Cycling with atrial fibrillation (AFib), arrhythmia and other heart issues

Sleep apnea and AFib are closely correlated, iirc. You can expect a significant improvement with using a CPAP machine.

I've had paroxysmal afib, svt, sustained ectopics for 7 ish years now. Maybe 20 events in that time. Dehydration seems to be the biggest trigger, followed by the usual other suspects. Carry around flecanide, Valium and magnesium supplements in my wallet, in case of an event.

Can recommend the Alivekor Kardia gizmo, for proper diagnosis.

I wonder, anyone know of good data of how the risks increase with number of hours of exercise?

Ooh interesting!
I had an ablation 10ish years ago and was told the AF would probably return and to keep an ear out for it after 5 years. I get very occasional irregularities now but nothing sustained so haven't gone back for anything. So it's not inevitable that it comes back? (It was explained to me as the erratic nerves finding new routes/connections over time.)

I wonder, anyone know of good data of how the risks increase with number of hours of exercise?

Nuanced... (one of my pet interest areas-AFLETES published in May was most recent update I'd seen but below is a collection of other interesting ones):
TAUPO study:

There was no sign that admission rates were higher amongst the more active participants than those who cycled less. For every additional hour spent cycling per week, the risk reduced by 0.90 (95% confidence interval 0.79 – 1.01). After adjustment for age and height the hazard ratio remained 0.90 (0.79-1.03). The model was run separately to control for BMI, and again this did not change the association between time spent cycling and hospitalisation for AF. There was no evidence of modification by age (50 and over compared with under 50 years).

2000 hours:

It was also found that moderate to severe activity in excess of 2000 hours during lifetime was significantly associated with a higher incidence of AF (odds ratio=3.88; 95% confidence interval= 1.55-9.73)

U-shaped association and deep overview:
Graph actually from this article:

Also supported here:

and a Clinical trial of sorts- which concluded:

Despite changes in LA structure and mechanical function after only 10 months of exercise training, there were no clear changes in atrial electrophysiology; a longer duration or dose of training may be required to induce LA electrical changes thought to be causative of the increased risk of AF in endurance athletes.

Sharing my experiences, as Wolfe Parkinson White runs in my family, both me and my sister have SVT but neither of us have WPW, oddly. I've had arrhythmia since I was about 12, only once did it cause me to black out (I remember being on a train, then was in hospital) which I know was stress induced. More often they'd happen when I was ill, and usually coincided with bouts of tonsillitis. Throughout this time I was beginning to get into cycling more and more, and so long as I didn't suddenly start sprinting from standstill, I was fine. Had some tests with the idea to have an ablation but they couldn't trigger the arrhythmia so we decided to leave it. Also decided that as it was so sporadic, permanent medication wouldn't be a great idea either. So, I just live with it. About 6 years ago (some 20years after initially being told I had tonsillitis ("but we don't remove them anymore") I threatened my GP with legal action re: negligence as I'd been having monthly bouts the whole time, so she finally referred me to a specialist who took one look, said I clearly have low level infection the whole time, and the tonsils came out the next week.
Since then, my arrhythmias have all but disappeared. As long as I get enough sleep, and reduce stress as much as possible, I'm fine. I'm cycling more then I ever have before, fitter than ever before and generally feel much better. Worth looking at underlying causes and knowing that there are lots of options and it's about finding the right one that works for you

So I had WPW (I’m not clear on the different causes and types). The ablation stopped the “extremely high heart rate for extended periods” which was the main concern.

My understanding (as a teenager) was that the main risk with the heart sitting at >250bpm for hours on end was a clot. But even that was more a later in life concern.

I still get some uneven rhythms at times - beat, beat, semi pause, beat kind of thing. I was told that this is due to the fairly unsophisticated method used to remove the pathway, whereas today it’s much cleaner and tidier.

Good info, thank you

AFLETES

Amazing.

Sleep apnea

This, combined with this

sustained ectopics

= fuck you when it comes to sleeping.

Waking up because you're choking, and then lying awake because you fell like you're falling off a cliff every 30 seconds.

I’d heard of the link between AF and sleep apnoea but the cardiologist in my case dismissed it as linked (seems a hell of a coincidence though!). The CPAP machine has made a difference to my snoring if nothing else. Fortunately I got it two days before going on a bike packing trip with two friends; much hilarity ensued.

One thing that does get my goat is that with each consultation I’m asked height, weight, have I ever smoked, what medication I’m on (including how many milligrams) etc - surely the record keeping is better than that? Or are they trying to catch me out on how much booze I say I drink?

So I'm a little earlier in the process.

Over the past 4-5 years I have had occasional episodes where, during or immediately after bouts of interval training, my HR spikes to 220-250 and stays there for a few minutes before returning to normal (screenshots of two examples attached). I guess I've had maybe 4 or 5 confirmed incidents (where I've both noiced the sensations and also caught it on an HRM) plus a handful of other suspected episodes. Shortly before COVID, I went to the GP about it, and while they seemed pretty unconcerned they sent me for an ECG and echocardiogram - I never heard back from them and what with COVID emerging I just assumed that no news was good news.

I think my previous episode was in 2021, but then a couple of weeks ago it happened again, but this time, rather than experiencing an elevated HR for ~3minutes, it was going for nearer 20. This prompted me to go back to the GP who said that the reason I never heard back about the previous tests was that the results appear to have been lost. He suspects that the cause is "exercise induced SVT" (supraventricular tachycardia). Again, he wasn't overly concerned - he said that he'd be concerned if I was experiencing several episodes per week, not approximately one per year, but he did say that if it ever stays high for 20minutes again, or if I get a shorter episode accompanied by any of the following symptoms: chest pain, shortness of breath, dizziness then it was ambulance time.

I'm now waiting on a new bout of tests, but the GP felt that these would inevitably fail to provide a diagnosis since my episodes seem to be triggered by high intensity efforts. Even a stress ECG in a lab was unlikely to uncover anything since I only get episodes in about 1% of interval workouts. So he recomended getting a portable ECG to see if I could capture an episode.

Does anyone have any experience with these? He recoomended Kardiomobile, but I see that a growing number of watches (Apple Watch, Garmin Fenix 7 pro etc) also have this functionality, as well as ecg heart rate straps.

2 Attachments

Yep I've got the AliveKor KardiaMobile gizmo and it's useful for a diagnosis and pdf of the 1 minute / 5 minute trace. Super useful for your doc/cardiologist to review. Cheaper than the watches, I suspect better too.

Hi - I’m not sure what “capturing an episode” is going to tell you, beyond what you already know?

Id push for a cardiac consultant (or go private) to discuss risks of intervention vs leaving as is.

As above ^^^ 30 years ago I was told there was little actual risk if you were young and healthy, but more of a risk of clots as you got older. Be interesting to hear if that view has changed!

The logic (as described to me by the doc) is that currently the doctor only has the information to guess at a diagnosis and the episodes are so rare and intermittent that any regular tests, and even any stress tests, are unlikely to yield the evidence needed to reach a clear diagnosis. The risks are apparently low, but there is sufficient evidence that something is wrong to try and reach a more certain diagnosis... apparently capturing an episode using a home ECG would help.

I'm 39 - I don't know where that puts me on the young /old spectrum as far as heart helth is concened... if the rest of my body is to believed then I'm probably somewhere near a cliff edge.

Makes sense. I had read your previous post as there being a reasonably clear diagnosis.

So, the cardio version that I mentioned in the first post happened on Tuesday. I was apprehensive - although it’s only for a short period, maybe 20 minutes, I hadn’t had a general anaesthetic for the best part of 40 years.

Staff were great, explaining things very clearly, checking in etc - I took some light pleasure in answering the anaesthetists “so, are you able to get round the shops?” by saying that I’m cycling regularly (albeit more conservatively than in the past” and playing singles county tennis (last match went north of two hours, very humid, so much that I had to change shorts; I was running on fumes at the end but so was the other chap; 10 minutes later and it was into a doubles). I appreciate that this was/is an unsubtle (not very) humblebrag but , then again, I was the youngest patient on the ward by 20 years.

I was told that they’d shock me up to 5 times but as it was I only needed 1 (I’m not sure that this particularly means anything but I’ve decided on no evidence that it’s a positive).

So, how do I feel as a result? Honestly, no difference (I was proper weary on Tuesday and Wednesday but that was the anaesthetic). I know it’s not clinical but I have been using the Apple Watch ECG function and it’s suggesting “sinus rhythm, no signs of AF “ (previously it was “signs of AF”) so that seems promising.

My exercise confidence has taken a knock though so it’s been slow and flat this weekend (this may also be due to a school friend dying on Wednesday, barely two months after his brother, from the year above, also died. No suggestion that health related but has given me pause). I’m sure exercise confidence will return, slow, steady, consistent.

Apologies for length and over sharing.

To update on the above, I had an MRI scan in December - this took an hour and had the clinician tapping me firmly on the leg and telling me “you need to relax” (which, amazingly, did not relax me). Outcome can be summarised as “patient did not relax so no reliable readings”. Hmm.

I also had an angiogram which was reassuring, the cardiologist said “no blockages, just what I was hoping to see”.

I also had a series of cardiac nurse led appointments focusing on diet and exercise; reassuringly I was on the right track for both so no significant adjustments to be made. One thing that was a concern was being asked to list all my medication including dosage (there were 7 different ones). I did ask whether that was a record that was already held and was told “the systems don’t link up but it’s your responsibility to manage your medication and know what it’s for”. This worried me - I like to think I’m reasonably on it but thought it was a bit much to expect me to know the purpose of each medication (I later checked this out with a junior doctor friend who said “that’s not right, you can’t expect patients to know exactly why they are prescribed what”) although I do know which the blood thinner is as that’s important for dentist, possible accident or, as I discovered, when a nurse takes a blood sample and refers to “ooh, this is very juicy” as my life drips from my finger tips 😀).

Fast forward, another ECG and a follow up with the cardiologist. It was the same one who did the angiogram and he was really positive saying that heart function was now “borderline normal” from “severely impaired”. Medication has obviously done it’s job (as well as exercise and diet), indeed I was able to discontinue one.

Tl;Dr There is light at the end of (my) tunnel and cycling/exercise definitely has a part to play

After my several svt’s of 175 plus i have settled on 1 adizem 120 mg a day and only 1 coffee a day but i need to be up two hours before i sip on one . Going from 4 or 5 to one was quite easy and i have nit had a episode since june . 11.5 stone ride every day to work dont drink smoke eat healthy . Dropping the coffee i think has been the greatest benefit as it was the only thing i could change . Unless i took up burgers and meat.