• Bryan

Mixing up the beats.......

Updated: Feb 13

Go ahead and take a second focus on your heart beating, how does it feel, fast, slow, or weird? Now, remember that feeling.

For the last couple of years, on occasion, I’ve had a proverbial “squirrel running around inside my chest.”

That squirrel first took a spin before and while I was warming up for a cyclocross race in Rochester in 2014. My heart rate bumped up to 150 bpm, which is higher than I’d expect for the effort I was doing. On top of that, I felt “off” and attributed it to that fact that it was 90+ degrees, not cyclocross weather and that I might be dehydrated.

At the start line, my heart rate was still about 130 bpm instead of a normal pre-race 70ish. When the whistle blew, I took off as normal and within a half lap, I was over 200 bpm about 20+ beats higher than my normal max heart. Opting to pull the plug I went and sat in the shade. After about 40 minutes, everything was back to normal. I didn’t think much of it and raced the next day without any problems.

Jumping forward to 2 years ago. After spending two days in bed with a bout of the “real flu” not the “man flu.” I decided on the orders of my wife; it was time to head to the Dr office. It was rather interesting when the nurse assistant checked, rechecked, and rechecked my pulse before going to get the Nurse Practitioner who confirmed that my heart rate was 155 bpm. Long and short of that I ended up in the ER and was eventually admitted for four days with a diagnosis of the flu and Paroxysmal Atrial Fibrillation aka Afib.

Being somewhat of an endurance athlete with a low resting pulse rates (high 30’s and low 40) drug therapy was not feasible as it is designed to slow heart rate and control rhythm when you’re normally low resting heart rate wise usually not best to go much lower.

So, my option was to see if it stopped or self-convert on its own or cardioversion. Cardioversion equals pads on the chest to deliver a dose of electrically shock to your heart to disrupt the electrical circuit, so it’ll ideally beat normally after that. Well, it didn't, so I got my first chance at "riding the lightning!"

So, you’re probably thinking, “Oh, tell me more about this, Afib.” Sadly, I think most people who have atrial fibrillation or any heart arrhythmia for any length time must become somewhat of a scholar in heart issues.

From the Center for Disease Control:

Atrial fibrillation, often called AFib or AF, is the most common type of heart arrhythmia. An arrhythmia is when the heart beats too slowly, too fast, or in an irregular way.

When a person has AFib, the normal beating in the upper chambers of the heart (the two atria) is irregular, and blood doesn’t flow as well as it should from the atria to the lower chambers of the heart (the two ventricles).

AFib may occur in brief episodes, or it may be a permanent condition. The Center for Disease Control says this affects 2.7 to 6.1 million people in the United States. Each year, AFib leads to 750,000 hospitalizations, nationwide, and costs the country a whopping $6 billion annually. With the aging of the U.S. population, this number is expected to increase.

Some people who have AFib don’t know they have it and don’t have any symptoms. Others may experience one or more of the following symptoms: Irregular heartbeat, Heart palpitations (rapid, fluttering, or pounding) Lightheadedness Extreme fatigue Shortness of breath Chest pain

Risk factors for AFib include: High blood pressure, Obesity, European ancestry, Diabetes, Heart failure, Ischemic heart disease, Hyperthyroidism, Chronic kidney disease, Enlargement of the chambers on the left side of the heart .

And the biggest risk factor. It’s said a lot that you’re not going to die from Atrial Fibrillation, but the risk factor of STROKE is four to five more likely times compared with stroke risk for people who do not have AFib. Strokes caused by complications from AFib tend to be more severe than strokes with other underlying causes. AFib causes 15%–20% of ischemic strokes, which occur when blood flow to the brain is blocked by a clot or by fatty deposits called plaque in the blood vessel lining.

Treatment for AFib can include: Medications to control the heart’s rhythm and rate. Blood-thinning medication to prevent blood clots from forming and reduce stroke risk, cardioversion, and surgery, aka ablation.

That’s just the down and dirty bits

Whose predisposed to Afib: Those with advanced age, high blood pressure, underlying heart disease, drinking alcohol, family history, sleep apnea, or endurance athletes.

Highlighted above are where I perhaps fall into the mix. On the sleep apnea front for a long time, I pretty much ignored that I would wake myself up gasping for air, night sweats. Perhaps as a point of interest to what I assume most of the readers here maybe be is the endurance athlete part. Generally, studies show that endurance athletes are more and more ending up in Afib.

Atrial Fibrillation is a progressive disease which means that most will end in permeant Afib if not treated as the abnormal electrical impulses that cause the arrhythmia to make their new path outside the heart’s normal electrical nodes and pathways.

Fast forward 1.5 to 2 years. I’ve had probably 20+ incidences of AFIB which come and go lasting anywhere from a couple of minutes to a couple of days. For me, I haven’t had any symptoms beyond that “squirrel in the chest” feeling, anxiety, and with the events that have lasted a longer period, it did leave me tired. I'm fortunate on the stroke risk side that my CHADS2-VASc score was 0 as this kept me from having to use blood thinners to mitigate risk for stroke. (see the BIGGEST RISK FACTOR above)

My cardiologist and electrophysiologist (think of them as the plumber and the electrician) were both on board with doing what activities I could tolerate, and they understood what I do. I've continued to ride, train, and race when I can.. Over the last year, especially last six months, I’ve had to not start a couple races as I jumped into a fast rate Afib/Atrial flutter thing well before getting to the event. Tried to ride it out but with no luck.

To date, I’ve had four cardioversions, which aren’t that bad in my experience. They give you propofol aka “Michael Jackson juice” you go to sleep for about 10 minutes, and then you wake up ideally in a normal rhythm (NSR - normal Sinus Rhythm is the gold standard of life.) In my experience, once you’re back in NSR, it’s like an instant shot of I feel pretty good now.

In my opinion, the most terrible side effects of AFib was anxiety. The anxiety of “when’s the next one coming?” The anxiety of “If I eat this or drink that will it trigger an event.” The anxiety of “If I don’t get enough sleep or if I’m stressed about other events, will it happen.” Anxiety of “will this one be the event that doesn’t convert on its own and last forever.” The anxiety of as much as people around you cares it’s hard for them to grasp the feelings behind the whole mess and of course, the anxiety of having anxiety about it!

Remember, at the begin of this blog when I said take a second and think about your heart beating, how does it feel? Another terrible thing with Afib, in my opinion, is being aware of your heart beating all the time. The, is it normal, not normal, that feeling like a “squirrel running in your chest,” feeling the missed or paused beats, the thumps whatever you want to call it.

About 5 Weeks ago, I had a cardiac ablation. This procedure entails the insertion of a catheter(s) into the femoral arteries in your groin (the radial or carotid arteries can also be used.) by an EP (electrophysiologist.) The catheters are advanced into the right atrium (top chamber of the heart) and then punctured through the atrial septum to the left atrium where the Dr will then map your atrium and pulmonary veins, induce atrial fibrillation and then using Radio Frequency burn a “fence” around the pulmonary veins as this is where Atrial Fib is likely to be starting from. During my procedures which lasted about 7 hours, they also found a spot in my right atrium that was causing Atrial flutter, another form of arrhythmia that originates in the atrium or top chambers of the heart. As of now, I feel great, and I’m optimistic that’ll I’ll stay that way which I haven’t been in a bit

To close out this blog post, I would urge anyone that has or suspects they have sleep apnea get to your Doctor and get a sleep study scheduled ASAP! Beyond Afib, there are a host of other issues that are not breathing while your sleeping can cause, and you should fix that sooner than later.

If you suspect you have Afib or something doesn’t feel right get, it checked don’t be one of those self-deniers. Get to your Doctor. The sooner you’re diagnosed and the sooner you get treatment, the better your long-term success will be.

See you out there int 2019!

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