Sunday, February 18, 2018

Atrial Fibrillation, Afib or AF, in the Endurance Athlete

"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 that writing that addressed rapid heart rates in general and review a very commonly seen abnormal rhythm called atrial fibrillation also written AF or Afib. More people than you would guess have this issue, particularly those in the sport for decades.

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.  Often this is more of a challenge than the patient (athlete) would like.

Medically, a number of medications are available for stroke prevention including aspirin, warfarin and the newer (read more expensive - and to be fair, much more user friendly) agents.  When addressing the abnormal rhythm, various meds are available and, when ineffective catheter ablation may be offered.  This is catheterizing the heart, usually through one of vessels in the leg, 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. Thanks for this blog John. I can relate personally to this having had exercise induced AF in 2015 just a couple of months after completing IM Mallorca. I had all the tests and opted for cryo-ablation in April 2016. It was a success and with judicious convalesence and an ease back into training, I have now got back to racing every distance up to 1/2 IM. Fingers crossed that it remains so. I am therefore a delighted 55 year old whose 25 year love of Triathlon and endurance sports is still alive. So do not give up guys, adapt and move on, i wish you all the best!

  2. Stephen - you are one of the lucky ones. All the best both in and out of triathlon.