Atrial Fibrillation Podcasts?

 

For many years I’ve been running with an iPod and truly enjoy listening to music while running – I wrote about it in a previous entry about Runner’s High – nothing like some nice stoner music to listen to while you’re high on life, right?

I realize that listening to music while running is controversial for many people; but I am an unabashed YES when it comes to running and music. Because I live in rural, mountainous Southern Oregon I do 95% of my running on trails of one sort or another – and yeah, yeah – bears, mountain lions, dogs – I get it – but I’m not changing anything. I’ve been running with music ever since my first Walkman cassette player in 1984!

Even worse – I’m Mr Bad Example and ride my bike with an iPod going, and again 95% trails but still not really a good idea.

Lately, with my atrial fibrillation requiring more and more medication to control (the high dose of the beta blocker carvedilol really takes the wind out of my sails), I am doing more hiking and less running – but still with an iPod.

Since “runner’s high” is a rare event with hiking compared to running I’ve been listening to more podcasts than music playlists. Podcasts are sort of like radio shows, either professional or homemade, that can be downloaded from the iTunes store and elsewhere, in MP3 format to be listened to using an iPod, smartphone, or even on your computer. They are mostly free, but many have commercials, and there are a few podcasts that cost money.

There are millions of them. Over the past couple of years here are the ones I’ve found most entertaining:

All of these recommendations are unrelated to atrial fibrillation

Dirtbag Diaries – a “dirtbag” is something along the lines of a Yosemite rock climber who lives in his or her car and lives for climbing. The term has a broader application and this excellent podcasts primarily deals with outdoor adventure, mostly done econo!

Outside Podcast – if you like Outside magazine you’ll like the podcast – the Science of Survival episodes are particularly great.

My Dad Wrote a Porno – The funniest podcast I’ve ever encountered – but truly dirty and probably offensive to most people – you’ve been warned. A young British man discovers his dad wrote a clueless porno novel so he reads it with his two friends and they basically give it a sort of Mystery Science Theater 3000 treatment.

Dan Carlin’s Hardcore History – probably my favorite podcast ever – fascinating and detailed episodes about various historic eras like World War I, Genghis Khan, the Roman Empire, etc. The episodes are long – like four or five hours long – and never boring. The narrator reminds me of Steve Dahl (only other Chicago natives will know who that is) merged with a historian who loves guy movies. Okay – if that doesn’t make sense just try an episode or two – it’s a great show.

Revisionist History – a Malcolm Gladwell podcast – very thoughtful and as with all his work always an amazing twist near the end.

The various NPR podcasts (Snap Judgement, TED Radio Hour, Radiolab, Invisibila, etc.) are consistently excellent, maybe a little too slick.

I think most people who listen to podcasts have already listened to Serial, Dirty John, and S Town. If not, what are you waiting for? They are among the best ones out there.

Others I’ve found interesting include Rich Roll Podcast, Beautiful Stories from Anonymous People, Judge John Hodegman, WTF, and the Nerdist.

Actual running podcasts include Trail Runner Nation and Ten Junk Miles.

But what about podcasts specifically about atrial fibrillation? It seems like any topic, no matter how esoteric, has a number of podcasts. If you don’t believe me do an iTunes store podcast search for your hobby, your favorite TV show, favorite band – and you’ll see what I mean.

I was surprised when I did an iTunes store podcast search on “atrial fibrillation” I found zero podcasts that were anything like this blog – that is to say produced by somebody with atrial fibrillation for non-clinicians who deal with their own AF. All I found were atrial fibrillation episodes for technical medical podcasts directed toward clinicians. Just have a look at the screenshot at the top of this post. It amazes me that with all the people dealing with atrial fibrillation none of them seem to be podcasting about it, although, as you know, several people blog about it.

Rich Roll Podcasting

If you know of any atrial fibrillation podcasts, or if you just want to discuss podcasts in general, please comment. Thanks for reading.

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Coffee and Atrial Fibrillation – Update

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?

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

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?

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!”

Bariatric Surgery Lowers the Risk of Atrial Fibrillation

Bariatric Surgery Lowers the Risk of Atrial Fibrillation

I’m not sure how much this applies to endurance athletes, but I found this interesting. As, I think, everyday knows, obesity increases the risk of cardiovascular disease, and that includes atrial fibrillation. Researchers in Sweden recently published a study where they followed 4200 obese individuals with normal sinus rhythm (ie. not in a fib at the beginning of the study) for an average of nineteen years. During that period approximately half of the subjects had had bariatric surgery – basically various surgical procedures to rearrange the internal organs to force the patient to eat less and absorb less resulting in significant, life-changing weight loss.

The study found that 12.4% in the surgery/weight loss group experienced atrial fibrillation compared to 16.8% in the non-surgical/still obese group. That’s a 29% lower rate of developing atrial fibrillation for the surgery/weight loss group. Furthermore the study also concluded that, “Compared with usual care, weight loss through bariatric surgery reduced the risk of atrial fibrillation among persons being treated for severe obesity. The risk reduction was more apparent in younger people and in those with higher blood pressure.”

(Citation is HERE)

Other studies have shown that weight loss can be helpful in reversing atrial fibrillation and that ablation success rate is improved with weight control. I don’t have literature citations but I read this here.

So what does this have to do with endurance athletes with A fib? All endurance athletes are already thin, right? Well, obviously that isn’t true; but probably very few endurance athletes would meet the criteria for bariatric surgery. So we should be in the low risk group to begin with – so why do so many endurance athletes end up in a fib?

Well, as everybody knows distant runners and other endurance athletes often gain weight when they have to quit or reduce exercises because of, say, atrial fibrillation. These studies suggest better outcomes with weight control regardless of method.

As to why endurance athletes have a higher rate of A fib – I’ll address that in next weeks post.

Thanks for reading – please feel free to post comments below.

Watchman Device Update

A little one a year ago I wrote about the Watchman device. People with atrial fibrillation often develop a blood clot in the part of the left atrium called the left atrial appendage. This Watchman device basically closes off this area to prevent clot formation.

Last time I wrote the device was relatively new (long term data wasn’t yet available), and based on my research it didn’t seem like a great choice. I would refer you to this excellent article on John Mandrola, MD’s blog: Say No to Watchman.

As a person who has already had a ministroke and a verified blood clot in my left atrial appendage, well yes, I am very interested in a device that would prevent me from having a stroke which, at this point, for me, seems pretty much inevitable. Technology improves over time, right?

So what is going on with the Watchman now?

Well, Boston Scientific released its final five year outcome data from the PREVAIL study, along with five year outcome data from the PROTECT-AF trial. I would refer you to an excellent article in Cardiac Rhythm News (link).

At first look I was fairly optimistic:

In the PREVAIL and PROTECT-AF randomized clinical trials, LAAC with the WATCHMAN device was compared to warfarin for stroke prevention in high-risk patients with non-valvular AF. In addition to stroke prevention comparable to warfarin, the analysis concluded the WATCHMAN device also effectively reduced non-procedure related major bleeding, disabling or fatal stroke, and mortality.

Source Cardiac Rhythm News

I had been thinking the best course of action would be to, perhaps, have a Watchman implant and just remain anti coagulated. After researching this, however, that doesn’t seem like a good plan. The Watchman device has been shown to protect from strokes with an outcome similar to warfarin; but it turns out most of the additional benefit of the Watchman is basically related to the fact that those patients didn’t suffer as many warfarin related side effects/deaths from strokes caused by bleeding or from other major bleeds:

The analysis confirmed a 55% reduction in disabling or fatal stroke, largely driven by an 80% statistically significant reduction in hemorrhagic stroke. Further, the combined data demonstrated a 52% decrease in non-procedure related major bleeding and 27% reduction in all-cause mortality when compared to long-term warfarin therapy

Source Cardiac Rhythm News

At best, regrettably, the Watchman device might be equivalent to warfarin as far as stroke prevention is concerned, but not necessarily better. At best, I think, it would be a good choice for people who have had problems (such as bleeding) with warfarin; but it hasn’t been tested on people who are not eligible for anticoagulation (who are generally less healthy patients). And the Watchman hasn’t been tested against the newer anticoagulants (Pradaxa, Eliquis, Xarelto) which may actually be more effective than warfarin.

So I’m just going to keep watching and hoping for a better option than the Watchman device. I’d be interested in your opinions, and especially in the opinions of anybody reading this who has had a Watchman implant. Please comment below.