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

I have an irregular heartbeat - it is never regular at rest but still pretty low (c50 bpm) considering my present level of fitness.I never get the incredibly fast heart rates that many of your poster refer to but the beat is never steady whatever the bpm. Medical specialists have never told me to stop running but say that my heart will not be as efficient as it would normally be. I take a small dose of something called Ramipril daily and (much against my will) warfarin.

I find running hard work (harder than I think it ought to be) but is this the AF or advancing years (I'm 56) and me still expecting to get through the sort of sessions I did 20 to 40 years ago? (at a slower pace, naturally)

Any other runners still run seriously with a similar condition?

Start eating paleo. Seriously. Might be too late for some, but it might lessen your symptoms. Four years for me and not a hiccup (late 50's, first A Fib mid-40s)

So, I came across this thread as I Googled to research to see what I could find about the possibility Diltiazem is the "culprit" for recent running experience. I started serious endurance exercise ten years ago, first with training to do my first ever 5K, then 10K, then Half Marathon, and then Marathon...was 62 then. Never been anything spectacular...think my 5 K PR is about 28 min and 10 K PR close to 1:03 or so...and my Marathon PR (7 1/2 mos after mitral valve repair in 2011) was 6:01. Anyway, I have two credible (like one recorded at Cleveland Clinic when I had the valve job and one recorded in the Exercise Physiology lab in 2013 during a VO2 max test....two credible PSVTs (paroxysmal (sudden onset) super ventricular tachycardia episodes, although I've seen the spikes on my Garmin many times, never any symptoms, even during the lab test when I suspect if they had not shut down the test (they had to for safety issues)..if they had not shut down the test I probably would have ran through it. But, actually, taking diltiazem was not for the purpose of controlling errant etopic heart rhythm anomalies, but rather as we (the docs and I work together (doc thinks I know something about this)..work together to manage my hypertension, which has become more and more of a challenge as years go by....So, a few months ago, because the calcium channel blocker I took was causing pedal edema, we changed to a type that was less likely to do that, Diltiazem is the one I am not on. Recently the dosage was increased to try to get me into the target area of 120/80. Well, I've noticed in the last couple three months for distance running as long as I pace myself at RPE of about 13 or so, I can seemingly run for a long time. That pace is about 12:30 min/miles...well....I've never been fast....but...this is depressing for me. My cardiologist doc saw I was depressed over a recent 3:01 Half Marathon and says....you're 72....and I think he doesn't get it...really....my metabolic age is not a day over 50, maybe a little less. Anyway, I run maybe an hour at 12:30 and my heart rate has stayed in the upper 130s and drifted to 142-145...and then it soon is high 140s and then into the low 150s (my max HR seems to have fallen to the low 170s, maybe 175 or a bit more, but not much, if any)...anyway...when the HR gets to 150 I know the running is soon to be over....sometimes, well often, wonder if I'm just not having the neural energy to push through...is it in my head as I "fight the monkey"...or is it the diltiazem managing my BP and screwing up my running....and how will I ever be able to do my goal Marathon in mid November. So, if anyone reads this far...and has advice....like I think just gotta train faithfully and do the best I can and let it go...but will be depressed as hell if I get picked up by what I think is the sweeper bus of shame at the Marathon...don't anyway want that to happen. So, any constructive advice other than just get over it?

Have had A-Fib on and off for 35+ years, first noted following a 12 mile training run in the early 80's. Self diagnosed (was a Cardiovascular Physiologist at the time with access to a treadmill lab). Ran myself out of it once I reached a HR of 250 using a standard Bruce protocol at stage 4. Went into NSR, dropped to a HR of 110 immediately. Was able to run myself out of it when I had periodic bouts until about the mid 1990's. Had to have a cardioversion in the late 1990's for a bout of it. previously on no meds except for a baby aspirin/day. As I am also a swimmer, I began masters competition in the late 1990's. Went into A-Fib at nationals in 2001, in Santa Clara. Swam my last 2 events, set records in both. Had the A-Fib cardioverted in San Jose following the meets conclusion. Was then 13 years A-Fib free, had a bout of it last year, coinciding with a hypothyroid condition that's being managed. Was traveling at the time, once home saw an MD to try and convert it, converted on its own on the way home from the MD office. Had an occipital CVA the next day as i hadn't as yet had time to fill the script for the Xaralto that was prescribed. CVA completely resolved, was A-Fib free for the past year, until about a month ago. Had a TEE (no clots in the atria) and cardioversion earlier in the week, did a heavy weight workout and 20 mile bike yesterday ( i also still run and swim), back in A-Fib this AM however. Will be chatting with the MD about an ablation on Tuesday, as not training hard isn't an option for me. As long as one is anti coagulated and rate controlled, running or other activity is OK, the risk is when the A-Fib is present for several days with no anti coagulation, as with my situation a year or so ago. There are many people walking around with persistent A-Fib, with minimal issues, they are anti coagulated and rate controlled however. My personal opinion is that heavy training creates morphological changes in the heart that predispose to this and other conditions such as cardiomyopathy etc. There's not much research on the subject in athletes and most cardiologists don't understand it, only dealing with the normal sedentary clients they see on a routine basis. You will likely have to make sure you know as much about it as possible so you can assist in managing your own case. My mistake was in becoming over confident in my own knowledge however, and not ensuring I filled the script for Xaralto when I should have. Lesson learned. :)

I had my first bout of afib senior year of college after a hard interval workout, lasted 2 days in the hospital. Just ran a tempo and am in it again (been about 8 months since the first bout). I didn't sleep a lot last night and was probably dehydrated, and fairly tired from work. The first time it was after the really hard workout the day after a concert that I danced tons at. I think for me, it is a combination of stress/fatigue, lack of sleep, electrolyte imbalance and running hard on top of all of that. Hopefully if I take it easy when I Have rough days it won't come back

I found this thread really useful following an Atrial Fibrillation bout so wanted to share my experience.

35 years old

75-79kg

2:39 marathon, 33:30 10k, 15:50 5k (also, as a triathlete, national age group champ and world champ medallist)

30-50 mpw (+lots of biking/swimming when I was racing triathlon)

The AFib Episode: uneventful

Summer 2018 (age 34) I went into AFib during an easy 'shakeout' swim 48 hours before a swim/run race in Sweden. After being in AFib for 24 hours (no symptoms other than the funky heart beat) I went to ER and was successfully converted back to sinus rhythm (cardioversion). I did the race the next day (won it - woop). It's also worth noting I'd been in a super stressful life period (2 toddlers, no sleep, big job etc.) and it was one of the hottest summers on record for most of my training.

The diagnosis: interesting

On returning to the UK I saw a cardiologist and had ECG/MRI etc. Upshot was I had a severely dilated (i.e. stretched) left atrium (46 ml/m2 indexed to body surface area). Everything else was hunky-dory. The atrial stretch was almost certainly the reason I went into AFib and the atrial stretch was almost certainly an adaptation to my training over the past 20+ years (I was a competitive swimmer age 10-18 and triathlete age 24 - 34).

The outlook: not great

My cardiologist explained (sensibly) that given the extent of atrial stretch, the chances were extremely high that I would (and will) go into AFib again. Maybe in a week, maybe a year, maybe a decade. But it will happen. And once it's happened twice, it is even more likely to happen a third time (and sooner) and so on and so forth until your in persistent AFib. Bad.

The solution: surprisingly simple

To decrease the chances, or at least delay the inevitable onset, of a my next episode the options were to have an ablation (which seemed hasty after only one episode) or to try and shrink the heart. I chose shrinking the heart. To decondition I reduced my training from 10-12 hours of swim/bike run down to 4 hours per week of running (~50k) keeping my heart rate below 110bpm and no single session >60 minutes.

The results: encouraging

After 3 months on the deconditioning program my resting heart rate had increased from 36bpm to 50bpm, and my left atrium decreased from 46 ml/m2 to 40 ml/m2 which only just left me in the 'severely abnormal' category. 1ml/m2 away from 'mildly abnormal'. Good news. We were so excited by the change that we tried another 3 months deconditioning - however there was no further reduction in volume. Ultimately we decided that it was a case of drastically diminishing returns and (given I want to keep racing and was not a happy bunny when deconditioning) it wasn't worth trying to push further.

Moving forward: moderation

I've quit triathlon for the time being and am focused on running where you can get much closer to your athletic potential with far fewer hours straining the heart. I needed to put in 15-20 hours per week to be competitive in triathlon, but with running 6-8 hours seems to be plenty. Interestingly, since the deconditioning, my max heart rate has also increased from ~170 to ~180. Presumably because my atrium is smaller it pumps faster (or potentially because it just appreciated the long break...). I'll get an ECG annually and keep a close eye on my resting pulse (if it gets into the 30's I'm probably getting 'too fit'.

Why fish oil?