A-Fib Patient Story #15

Cyclist/Triathelete with Persistent A-Fib

by Ed Webb, 2006 with update 2008

I am a 60 male and have been a competitive runner, triathlete and cyclist for most of my adult life.  Over the last five years I have competed at the World Masters Road Cycling Championships in Europe placing as high as 7^th in the time trial.  Virtually all of my cycling training has been heart rate based and more recently, my running as well.  Coming off a highly successful triathlon season last year (2005) where I won a World Master Games Age Group championship I decided to take a break from cycling last fall and winter and switch to full time swimming.

Things were going fine until one day after a particularly hard swimming workout, I felt like crap (early Feb).  Not having been concerned about my heart rate while swimming—it naturally tends to run much lower than my vertical (running and cycling) heart rate, I attributed my lousy feeling to a touch of the flu.  I checked my pulse and noted that it seemed to be high—around 90—when it should have been 70 or less as I recovered from the workout.

The next day, I still felt under the weather but decided to go out for a bike ride.  Right from the start, my heart rate was higher than normal—running around 95 to 100 when normally it would have been 15 to 20 beats lower.  It quickly jumped up to 120 with very little effort and, as I increased my effort, it jumped to 145-150 (when it normally would have been 110-120).  While all of this was happening, I noticed that I felt like I was just finishing a sprint with an out-of-breadth sensation, but I wasn’t working that hard.  That’s when I knew something wasn’t quite right.

After taking a day off, I decided to bite the bullet and pay my doctor a visit.  He confirmed what I had suspected, that I had an arrhythmia situation going on.  A few days later I was seen by a cardiologist and diagnosed that I was in A-Fib.

Up until then, I knew nothing about A-Fib and was as surprised as anyone that with my long history of aerobic and anaerobic activity that I should develop a sudden onset of A-Fib.  My cardiologist started me on a blood thinner, Coumadin, and advised that I could resume normal workouts with the understanding that I would probably continue to feel out of breath at higher levels of activity until I returned to normal sinus rhythm.  Well, I continued to work out with no change to my A-Fib.  It had set the hook and wouldn’t let go.  After the first week or so, it seemed I became adjusted to the A-Fib and no longer had that flu-like feeling.

But I still got a head rush every time I stood up, had the out of breath sensation at higher workout levels, and had a general sense of being more tired than I remembered.  Well, the A-Fib persisted; and once I was stabilized on the blood thinner, I had my first cardioversion (Apr 20, 2006).  At that time I was started on the drug Altace though I frankly did not really understand what benefit I would derive from it, but took it anyway. (Altace is an ACE inhibitor usually used for high blood pressure and to reduce the risk of heart attack.)

Told I could resume my normal activities right away, I took one day off and then had a comfortable swimming workout.

The next day I went out on the bike and things were going fine until my heart rate jumped from a steady 135 to 170!  I slowed immediately hoping it would return to normal sinus rhythm, but no such luck.  I was told to discontinue the Altace and one week later I went back in for my second Cardioversion (May 4, 2006).  I was then started on Rhythmol SR which, as I understood it, would help keep me in normal sinus rhythm.  Well, I stayed in normal sinus rhythm until a week later when, while swimming at the Masters Short Course Swimming nationals, I reverted to A-Fib during the 200 yard freestyle event (I faded to 7^th in my age group as a result).

That’s when it became clear to me, that there was an ablation procedure in my future.  Note that I discontinued the Rhythmol SR per EP (electrophysiologist) direction.  After doing quite a bit of research on the Internet and consulting a cardiologist friend of mine, I decided I would need to part ways with my current cardiologist, who had only performed a handful of A-Fib ablations and track down a more experienced EP. This search wasn’t quite as easy as I had hoped, owing to the challenges of dealing with my HMO healthcare plan.  However, my persistence finally paid off when I was able to be seen by a highly recommended Arrhythmia group, Florida Arrhythmia Consultants, here in Fort Lauderdale.  My new EP, Dr. Philip Zilo, was in complete agreement that in my situation, an ablation was my best option.

(Note: I gave serious consideration to trying to get into the Cleveland Clinic here locally (Weston), only to discover that they were out of network.  Wouldn’t you know it, though, the Cleveland Clinic in Cleveland was in network!  However, it was likely not going to be until Winter or even Spring of 2007 before I could reasonably expect to be scheduled for the ablation.)

Aug 7 was the big day, but I had to go in 3 days early to be taken off of Coumadin and started on Heparin.  During the procedure, my EP did:

• Left atria PV regions, circumferential pulmonary vein antrum isolation, posterior line and Mitral isthmus
• Right atria between the tricuspid annulus and the inferior vena cava

Following the procedure, my cardiologist was a little surprised that I did not have a little more chest discomfort. Apparently, he uses that as a gauge of how deep the RF burns were.  He spent five hours doing the procedure which he indicated was normal.
(Note: You read on some web sites that the procedure takes as little as 1 to 1/2 hours.)

Other than starting back up on Coumadin, I wasn’t put on any medication. I remained in the hospital another 3 days, for a total of 6, awaiting my Coumadin level to rise to an acceptable range. (Note: Going into the ablation procedure, I had no idea I would be in the hospital 6 days.  You can be in and out for a heart transplant in 6 days!)

My cardiologist indicated I could resume normal physical activity 4 days after the procedure.  Wanting to play it safe, my plan was to go cold Turkey for several weeks to give the scarring plenty of time to heal. However, on Day 5 (Aug 12, 2006) after the procedure I was doing a little light work outside—it was particularly hot and humid—with my heart rate running around 85 when I reverted to A-Fib.  I saw my cardiologist Aug 14 where he started me on Toprol to see if that would have any effect.  It did not, and he cardioverted me on Aug 17.  Six days later, I was once again outside doing some light work when the same thing happened.  Brought me in the next day—I was becoming a regular around the corridors of Northridge Medical Center in Fort Lauderdale—for my 4^th cardioversion.  This time he started me on Rhythmol SR.

At this point, 18 days after the ablation, he was becoming concerned that the ablation procedure was not a success—even to the point of discussing my follow-on procedure where he would plan to use a new catheter tip which had just recently received FDA approval (a cooled tip which allows more energy to be dispersed over a wider area as I understand it).

Now I didn’t just fall off the turnip truck, so I stopped going outside for anything for the next week!  Then I started a very easy regimen of walking knowing my wife and I were going to be spending 3 weeks in Europe, so I wanted to get in some semblance of walking shape.  By this point I was really gun shy and was particularly anal about watching my heart rate monitor in the days and weeks ahead.

(Editor’s comment: He uses two monitors, the Polar S510 and a backup Timex which doesn’t record data. He wears a monitor for all cycling workouts, and also when running.)

I started my walking regimen on Sep 4, 2006 at a heart rate of 78, building by 1 beat per day.  I started riding the Lifecycle while still in Europe building to a steady heart rate of 105.  I should also point out that my cardiologist advised NO caffeine and only 1 glass of red wine per day allowed.  He wasn’t too keen on decaf coffee even, but accepted that I would be drinking 1 cup of decaf a day.  This of course meant I also had to switch to caffeine free coke which the Europeans haven’t discovered!

Dr. Zilo wanted me to accelerate my workout efforts. After nearly two months of being in normal sinus rhythm, he felt it was time to determine if the procedure was a success, especially given the two episodes of A-Fib post procedure. I was probably the best conditioned persistent A-Fib cyclist going into the procedure, so the time off the bike (I had hung up my bathing suit in the Spring for the time being) was probably a welcome rest. I felt really fresh, especially given that I was in normal sinus rhythm.

Nov 5, 2006, I completed a century ride (100 miles) on my bike at an average heart rate of 127 and a max of 151.  My previous LT (lactate threshold) was 148 which I have been able to successfully maintain for intervals of 5 minutes and longer as I look to regain my previous cycling form.  My cardiologist seems to be as surprised as anyone about my turnaround. (I had actually done a couple of centuries during the Summer while still in A-Fib, and maybe that helped a little with muscle learning. Surprisingly I never felt any muscle fatigue during these rides in A-Fib, but simply ran out of gas at about the 75 mile point when I fell off the lead pack.)

I have had several hard rides in the week following and feel as though with another month I will be ready to resume racing. FYI, when I do race, I’ll ride with 35+/45+ groups for creds rather than with my age group just to push myself.

I feel great right now as though nothing ever happened.  The next event, provided everything stays normal, will be to discontinue the Rhythmol SR.  However, I’m kind of thinking right now that “if it ain’t broke, don’t fix it”!

Ed Webb
Late 2006
E-mail: Edandlindafll (at) aol.com

Update:

Ed recently wrote that he is off of the Rhythmol SR and in sinus rhythm, but then he was hit by a truck (broken ribs, contusions)! He recovered, is doing fine, and is racing again.) I am feeling better then ever and am thankful that the ablation procedure was a success after all.

Update 12/29/08:

I took the better part of a year off to swim (went to World Masters Swimming Championships on a lark).  I got back on the bike this past summer only to have my A-Fib problem pop up out of nowhere again in August.  Just like before, it was like you flipped a switch and, voila, I was in A-Fib full time (persistent).

Fortunately, I was able to get in to see my cardiologist within 2 days for another cardioversion.  Four weeks later, I had another ablation procedure (my second and hopefully last).  That was the end of September (2008). Following the procedure, I didn’t do a thing for four weeks and then slowly started getting back into some physical activity.  I started with easy walks and got back on the bike the beginning of November (2008), still taking it very easy.  My first time around, I had a couple of episodes of A-Fib (both required cardioversions to get me out) and I attribute that to trying to do too much too soon (before the scarring had a chance to heal).

At the end of November my cardiologist cleared me to resume unrestricted physical activity. As luck would have it, the first week of December I got involved in a big cycling pile up (kind of like a NASCAR wreck) and really screwed up my shoulder and back—nothing broken but painful muscle strains and bruising.  I took 2 weeks off and only began to get back into it right before Christmas.

So, bottom line, and aside from the lingering aches and bruises (combined with old age!), I’m actually doing great.

Regards,

Ed Webb
E-mail: Edandlindafll (at) aol.com

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