Saturday, February 26, 2011

Atrial Fibrillation, A Rapid Heart Beat

"Don't call for your surgeon, even he says it's late.  It's not your lungs this time but your heart holds your fate."          Manfred Mann

Although it might be somewhat surprising, the single most popular piece I've written here, and mind you this is a triathlon oriented blog, was on pills.  Antihypertensives to be specific; medication for blood pressure control.  So this issue will expand on the 12/10/2010 writing that addressed rapid heart rates in general and review a very commonly seen abnormal rhythm called atrial fibrillation also written AF or Afib.

Usually the heart beat is regular and labeled normal sinus rhythm, NSR.  But in Afib, the ventricles, or major pumping chambers, receive a rapid, erratic signal and pump at a varying irregular rate.  Although some can have AF and be symptom free, others can experience chest pain, dizziness, fainting, or be intolerant to exercise,etc. They can be at a 7-8 times increased risk of suffering a stroke.

The diagnosis is made after obtaining a history, physical exam and EKG.  Occasionally an echo cardiogram or blood work are also indicated.  Then, one would search for the underlying cause to choose treatment options.  Interestingly, a common cause is dehydration.  Also found can be an over active thyroid, hypertension, certain types of lung disease, diabetes, excessive alcohol consumption, etc. although finding no definite cause is quite common.  If the diagnosis is in doubt, the patient can be fit for a monitor which continuously records the EKG for 24 hours or longer. Once this diagnosis is made, the goal of treatment is to restore the heart rate back to a normal level and diminish the risk of stroke.
                                                               Medically, a number of medications are available for stroke prevention including aspirin and warfarin.  When addressing the abnormal rhythm, various meds are available and, when ineffective catheter ablation may be offered.  This is catheterizing the heart and attempting to both locate and destroy the tracks along which the abnormal electric signal travels.  As you might imagine, it's a big deal!  I found an on line ad for the Cleveland Clinic where they advertise having performed more than 1200 ablations for AF last year with success.

I've read various posts over the years on various tri forums, readers echoing the disappointment that their medical issues not only limit their ability to train but race as well.   One athlete with significant AF summed it up this way, "I am not letting it take over my life, but it ****ing sucks that I can no longer participate at the level in endurance sports that I had been able to achieve with 20 years involvement in one sport or another (running, cycling and tris).  I even dropped out of IMLP since I knew I couldn't train for the race in my condition."  (I really feel for this guy and I know you do too.)

So, if you've recently been given the news that you have AFib and it requires treatment, research it out, get as much information as you can, and do what you and your physician think is best for you.


"No One Said It Would Be A Piece Of Cake?"
This hand written note was tied to a sign at about the one mile mark of the bike in Kona in October.  A mile later there was one that read, "Cake?  We have an App for that!"  And a mile get the picture.  Isn't it nice that on days when we occasionally feel isolated and exhausted, that we have friends and family to remind us that they're still there, and they care.  Make sure you thank them every day.                                 


  1. Nice summary.

    One of the most common (and frustrating) heart-related problems that endurance athletes face.

    Larry Creswell

  2. Larry - thanks. I agree with the frustrating part. We are so used to defining the problem, outlining known treatments and then hitting the home run for the cure that when we are affected by a problem of this sort, it can be a real downer. I think this is particularly true in the personality that gravitates to triathlon.


  3. What is your experience or thoughts on magnesium supplementation? Seems like an easy thing to try and deficiencies are common. I learned about it on the Heart Scan Blog (Dr. William Davis) and it seems to help me with esophageal spasms and palpitations that showed up for the first time last year.



  4. Cynthia - as an Orthopedic Surgeon I wouldn't have a great deal of experience with treating AF. (You would hope!) But, you might post this same question on Slowtwitch for the collective experience of the readers. Frequently they come up the correct answer and an option or two that you may not have considered.

  5. I have had AF for about 20 years. I got progressively worse but i never stopped exercising (road cyclist) - finally about 3 years ago my heart 'stopped!' Fortunately i was in the hospital at the time for something very minor. I had a 'mapping' ablation (6 hours in the operating room). My heart now works perfectly and i am doing better than i have in many years - its as if i have a new life. So never give up - i tried all the pills and did everything the Doc told me to do except stop exercising. BTW i am much closer to 70 than 60 to the surprise of some 30 and 40 years olds on the road:=}

  6. Thanks for the article! For what it's worth....I didn't know it until I looked it up but the quote at the top...Bruce Springsteen wrote the song and it was later sung by Manfred Mann.

    1. Tommy - thank you. Funny, I thought that Springsteen's version was a cover of the song written by Mann. When you look at some of the lyrics web sites, I believe they think the same thing. Thanks.