Atrial Fibrillation – A Visit to the Electrophysiologist

While at my previous job, at Klamath Family Practice Center, I always had easy access to an EKG. Just for the record, remember that I am a podiatrist, not a family practice physician, but if I wanted to have an EKG done I would just have a tech do one on me. I have had a fairly long history of arrhythmias, including PACs, PVCs, and even runs of paroxysmal supraventricular tachycardia. But one day when I returned from a 20 mile trail run I was in a particularly persistent arrhythmia and I wondered if it was atrial fibrillation. I had the tech do an EKG and my suspicions were confirmed.

At that point I walked down the hall and went to see my primary care doctor, who is also one of my coworkers, and she recommended Pradaxa, gave me some samples, and made an appointment for me to see my local cardiologist, Dr. Dale McDowell.

martinmiro

At Dr Martin’s Office

Dr. McDowell, with whom I have been a patient for the past twenty years, then examined me, did a stress EKG, told me to continue with the Pradaxa, and advised that I should see an electrophysiologist for consultation.

We have several cardiologists in Klamath Falls, all of whom are excellent, but we don’t have any electrophysiologists. An electrophysiologist is a subspecialty cardiologist who focuses on arrhythmias, and are the ones who performed the ablations, install pacemakers and defibrillators, and so on. I think their most common patient is probably people like me who have atrial fibrillation.

I had an appointment with David Martin, MD of Southern Oregon Cardiology and I will admit that I was extremely nervous about this appointment, because I was afraid that he would tell me I had to quit running and quit mountain biking. Or at the very least he would tell me to quit running marathons and start running 5Ks. I was also afraid that he was going to put me on a performance killing medication such as a beta blocker, or worse, recommend and ablation procedure which could be quite an ordeal.

Like other endurance athletes I often have to deal with people that really don’t understand what it is that we do, and why we do it. That’s one thing if it’s a relative, friend, or an acquaintance – but when it is somebody who is going to formulate a treatment plan that is going to affect the rest of your life, it can be a scary proposition.

lakeo

High Lakes Trail

So when I did a Google search on Dr. Martin I honestly wasn’t very interested in where he graduated from, or what he did during his fellowship – I just wanted to try to figure out if he was a runner, bicyclists, or a triathlete. The little blurb about him and the Southern Oregon Cardiology website didn’t mention anything one way or the other, but in his photograph he appeared to be a thin man, and I found that to be encouraging.

I think I even searched local race results looking for his name to no avail.

When I called to make an appointment I asked the receptionist, “Is this guy a runner, or anything like that?” She said that she had no idea.

It took a while before I can get an appointment and in the meantime I had a question. I had spent four or five months training to run an ultramarathon, the Bighorn Mountain Wild and Scenic Trail Run 50K in Wyoming. Even after I was diagnosed with atrial fibrillation I continue to train for this race, which was to be my first 50K. I was getting mixed messages from people as to whether or not I should run it. My primary care physician, who is an ultra runner and has completed a couple of hundred mile races, and who happened to be signed up to run the 50 mile event at the same race, told me to run it. She said it would just take me a little longer – no problem. A friend of mine, with whom I was going to run the race and was also running his first ever 50K, and is a family practice physician in Wyoming, told me to quit complaining and get on the plane to Wyoming for the race. My cardiologist in Klamath Falls, Dr. McDowell, advised me to quit running marathons and not to consider running an ultramarathon. I have a cousin in Chicago who is an electrophysiologist/caridologist and I spoke with him on the phone – he runs marathons and his wife runs ultramarathons. He said I should run it. Another acquaintance, who is a cardiac surgeon, but have never actually examined me, said he thought it might be safe for me to run the 50K, but advised me that it is important that I agreed with my cardiologist (good advice).

If you’re keeping track, so far that is four doctors that said go ahead and run it, and one doctor, who happens to be my cardiologist, and has the biggest vote, that said not to run it. I decided to call Dr. Martin (the electrophysiologist), who would be the tiebreaker, even though I hadn’t been seen by him yet, and ask him about running that 50K.

highlakes

High Lakes Trail

I was able to get a message to him through his nurse, and then she called me back and said I shouldn’t run it. So I didn’t run it.

This is unfortunate because I had already paid for it, but when I contacted the race director she told me I would be unable to get a refund, or even a credit for next year’s event. Also, I had already bought an airline ticket Wyoming which is more expensive than you might imagine. I was able to get a partial credit for this.

I didn’t want to waste all that training so I decided to run a marathon that weekend. I found a nearby marathon in Vancouver Washington and ran that while in persistent atrial fibrillation. It was slow, but I survived, and that’s another blog article altogether.

vancouver

Vancouver USA Marathon

When I finally got in to see Dr. Martin he examined me, looked over all the EKG’s, the stress test, the chart notes from Dr. McDowell, and the lab work and spent quite a bit of time talking with me.

I’m glad that my wife came along because she wouldn’t believe me if I came home and told her that he told me, “Keep exercising like you don’t have atrial fibrillation.” He then went on to tell me, “in the future you may want to consider some moderation as far as your exercises concerned.”

That seems reasonable enough. In fact I was delighted.

The next thing he said was kind of funny. He said, “People like you are a type – ultra marathoners, triathletes, Ironman competitors . . . and you can be pretty hard on your bodies.”

“People like you are a type . . .” Well . . . that certainly is true.

In addition to clearing me to continue with my running, he advised that I did not need to take an antiarrhythmic, which probably would not be very helpful in my specific case, and didn’t recommend a rate control drug at this point in time. Furthermore, he advised me that he thought I had a low likelihood of having a successful ablation procedure given the severe hypertrophy of my left atrium and the fact that the atrial fibrillation was persistent.

He did recommend that I try cardioversion with a “one strike and you’re out” policy – that is to say it probably would not be any type of permanent solution, but it is certainly worth trying at least once. That seems perfectly reasonable to me and I went back to Dr. McDowell for the cardioversion, and was in sinus rhythm for a total of thirty-three days.

I was so pleased with my visit to see the electrophysiologist, Dr. Martin, that I wrote him a letter afterward thanking him. I hadn’t really expected that kind of empathy.

I would be interested in hearing from other endurance athletes with respect to their medical care, and how they perceived the way they were treated by their cardiologists and electrophysiologists. Please feel free to leave a comment.

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35 thoughts on “Atrial Fibrillation – A Visit to the Electrophysiologist

  1. Okey dokey… I’ll share a comment, but be advised, by no means am I any kind of athlete. That is, unless one considers Couch Potato competition to be any type of sport. Hah! Seriously, however, I’d like to reinvigorate my sedentary lifestyle, and lose about… oh, a bunch of weight. And we’ll leave it at that. Having done such previously, I know what to do. It’s the “finding motivation” part that often bedevils me. Any thoughts on that?

      • Really enjoyed your weight loss piece, especially because it mirrors my own diet experiments with Atkins, veganism–and ice cream! My comment really has to do with the visit to the electrophysiologist piece…in my experience, both of my electro docs were quite unsympathetic, warning me of dire consequences if I kept running, and one of them actually attributing the cause of my a-fib to LDR. I’m still slogging out miles…but slower. I find I have to pay attention to hydratiion, moderate my alcohol consumption and just accept that my pace will sometimes be a crawl. BTW I’m 63, been running since I was 19…still have atrial flutter, after 3 cardioversions. Thanks for taking the time to do the articles…

      • Thanks for your kind words. It sounds like you have, like me, resolved to have a sort of compromised exercise life. As I always say it is important that you come to an agreement with your doctor regarding your a fib/a flutter. But then again it is also important that you have a doctor who at least tries to understand your life and what running/exercise means to you.

  2. Pingback: Running My First Marathon While In Persistent Atrial Fibrillation | A Fib Runner – Distance Running and Mountain Biking With Atrial Fibrillation

  3. May I ask who your cousin in Chicago is? I need a 2nd opinion about 2nd av block,mobitz 2.
    I used to be an ultrarunner having run Comrades in 7:02. My Cardio is recommending a
    pacemaker. I’m looking for a electrophysiologist that can factor in my endurance activities
    to his conclusions

    • Hey Phil,
      If this gets to you write back, I’ve been hoping to track u down, I moved to Albuquerque in fall of 2014, loving it here. Met a runner named Lion Caldwell who knows you. I’m running a bit, got into road biking over the last ten years, just completed a six day tour in CO called Ride the Rockies,
      Yours,

      Howie Sagrans
      ex roomie

      • Hi Howard,
        Glad to hear your doing well in ABQ.
        Train at some altitude! I met Lion
        through Gerald Kirkpatrick who you
        also met when we went to
        Scottsdale. Remember the run up the
        fire road into the snow? The
        afib runner got me a good electrophysiologist that was able to get my pacemaker to cooperate with mu
        running. My email is jpheath2@att.net.
        I also do FB and athlinks. I communicate
        with
        Duke every once in a
        while. Talk to you later
        Phil

  4. Hi there,
    I’m really enjoying your blog! Just curious – why do you think an ablation procedure would be the worst option for you? Generally you’re only in the hospital for a day or two, you can usually kick your meds afterwards, and if you have a good doctor you’ll have a successful outcome and will be running agin within a week. What are your thoughts on this?
    Thanks and keep writing!

    • Hi Daryl,

      Thanks for your comment. I have not pursued the option of ablation because I have been told that for me, given the fact that I am in persistent (permanent) atrial fibrillation and that I have severe left atrial hypertrophy (enlarged top part of the heart), ablation would have a very low expected success rate. And if it was successful it would be unlikely that it would remain successful. If I thought there was a reasonable chance of permanently reversing my a fib I would certainly have an ablation.

      I think that people without the same anatomic changes that I have, that is, people who go in and out of a fib, ablation might be a great option. Your electrophysiologist can give you a better idea of whether or not ablation is worth it for you.

  5. An interesting blog – thanks for sharing your stories!

    After studying cardiac arrhythmias for 20 years (as a biomedical engineer, not a physician), I was diagnosed with AF two years ago. Since then, I’ve met with 4 cardiologists and 3 electrophysiologists. They each had their favorite approach to treating the typical middle-aged (late 40’s) endurance athlete with occasional prolonged bouts of AF. I also had my own ideas based on the research literature and my own experiences.

    I’ve found that it is important to be my own advocate, to learn as much as possible about my condition, and to seek second, third, or even fourth opinions when needed. My primary care physician was a great resource and helped me to navigate the many loops and hurdles presented by my insurance company when I requested these additional opinions.

    It took me two years…but I first found (with my cardiologist) a pharmaceutical pill-in-pocket (propafenone) approach that helped me to terminate episodes of AF and recently underwent pulmonary vein ablation to try to prevent future occurrences of AF. Eight weeks after ablation, I am AF free but still taking an anti-arrhythmic (again, propafenone) but I’m pretty optimistic that my ablation was successful.

  6. Pingback: Afibrunner: Patient Perspectives: Long-Distance Running and Mountain Biking in Permanent Atrial Fibrillation / EP Lab Digest | A Fib Runner – Distance Running and Mountain Biking With Atrial Fibrillation

  7. Great Blog,

    It’s a real novelty to find someone with afib who promotes what you can do with this condition NOT what you can’t do.

    My afib was diagnosed 4 years ago ages 40 and I was in persistant for 6 months until I got it under control with more meds. Now it’s in and out all the time but this is not the reason I am writing this, it is because I stopped exercising and bought into all the negative hyperbole about afib. Now, I have started exercising again (slowly), which is a breath of fresh air for me considering I have been a avid exerciser since the age of 10 (boxing).

    I have managed to lose 30 pound this year and expect to get to an optimum weight in the next 3/4 months. My a fib has not changed in the last year only my psychology on afib has changed.

    Will be following and posting closely for motivation and positive encouragement in the future.

  8. Hmm a great and in many ways reassuring Blog. Just been found to have AFib and due to see EP in a week. Told I can exercise but have to keep HR below 130…that means something as exciting as climbing the stairs (slowly). Very much hoping it will either go away or that it will get better/be cured. A strange experience I get high,…very high…HR but without getting out of breath.

    • Just wait until the EP starts you on a beta blocker – the whole heart rate under 130 is a done deal. I also have, over the years, always had a high heart rate. I could XC ski, for example, with a heart rate of 185 and still have a normal conversation. These low beta blocker heart rates are really tough for me.

      • Thank you for the reply. Already on a Beta blocker but suspect that there may be some caution since I am usually bradycardic also my BP is falling away some of the time

  9. Pingback: Re A-Fib: 5 Things I’ve Learned in 10 years… A Guest Post by David Grayson Lees | A Fib Runner – Distance Running and Mountain Biking With Atrial Fibrillation

  10. When I have an AF attack it lasts 8 to12 hours. During that time I feel like Sh*T and can’t do more than walk around without getting dizzy and feeling like I’m going to pass out. The attacks usually happen about every 3 or 4 months with or without meds (flecainide). More often than not, the attack starts at around 11:00 pm so not only do you feel like death warmed over, you don’t get any sleep. Is this how it affects you?

      • So which is worse? Wondering if you’re going to die every 3 or 4 months or whether you could die on any day ( sort of kidding )? I’ve read that the ablation has a 98% success rate. I was also told by my VA doctor that I couldn’t undergo the treatment because you have to be in a state of AF to do the procedure. Can’t they induce the AF? If you’re in AF all the time, Why haven’t you done the ablation?

      • OK OK—but barring any underlying cardio problems and assuming your anti coagulation regime is tight, AF won’t kill you…if you are relatively young and have been recently diagnosed, then ablation MAY be the way to go. (Go to Dr. John Mandrola’s site, Dr John, for a great article called “Put the catheter and Rx pad down…”)And —it usually takes more than one ablation. The 98% success rate you were quoted is total BS.

      • I read it on the internet! You mean they lied? lol. I’m 72 so not too young. I used to be, though. I’ll take a look at Dr. John’s site

      • You certainly do not have to be in Afib for ablation (they will provoke you into Afib when needed). 98% seems unlikely and I would want to see the evidence. There is a lot of variation between different EPs and between different ‘patients’. Whether to go down in the ablation route is a personal decision but if chosen take great care with the EP you go to some have much better outcomes than others.

        Not ablating means either using medication to keep Afib at bay, this often works for a few years but then stops working by which time ablation has become trickier. Or living with Afib anticoagulation works but still leaves you at increased risk of stroke and has a considerable risk of very serious adverse events as a side effect itself.

        I have just been ablated (as part of a pilot/trial) my heart had been damaged by the AFib and PVC (both atria severely enlarged) with medication with either ineffective or giving unacceptable side effects. Enlarged atria make ablation even less likely to be successful hence being part of a pilot.

      • So now the problem is how to find a real good electrophysiologist. There are several electrophysiologists listed in Vancouver and in Portland but there is nothing on their web page tells you how good they are. Maybe they only got a ‘C’ in school on ablations. I want the one that got an ‘A’. I would be willing to travel a bit to a ‘Good’ electrophysiologist with a good reputation for being successful. I don’t think the VA is the place to go.

      • Yes I would like the one who “got an A” but it’s also important is to find one who is willing to say, “I don’t think this procedure will be helpful for you.” In general people think they are better off going to an academic center for their procedure but my opinion is that isn’t necessarily true because 1.) they may be more likely to do a procedure with a high risk of failure 2.) The director of the fellowship might be the person you spoke to pre-operatively but it is highly likely the resident or fellow (the person who is learning how to do the procedure) will be the one doing the procedure. I know this firsthand – I was once a resident and a fellow.

  11. Pingback: Does Drinking Coffee Cause Atrial Fibrillation? | A Fib Runner – Distance Running and Mountain Biking With Atrial Fibrillation

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