Tag Archives: marathon

Guest Blogger Adam Durnham – 5 Athletes that have Atrial Fibrillation

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Special thanks to writer Adam Durnham who has kindly sent me an article he wrote on atrial fibrillation and athletes – You are truly appreciated Adam!

 

5 Athletes that have Atrial Fibrillation

Atrial fibrillation (AF or AFib) is an irregular or quivering heartbeat that can lead to heart failure, blood clots, stroke, and other heart-related complications. According to the American Heart Association, approximately 2.7 million people in the United States live with AFib.

During AFib, instead of beating effectively to move blood into the hearts ventricles, the upper two chambers of the heart (the atria) beat irregularly and wildly. Some people experience no symptoms of this medical condition and become aware only during a physical examination. For those who do experience symptoms, they often include:

  • Heart palpitations
  • Shortness of breath
  • Weakness
  • Fatigue
  • Confusion
  • Lightheadedness
  • Chest Pain
  • Reduced ability to exercise
  • Dizziness
  • Sweating

Different Types of Atrial Fibrillation

Atrial fibrillation symptoms are typically the same; however, the underlying reasons and the duration of this medical condition help to classify the different types of AF problems. The different types include:

  • Occasional – With occasion AFib, symptoms may come and go and may last only a few minutes or hours and end on their own.
  • Persistent – With persistent AFib, the heart rhythm does not return to normal on its own. In order to restore normal heart rhythm, the patient will need treatment such as medications or electric shock.
  • Long-standing persistent – With long-standing persistent AFib, the condition is continuous and persists for more than twelve months.
  • Permanent – With permanent AFib, there are no further attempts to restore normal heart rhythm and the heart rate is often controlled by medications.

Atrial Fibrillation in Athletes

AFib is the most common arrhythmia seen in athletes. This is especially so for middle-aged athletes, although it can be seen in young athletes as well. Here are five athletes who have atrial fibrillation and how they handle the condition:

Larry Bird –  NBA legend, 12-time All-Star, three consecutive regular-season MVP awards, Boston Celtic Larry Bird suspected he had problems with his heart while still playing his beloved game but never told the team physician. It wasn’t until he retired in 1992 that he was diagnosed with atrial fibrillation. He claims his symptoms which included rapid heart rate, disorientation, and light-headedness, are now under control.

Jerry West – The 14-time NBA All-Star guard Jerry West who played for the Los Angeles Lakers from 1960 to 1971 was unaware he had symptoms of atrial fibrillation while he endured sleepless night, heavy breathing, and anxiety. West remembered breathing into paper bags during halftimes to help with his hyperventilation. He described these episodes as panic attacks. It wasn’t until his heart raced out of control after he became the coach and general manager of the Lakers that he was diagnosed with atrial fibrillation. To restore a normal heartbeat West was treated with cardioversion. Cardioversion is a procedure that utilizes a low-energy shock to the electrical system of the heart for the purpose of restoring normal heart rhythm. However, after this procedure, his AFib persisted and after 40 years with the NBA he retired.

Haimar Zubeldia – Spanish cyclist and Tour de France race Haimar Zubeldia, announced in 2012 that his AFib condition forced him onto the sidelines for a period of three months. Although his physicians explained to him that AFib could end his career, Zubeldia returned to the sport after treatment and weeks of rest. His was determined to remain competitive in the sport and finished sixth best overall that year in the Tour de France.

Karsten Madsen – Triathlete Karsten Madsen felt faint and short of breath in 2010 after a routine fitness test. He was diagnosed with atrial fibrillation at that time. He was informed by his doctors that he would need to undergo cardioversion to restore normal heart rhythm. Madsen’s doctors reassured him that he can continue to train, and he has his condition monitored closely.

Billie Jean King – In 2015, the legendary tennis champ Billie Jean King went into atrial fibrillation. After visiting a cardiologist, she was diagnosed with AFib and prescribed daily medication. In addition, she also underwent an ablation to destroy abnormal tissue that may cause arrhythmia. King has teamed up with Janssen Pharmaceuticals to raise awareness about atrial fibrillation and to educate those with AFib about their risk for afib-related stroke.

If you or someone you know has symptoms of atrial fibrillation, it is crucial to seek medical attention immediately to reduce the risk of complications.  If a person is a heavy drinker, it is important they get rehab services as this can affect their heart condition. Do not waste time if a loved one you know suffers from a-fib and drinks heavily.

Guest Blogger – “Old Runner”

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“Old Runner” is a seventy five year old well seasoned runner still running marathons with atrial fibrillation. I find him to be truly inspirational.

 

 

It was November, 2002, at the NYC marathon. I had previously run 15 marathons over a period of eighteen years, none slower than four and ½ hours.

This one was going to be five hours and 15 minutes!

I experienced shortness of breath while running to the side of the street and high-fiving the kids watching from the sidelines. I had to walk the bridge decks (the only change in elevation on an otherwise flat course.)

Suffering no ill effects from this race, I kept on running over the years, experiencing occasional periods during a training run where I had to slow to accommodate perceived extra effort without any change in actual pace. These episodes would pass after a few minutes and I could resume my normal pace again.

Then, in 2007 I passed out in the bathroom while urinating (the doctors have a word for this phenomena which I can’t recall). I went to the hospital for observation and after a stress test was diagnosed with right atrial fibrillation. An ablation procedure changed nothing.  Another doctor I visited said he would not have performed the procedure; when I asked why he stated, “too many trigger points”.

Today I’m seventy five years old, a veteran of 37 marathons. I haven’t run a marathon for a couple of years, my most recent half marathon was last year. I’m still running but most of my runs include some walking. My A-fib is on and off, meaning I go in and out of fibrillation, I have no idea when this occurs any more just that it does occur. A stroke is the biggest danger I face with this form of a-fib so my cardiologist prescribed “warfarin” a blood thinner.  At 75 years of age my pace is closer to twelve minutes a mile, which is a bit depressing, but it is what it is and I know moving is the most important thing I can do for my health – so I keep moving.

Signing out,

“Old Runner”

 

 

Guest Blogger – UK AFib Runner Mike Munson

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This is an amazing story from a British AFib Runner, Mike Munson. This guy is truly hard-core and persistent. Non-runners who read this will be shocked, but I think most endurance athletes with atrial fibrillation will “get it.” Mike has been a gifted athlete over the years – his times when he was having to walk and jog because of an AFib attack are probably faster than my PR times! He initially dealt with attacks of atrial fibrillation, and eventually had to deal with (probably unrelated) cardiac arrest and coronary artery disease. Please feel free to comment. Thanks for sharing your story, Mike!

 

I had run regularly since about 1964 when I won my local district schools 1 mile in 5m 4secs (aged eleven) on a grass track, bare footed (the school did provide spikes but they hurt my feet). I joined my local Athletic club at twelve, running Track & Field in the summer, Cross Country in the Winter at County & National level. After University I worked in Africa but ran hard most days and started running slightly longer distances in hot climates in Central Africa (ie 10km & 10 Miles). I didn’t race much but did my first 10k in Lagos, Nigeria.

On returning to the UK in my mid 30’s and just starting a family I eased up on the intensity of my training but still ran most days and competed regularly for my local Running Club. As a club we had an internal “Grand Prix” where we competed against clubmates of similar ability.

In late 2000 (aged 50) I was taking part in the last 10km of the year, a relatively easy course that would normally have taken me about 40 mins to compete. I was a very consistent runner and usually started slower and ran negative splits. On this occasion I found myself collapsing for no apparent reason within a few hundred metres of the start. As it was the last run of the series (& I am not one to give up anyway), I picked myself up and initially started walking then broke into a jog, but very quickly had to stop again. I had no idea what was happening but by stopping and walking and jogging very slowly I eventually got round but really collapsed at the finish in around 60min . I went to see my GP the following morning and she sent me straight to Hospital. On doing a test on the treadmill they noted I had an irregular heartbeat, but didn’t do anything about it.

Over the next few years the attacks increased from every few months to every few weeks and seemed to be quite random, although I tried to work out if by running at a particular pace or warming up longer would help. If an attack occurred in a race I tended to stop  and walk to the finish as I was coaching youngsters and didn’t want them waiting around too long for me  if I ran to collapse .

In 2006 I moved to Suffolk and introduced myself to my new GP who happened to be a runner. He immediately referred me to a Cardiologist at the local Hospital who had me tested immediately and then transferred me to Papworth (Our Regional Cardiac Centre). They carried out an ablation which unfortunately didn’t work and I still have AFib. However I was given medication (Flecainide ), this had side effects of dizzy spells and blackouts which became very regular. Some of my friends found me a bit blasé about my collapsing and I was often heard to say to a fellow runner who might have stopped to help me, “Oh it’s no problem, I just have a heart problem.” Sometime they would be very shocked but would still try to encourage me to get up quickly and run fast to the finish but all I ever wanted was to get to the finish at my speed, which sometimes could be quite fast and sometimes I would be walking through the line. I became incredibly inconsistent. Over the past 25 years I have been in clubs that had 5km handicap championships each summer. Previously they would very by under a minute over the season but latterly on a good day (prior to going on beta blockers) I could vary from 22 to 31mins, depending how many times I collapsed.

All this time my pace was getting slower as I was unable to train properly (ie more than I would have expected due to my getting older), although one time I spoke to my GP about it an she said “don’t you realise you are getting older” to which I replied yes but I am slowing down too much!

 Therefore I turned to trail running with self navigating. This became very enjoyable and I particularly enjoyed the refreshments at check points, however by 2013 I was getting concerned about my ability to compete longer events and started collapsing and feeling sick if I tried pushing the pace at all. I spoke to my GP who arranged a 24 hour monitor. During this period we had our club 5km championship so I was happy to test myself with the monitor on. Please bear in mind I had been assured that  Afib wouldn’t kill me by my GP.  About 400m from the finish I had a black out  and I went down. A friend was just behind me, checked on me, I had come to and told him I was OK and would walk to the finish. He informed the next official who advised him I was now just behind him. In fact I recovered so quickly I actually overtook him before collapsing again near the finish. I returned the monitor to the Hospital the following day and soon after getting home a Consultant called me to come in immediately but I shouldn’t drive. I was kept in for tests, but in the end they changed my medication to a Beta blocker, which did stop the dizzy spells and blackout, however, my pace in training immediately slowed further from around 8 minute mile to 10 minute mile.

I was then doing more Trail Marathons as it didn’t seem to matter what pace I ran and was good fun, whilst still a challenge and hopefully keeping me fit. 2016 & early 2017 I found when doing easy Trail Marathons increasingly I was struggling over the last few miles, even contemplating taking short cuts, not wanting to cheat but just to finish. I did actually collapse twice at the finish and on one occasion the paramedic suggested going to A&E but I felt I would be OK in the morning (and of course I was).

Then 4th June 2017 I was in the 25th mile of the Stour Valley Trail Marathon (a fairly tough race with several long hills which was my 7th Marathon of the year) on one of the warmest days of 2017 in England, when I collapsed with an SCA (sudden cardiac arrest). Apparently this may be nothing to do with my Afib.

I had an ICD fitted and it has triggered twice since (during runs/ long walks as I am supposed to be taking it easy) and I have now had a double bypass as 2 arteries were narrowed. I am now doing Cardiac Rehab and hope to get back running soon, but will be patient (especially after dying last year for 25 minutes). However the Afib is still with me and I am still on 3.75 mg Bisoprolol.

 However now my wife carefully vets anyone giving me a lift. The guy who gave me the lift on that fateful day is still not allowed to drive me.

The local running community have been great. As I lost my driving licence friends have driven me around. As I could run last winter the local Cross Country League have let me walk the ladies distance. Unfortunately my last collapse meant I missed the penultimate race as I was in Hospital, so as race Director I was busy sending messages out to get the race on. At the Presentation night I was given a special award which was very humbling. I was the first recipient of this award named after a regular runner who had passed away in the previous season.

This summer as I have not been allowed to run I have been raising money for local cardiac charities by organising 21 Trail runs in my County on Wednesday evenings, starting at a Village Pub and using Public Footpaths. It is a simple concept whereby we sell an instruction sheet for £2 and runners self navigate round one of 2 routes either short (maybe 3-4 miles) or longer 6 + miles and then finish at the Pub. We sometimes put on additional things, like one night we tested people for AFib before they set off. This was well received and 120 people turned up; however I was the only person testing positive for A Fib! It created a fair amount of awareness and we managed an article in our Regional Daily.

Is this the sort of thing you wanted to see?  My family have been very supportive of me as they saw me in Hospital with tubes in me etc and where told that maybe I wouldn’t survive the induced coma and if I did as I was out for 25 minutes I might have brain damage but I seem to be very lucky!

Best Regards Mike Munson (aged 65)

Guest Blogger Request

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Note: This is a post I made on a couple of atrial fibrillation Facebook groups – specifically:

Atrial Fibrillation Information Exchange

and

Healthy Hearties

and I’m including it here in the hopes that readers will be inspired to write and share. Thanks!

Joey and I hiking on the nearby Pacific Crest Trail

I write and maintain A Fib Runner (afibrunner.com) – a blog about atrial fibrillation and trail running, ultra running, mountain biking, and other endurance sports. Studies have shown that atrial fibrillation is much more common in middle-aged athletes than in non-athletic individuals of the same age – doesn’t seem fair, does it? I’m a marathoner, ultra-marathoner, hiker, mountain biker with permanent atrial fibrillation – and I blog about it.

I would like to request guest bloggers to submit articles. I’ve written a lot about *my* experience; but your experience is going to be unique and will be of great interest to readers of the blog. At this point I have had several people send me articles and they have been very popular – some of the most popular articles on my blog.

So here’s how it works: if you’d like to submit and article let me know via comment or message. I’ll send you my email and we can get started. If writing intimidates you that’s fine – just right it in your own voice, like you are writing a letter to a friend.

If you want to use your full name – great! A lot of athletes with atrial fibrillation come from a generation that values privacy a little more than millennials – that’s fine. My 58 year old life is an open book, but maybe yours isn’t – a first name or even a pseudonym is fine. I’ll edit the article for spelling, grammar, punctuation, etc., and send you a revised copy (if there any revisions) for your approval.

If you’d like to send photos I’ll let you know how I do that. Blogs need photos – but if you have none to share I will provide appropriate photos.

The article should be about your experience and NOT about giving medical advice. Personally, I try very hard to write as an A Fib Runner and not as a health care provider. If you are a cardiologist, or other type of health care provider, and would really like to make suggestions we can discuss that. Clearly there are some real liability issues with giving medical advice over the internet.

Any topic involving atrial fibrillation is appreciated, and I especially would like to hear from people who have had various treatments like ablation, a watchman device, or an Atriclip, as well as the various medications that you’ve used for atrial fibrillation. How did you find out you had a fib? What did it feel like? What is your emotional reaction to a fib? What is your psychological response to the new normal of a fib? What was your cardio version like? What are your triggers? What things did you change after the diagnosis was made? Did a fib destroy you or did it strengthen you?

And so on.

Please let me know – THANKS!

Reversal Agent for Eliquis and Xarelto Receives FDA “Fast-track” Approval

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This is great news for people with atrial fibrillation (AF) who take the newer anticoagulants Eliquis or Xarelto. According to a recent article in Cardiology News the FDA, in early May 2018, approved Andexxa (Portola Pharmaceuticals), the first reversal agent for the popular newer anticoagulants Eliquis and Xarelto.

I think runners and mountain bikers, correctly, worry about problems with excessive bleeding while on anticoagulants because we are certainly at increased risk of falls or of being hit by a car, and many have hesitated to transition from warfarin (Coumadin) because of the lack of a reliable reversal agent.

Pradaxa (dabigatran) and warfarin both already have reversal available reversal agents.

Andexxa acts as a decoy molecule and essentially binds to the drug preventing it from interacting with clotting factors.

Terrific news, right?

According to drugs.com “In the U.S. alone in 2016, there were approximately 117,000 hospital admissions attributable to Factor Xa inhibitor-related bleeding and nearly 2,000 bleeding-related deaths per month.” 

But wait – there’s catch!

Andexxa has been approved but as the writing of this blog post (May 23, 2018) it is not yet available. It exists, but you can’t get it!

I called one of the pharmacists at our hospital (Sky Lakes Medical Center) and asked if it was going to be readily available at our hospital – that’s when I discovered that it wasn’t yet being distributed – but she told me that our hospital plans to have it in stock and available for use.

She also said that once Andexxa is actually available our hospital would then develop guidelines for usage of the new drug. These have not yet been declared but she expects that it will be similar for guidelines pertaining to the reversal agents for Pradaxa and warfarin which are 1.) Patients with serious, life threatening bleeding and 2.) Patients who need emergency surgery.

I think that means that people having elective surgery (like a knee replacement) will not be eligible and will have to taper off their anticoagulant and bridge with Lovenox, just like they do now. I imagine that emergency surgery refers to surgery that is necessary to save your life, not necessarily surgeries like fracture repair, where it would be possible to wait a few days.

As far as my personal experience – I take warfarin and don’t intend to change. I had taken Pradaxa for several years and was very happy with it until I had a mini-stroke and a trans-esophageal echocardiogram revealed that I had a blood clot in my left atrium.

The next big question, of course, is how much will Andexxa cost? I have no idea and I can’t find any information about cost – but I’m guessing it will be really expensive. But then again – people who are anti coagulated and have life threatening bleeding or need emergency life-saving surgery can just go ahead and get Andexxa and worry about how to pay for it later.

 

Any comments are appreciated! Thanks for reading.

Is Digoxin a Good Choice for Treatment of Atrial Fibrillation?

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Is Digoxin a Good Choice for Treatment of Atrial Fibrillation? I want to make it clear, once again, that I am writing this blog as an endurance athlete dealing with atrial fibrillation (AF) – not as a clinician. I’m not a cardiologist or a primary care physician. I’m simply posing a question and not answering it. It is important for you to be in agreement with your cardiologist and primary care provider about your treatment plan Whatever you do – DON’T STOP TAKING ANY MEDICATION YOU HAVE BEEN PRESCRIBED BECAUSE YOU READ ABOUT SIDE EFFECTS ON SOME GUY’S BLOG!

Also – full disclosure – I take a low dose of digoxin.

Digoxin is the generic name for Lanoxin which has been actually been used for hundreds of years as an herbal preparation (Digitalis) from the foxglove plant, seen above, which is a lovely plant, don’t you think?

Digoxin is used to treat atrial fibrillation, atrial flutter, and heart failure. My cardiologist told me that many of the younger cardiologists don’t generally even prescribe it any longer.

Digoxin has a narrow therapeutic index, which means that at too low of a dose it isn’t very effective and at higher doses it is toxic. Because of this it has many side effects. It is unknown whether digoxin is safe during pregnancy. Digoxin works by improving heart function by strengthening the contractions and slowing the heart rate.

A 2018 paper published Journal of the American College of Cardiology concluded that digoxin increased mortality in patients with atrial fibrillation regardless of heart failure.

Conclusions In patients with AF taking digoxin, the risk of death was independently related to serum digoxin concentration and was highest in patients with concentrations ≥1.2 ng/ml. Initiating digoxin was independently associated with higher mortality in patients with AF, regardless of heart failure.

Yikes!

Also consider that several of the authors of the study disclosed that they had financial ties to pharma and medical device companies, including pharmaceutical giants Bristol-Meyers Squibb and Pfizer who funded the study.

But look! Runners and other endurance athletes need to ask their cardiologists about digoxin toxicity because both dehydration and low magnesium increase the chance of toxicity. Who among us hasn’t been dehydrated?

I’m going to be asking my cardiologist more questions about digoxin next time I see her. As I mentioned I take a small dose and when we did lab work my digoxin level was low, below the therapeutic window, which she said was fine – she just wanted to make sire it wasn’t too high. Me too!

I’d love to see your comments!

Dehydrated Trail Runner – me!

Coffee and Atrial Fibrillation – Update

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A couple of years ago I posted an article on this block entitled Does Drinking Coffee Cause Atrial Fibrillation?   

It had been determined that drinking coffee, even in fairly large amounts, did not increase the risk of an individual going into atrial fibrillation.

 

In their analysis, the researchers found that coffee consumption was not associated with AF incidence, even in more extreme levels of coffee consumption.

 

The article went on to state that while drinking coffee does not cause atrial fibrillation individuals who have no history of atrial fibrillation, it was thought that coffee may be related to recurrence of atrial fibrillation and individuals who have the arrhythmia intermittently:

 

“These findings indicate that coffee consumption does not cause atrial fibrillation,” Larsson says. “However, high coffee consumption may still trigger arrhythmia in patients who already have atrial fibrillation.”

 

 

It was stated that more research was necessary. 

A recent, widely reported Australian study, a very large review of existing studies, determined that coffee is likely safe for people with atrial fibrillation.

 

“Although coffee increases your heart rate, it does not make it abnormal,” explained senior researcher Dr. Peter Kistler.  . . . “We found that there is no detrimental effects of coffee on heart rhythm and, in fact, coffee at up to three cups per day may be protective,” he said.

 

Protective?  That sounds like terrific news!  It is always nice to find out that something that is so enjoyable, but which you have assumed is possibly unhealthy, turns out to be not only safe but good for you also, reducing, to a small extent, episodes of atrial  fibrillation.

 

 Kistler’s group found that, among more than 228,000 patients, drinking coffee cut the frequency of episodes of atrial fibrillation by 6 percent. A further analysis of nearly 116,000 patients found a 13 percent risk reduction.

One cup of coffee contains about 95 milligrams of caffeine and acts as a stimulant to the central nervous system.

Caffeine also blocks adenosine, a chemical that can trigger atrial fibrillation, Kistler explained.

 

This study did, however, go on to recommend that people with heart arrhythmias avoid caffeinated energy drinks.  Furthermore, people who are sensitive to caffeine, should still avoid coffee.  Again there are certain people who identify caffeine is a trigger for atrial fibrillation and those individual should, by no means, return to drinking coffee.

 

Please comment with respect to your experiences with coffee, energy drinks, and atrial fibrillation.  Thanks!

The original study can be found here:

 Peter Kistler, MBBS, Ph.D., director, electrophysiology, Alfred Hospital and Baker Heart and Diabetes Institute, Melbourne, Australia; Byron Lee, M.D., professor, medicine, director, electrophysiology laboratories and clinics, University of California, San Francisco; April 16, 2018, JACC: Clinical Electrophysiology

Whatever Happened to AFIB Ultrarunner?

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Sunrise at the start of an ultramarathon

So, whatever happened to “that one guy?” The one with the AFIB Ultrarunner blog?

When I decided to start this blog I had, of course, scanned the internet for similar blogs, and I found AFIB Ultrarunner. This was a somewhat short-lived but excellent 2010 blog by an unnamed man who was an ultrarunner, who like me, was dealing with atrial fibrillation (AF).

“Afibultrarunner” was actually the name I originally chose for this blog, but it was taken so that’s okay, I’d be simply “afibrunner.”

I’m particularly interested in contacting him for two reasons.

First of all, at the time I was starting this blog I was personally just starting to train for ultras. In fact, I went into permanent AF right at the end of a twenty mile training run while trying to train for my first 50K.  I didn’t really know how to train so I was simply running a twenty mile trail run every weekend and I truly loved those long, slow training runs; but evidently that wasn’t a good idea given what happened!

Second of all the AFIB Ultrarunner guy had had an ablation, and has an excellent description of his experience. I have never had an ablation and likely never will (I’ve been told my chances at success are poor) and wanted to find out how he did on a long term basis. At this point I’d really like to find somebody to write about the experience for this blog – but I’ve never been able to find out who he is or how to contact him.

His blog is excellent and ends, I think, on a very sad note:

My cardiac procedure was painful or uncomfortable in constantly new ways for 20 hours.  I think I took it

pretty well, but at the time I thought that that day would be amongst the worst in my life, as in up

there with losing a spouse, child or dying yourself (although this just might be my inexperience with death speaking.)  Also I tried two drugs and nothing worked. Also my condition effects my day to day life more, such as it is now harder to carry dog food from the car without an attack, and my running has suffered.

Lets hope 2011 has more adventure running, and less heart problems.

 

And that was the end. I’m curious. How’s he doing now? Still running? Still dealing with AF? Maybe he doesn’t want to talk about it anymore – he is a little secretive about his identity, although there is a photo of him during a 50 mile race but there’s no contact info. A fifty mile race while dealing with AF – not too shabby!

Hey, man, if you’re out there let me know!

Alcohol, Athletes, and Atrial Fibrillation

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Alcohol, Athletes, and Atrial Fibrillation

 

Beer drinking with my buddies at Marster Springs Campground

Does alcohol cause atrial fibrillation (AF)?

We’ve been reading for years that a glass of wine or two can reduce the risk of heart attack and stroke; and it’s pretty clear if you’ve been hanging around at the finish lines of marathons, ultras, and long distance bicycling events that endurance athletes like to drink alcohol. Also, some studies have shown that endurance athletes have up to a five-fold increase risk of AF. 

So . . . is alcohol consumption a risk factor for endurance athletes dealing with AF?

Uhh . . . yeah.

Drinking alcohol frequently raises the likelihood of developing AF,  and more alcohol means more risk. One to three drinks (considered to be “moderate drinking”) increases the chances of AF, and “heavy drinking” (four or more drinks per day) increases the odds even more. It’s been suggested that every extra daily drink increases the risk by 8%!

Even if you aren’t a daily drinker so-called binge drinking, defined as five or more drinks in a day, also increases the chances of AF. (Some call it “binge drinking,” I might call it any weekend during my college years!)

Typical weekend from my college days

So how much alcohol is safe? Once you’ve been diagnosed with AF one or two drinks per day is probably safe, but three or more may be likely to trigger an episode. Also – make sure you figure out how much alcohol is one drink – a standard glass of wine versus a large glass of wine. A bottle of American light beer is going to be less alcohol than a bottle of craft brew IPA or stout.

My personal advice is that once you are diagnosed with AF the best move would be to quit alcohol altogether. That’s what I did. But consider that this advice is coming from a guy who is in permanent AF.

A very helpful WebMD article advises that even with moderate drinking you should avoid drinking every day: 

Even if you drink moderately, experts suggest you take a few days off from drinking alcohol every week.

  • Limit yourself to one to two drinks a day.
  • Try to have 2 to 3 alcohol-free days every week.
  • Talk to your doctor if you have an episode of AFib within an hour of drinking alcohol.

 

Exactly how does alcohol increase the chances of AF?

It isn’t clear why, but it is thought that hit might be related to increasing vagal tone. The more alcohol you drink, the higher the vagal tone. Another idea is that dehydration caused by alcohol triggers AF. A lot of people with AF know that alcohol can trigger their AF. Let’s face it – alcohol is basically a toxin with some pleasant side effects.

If you already are being treated for AF alcohol can interfere with the treatment – increase blood pressure, interact with anticoagulants, etc.

What is “Holiday Heart”?

Basically it is a nickname for the way heavy drinking around the holidays, so called “binge drinking” can trigger AF. According to Medscape:

Holiday heart syndrome most commonly refers to the association between alcohol use and rhythm disturbances, particularly supraventricular tachyarrhythmias in apparently healthy people. Similar reports have indicated that recreational use of marijuana may have corresponding effects.

 

The most common rhythm disorder is atrial fibrillation, which usually converts to normal sinus rhythm within 24 hours. Holiday heart syndrome should be particularly considered as a diagnosis in patients without structural heart disease and with new-onset atrial fibrillation.  Although the syndrome can recur, its clinical course is benign, and specific antiarrhythmic therapy is usually not indicated. Interestingly, even modest alcohol intake can be identified as a trigger in some patients with paroxysmal atrial fibrillation. 

Finally – what is meant by “Drinker’s Heart” (a.k.a “beer drinker’s heart”)?

That’s cardiomyopathy, a serious disease of the heart muscle, related to chronic heavy drinking. Don’t let it happen to you. It’s bad.

 

beerMPG

I would love to have any readers with comments post them below. I’d love to hear from  athlete’s with atrial fibrillation who have had experience with alcohol as a trigger. Thanks for reading.

 

Endurance Sports and Atrial Fibrillation – WHY?

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Endurance Sports and Atrial Fibrillation – WHY?

starting a long run on the local PCT. We saw a bear that day – fun.

Exercise is supposed to be good for you, good for your heart, right? Then why is that endurance athletes have two to ten times the rate of developing atrial fibrillation compared to “normal” people? Is a little or moderate exercise good but excessive exercise bad? As an endurance athlete (marathons, trail running, long distance mountain and road biking) who has permanent atrial fibrillation (AF) I would certainly like to understand “WHY?”

There is a terrific article on Europace entitled Endurance Sport Practice as a Risk Factor for Atrial Fibrillation and Atrial Flutter . By internet standards it’s a long read but I will review it here.

The studies aren’t large, and male athletes predominate – but it is clear that endurance athletes have, as mentioned above – 2 to 10 times the likelihood of developing AF. It is not actually known why but it is thought that ectopic atrial beats, chronic inflammation, and larger atrial size are all risk factors.

Personally – the story checks out – I started having runs of “premature atrial contractions” years before ever going into AF, and because endurance athletes train more frequently and tend to avoid rest the atria are chronically inflamed, which leads to fibrosis (scarring) of the atrial muscle. And of course my left atrium has been severely enlarged for decades – not as much because of sports but because I had previously had mitral regurgitation (repaired surgically 1994 but the atrium never shrunk back to normal).

But even without the mitral valve issues endurance athletes tend to have enlarged atria. And we don’t rest enough leading to inflammation and scarring. The Europace article cites several studies that link long term endurance sports with AF, compared to sedentary individuals.

Moderate exercise may actually protect against AF.

Ringo after a long run – Fremont Trail

The Europace article also cites studies that show a correlation with “occupational physical activity” and AF – meaning people that have difficult, physically demanding jobs are also in the same boat as endurance athletes.

I didn’t know this – there is also a higher rate of AF related to how tall a person is – damn! I’m 6’3” (or 6’4” – depending on what year was measured.)

The article discusses, speculates, as to the mechanism of AF in the athlete’s heart but much of this is a bit technical for this blog. Feel free to explore the article if you are curious.

The typical clinical profile of sport-related AF or atrial flutter is a middle-aged man (in his forties or fifties) who has been involved in regular endurance sport practice since his youth (soccer, cycling, jogging, and swimming), and is still active. This physical activity is his favourite leisure time activity and he is psychologically very dependent on it. 

Interestingly the AF rarely occurs during running:

They almost never occur during exercise. This makes the patient reluctant to accept a relationship between the arrhythmia and sport practice, particularly since his physical condition is usually very good. The crises typically become more frequent and prolonged over the years and AF becomes persistent. Progression to permanent AF has been described by Hoogsteen et al .

Again, for me, the story checks out. I certainly recall long episodes of palpitations at rest that I now can identify as AF – until the day when it became (dreaded) permanent AF!

The article suggests that abstinence from sports is helpful for athletes having episodes of AF, although it isn’t curative. The problem, as any endureance athletes knows, is that it is nearly impossible to get us to give up our long runs, bike rides, etc.

Other therapeutic measures are also discussed – but that is a talk that is best left to the runner and the cardiologist.

Although ablation seems to be quite effective, endurance sport cessation associated with drug therapy seems to us a more suitable approach as an initial therapy, particularly in non-professional, veteran athletes.

To conclude I’m just going to quote their conclusions right here:

Vigorous physical activity, whether related to long-term endurance sport practice or to occupational activities, seems to increase the risk for recurrent AF. The underlying mechanisms remain to be elucidated, although structural atrial changes (dilatation and fibrosis) are probably present. There is a relationship between accumulated hours of practice and AF risk. Further studies are needed to clarify whether a threshold limit for the intensity and duration of physical activity may prevent AF, without limiting the cardiovascular benefits of exercise.

I’d be interested in others opinions and experiences with these issues. Reading this article was a little emotional for me – like I said – the story checks out! I guess that if I knew what I know now I might have cut down a little on the endurance sports before I was forced to do so by permanent AF. Truly, for me, a day long run with my dog, on a trail, in a local wilderness area was the most enjoyable thing I can imagine. And at this point it isn’t even the AF preventing me from still doing it – it’s the  high dose of beta blocker I take for rate control – really takes the wind out of my sails.

 

 

“C’mon Boss, let’s go for a trail run!”