find that I didn't really have one..... just a random beat here and there! I freaked which probably didn't help matters. Now I can tell right away (particularly if I drink something cold or lie on my left side). Ablation is definately a last resort, especially for folks like me who have episodes separated by years or months. But if it ever got to the point where years and months became weeks or days, then it would seem like a very good option.

In my particular case, the events are very debilitating. I can't imagine going through that on a regular basis! I know some folks walk around in afib, or have lesser events, but mine tend to be more violent with higher rates. Afib does not manifest as simply a high rate.....it's a higher ventricular rate as the ventricles respond erratically to atria that are essentially quivering at 300-600 bpm. That's the "bats in the belfry" feeling most get. There may not be a large body of work that has pinned things down, but my gut tells me that there is something to long term endurance sport and afib. I've seen similar outcomes in cyclists and xc skiers reported. Looking back.....mabey it was best to listen to Mom....."don't stress your body so hard, everything in moderation". Now I know.......

When I was in A-Fib, if I was lying totally still and not moving at all, my HR would settle at around 80-90 bpm if you count it by hand, but if you put on a HRM to gauge it, the HRM would go haywire and constantly change numbers. And if I got up to go to the bathroom or something it would immediately jack up 30 or more beats. I can't imagine needing an EKG to know you are in A-fib because your heart just beats any damn time it wants to - you will get like 5 or 6 shallow beats in quick order, then a long pause, then a bunch more beats in quick or random order, and so on. The worst was lying at night trying to sleep and listening to this shallow random activity taking place where your normally metronomic heart should be. You swear after one of those long pauses it just isn't going to beat again. I still have trouble sleeping if I can hear my heart while lying in bed even though I am now in fine sinus rhythm and have been for nearly 3 years and I have to avoid paying attention to it - I can't sleep on my stomach because feeling my heart freaks me out and I can't rest my hands on my chest to sleep because I can't stand paying attention to my heart beating.

I am still wonddering why I started running so well immediately after the A-Fib episode and the subsequent cardioversion though. Perhaps it was just because it forced me to take some days off, whcih I am normally loathe to do. Whow knows.

Eric L wrote:

PS how many people just have their a-fib manifest as a high heart rate versus an irregular heart rate? Mine is usually an irregular heart rate without any real pattern, though when exercising it can often convert to a regular but unnaturally high rate (and it feels like the heart is pounding really hard, even in relation to how fast it is beating).

mine is high and irregular. No pattern, but the average when you can get one is real high. When I convert though, it seems to go back to completely normal.

However, even when I was extremely fit but had no signs of Afib yet (hundred mile weeks, 5k's under 14:20, etc...) my resting HR was high. When a doctor or nurse would check it while I was sitting in the office, it was always like 75-80. This while my teammates could sit there and register down to even 45 or other such ridiculous counts (these were the all-american, national champ types, but still discouraging for me)

did any of you other guys notice this high resting HR even before having Afib problems?

I have to admit to the opposite side of the spectrum.....even now at 30mpw or so. My rate can get down to the high 30's, but typically is between 48-52 while sitting. I always thought there was a connection, in that the ectopic beats would occur at such a slow rate (leading to a really long pause) that this would trigger some atrial flutter or afib. My understanding is that resting rates in the normal range (60-80) are better for afib suffers. This thing is mysterious......much more study needed.

Thanks Eric, helpful reply. Admittedly a layman here, but if your episodes are 20 minutes and you self-convert, I would not be too worried either. The thing I'm sure they have told you is to watch for increasing frequency/length of episodes. My cardio explained to me that the heart has its own rudimentary nervous system and once it essentially "learns" to be in a-fib it does so increasingly. Hopefully yours won't. I wouldn't start drinking though. ;)

I am obviously an advocate of the ablation as it worked for me and got me off the potential for a lifetime of drug therapy. The drugs for this condition, at least for me, were really rotten. The ablation is really not that invasive of a procedure. You are awake throughout, talking with the techs, etc. I had no stitches even and was up and running again in 10 days. Compared to drugs, it is a breeze and if it cures the problem, well worth it in terms of quality of life measure.