Last winter I was on a long base training ride, and I felt generally awful. At first, I blamed my much higher-than-normal heart rate on fatigue, or perhaps a dying HRM battery. But after a couple of days off the bike, and more closely monitoring my heart rate in general, I decided something still didn’t seem right.
A visit to my primary care doctor and a quick EKG resulted in a speedy referral to a cardiologist. Long story short, the diagnosis was Persistent Lone (or Idiopathic) Atrial Fibrillation or AFib. “Persistent” meaning my heart was in a state of AFib all the time; “Lone” or “Idiopathic” meaning that (with no commonly recognized risk factors) the cause was unknown.
Atrial fibrillation (AFib) is a heart condition characterized by an irregular and often rapid heart rate. It’s not lethal on its own, but it can increase your risk of stroke, heart failure and other heart-related complications. The American Heart Association estimates that at least 2.7 million Americans are living with the disorder. Traditional risk factors include what most would expect for heart conditions: congenital defects, age, heart disease, excessive stress, and stimulant use. However recent evidence suggests that long-term endurance sports training might also be a significant factor.
I am not a doctor, and my intent is not to contribute to the debate around AFib and endurance athletes. The purpose of this article is instead to raise awareness, and to provide some lessons learned through my firsthand experience with AFib, in hopes of helping athletes better-identify and deal with the issue if it arises.
Know What’s Normal
In my case, the doctors cited my quick identification of a potential problem (and seeking of medical attention) as critical factors in what would ultimately be a successful correction procedure. Like many athletes, I have a good understanding of what I “should“ be seeing with my heart rate relative to power and perceived effort, and was able to quickly identify that something was wrong. For performance, monitoring HR is becoming less prevalent, but there is a lot of value in consistently using it for insights into your overall health. (Here’s how to get started with a Heart Rate Monitor).
Don’t Self-Diagnose (or Attempt to Treat) Potential AFib
If you suspect any potential issues, just go see a doctor. If you are indeed dealing with AFib, Early detection could be critical in determining the effectiveness and complexity of your treatments. Furthermore, this stuff is nuanced, and the symptoms, causes and contributing factors are varied. Subtle differences could change your particular treatment options and likelihood of management.
It’s natural to be curious, and it’s always good to learn a bit more about what you are dealing with online. However I would recommend sticking with the more straightforward explanations and source materials. Fringe pieces can be really counterproductive, and can potentially give false hope, or undue fear. I read an article early on that said “shocking” your system with a surprise burst of cold water in the shower can “reset” your heart. I can report that it entertained my wife, but didn’t cure my AFib.
Trust the Process
Once diagnosed, you’ll have to work to accept the situation, along with the timeline for treatment—which for me was around six weeks. For athletes that can mean a good chunk of a key season, but it’s important to work through it one step at a time to ensure you get the most accurate diagnosis and effective treatment. I can also report that no amount of fighting, flailing or pouting is going to change AFib or make things move any faster.
I was fortunate that my first treatment approach (electro cardioversion) was a success. Basically, I went under general anesthesia while the doctor applied an electric shock to my heart, sort of like rebooting a computer. I have been in normal (sinus) rhythm since, and after a period of caution post-procedure I have pretty much returned to regular training. I even raced a good part of the spring and summer.
Live Your Own Life
There is an ongoing discussion in the endurance sports community over whether prolonged endurance training increases risk of AFib. Some prominent figures are sounding alarm bells, but others insist there is no clear evidence, and too many variables to connect the two.
My doctors acknowledged the debate, but said that from their perspective there wasn’t enough compelling evidence to stop me from training and racing as much as I liked. I have continued to train and race, but I admit there are days when I might not hammer as hard as I once did, just in case. Since the cause of my AFib was unknown there’s always a risk that it will return—but statistically speaking, the longer my heart keeps a normal rhythm, the more likely it is to stay that way.
Ultimately, nobody can tell you the right answers here but you. If you’ve noticed symptoms of AFib or have already been diagnosed, I recommend staying calm, seeing your doctor, informing yourself as best you can. That way, you can choose your own best path accordingly.
Mayo Clinic (2018). Atrial Fibrillation Symptoms and Causes. American Heart Association (2018).
What is Atrial Fibrillation? David McNamara; Mark S. Link, MD, FACC.
Ablation of Atrial Fibrillation in Athletes: PRO, Expert Analysis. American College of Cardiology. Mar 08 2017. Chaitanya Madamanchi, MD; Eugene H. Chung, MD, FACC.
Ablation of Atrial Fibrillation in Athletes: CON, Expert Analysis. American College of Cardiology. Mar 08 2017.