A-Fib and the Master Endurance Athlete

In the last week I’ve been asked several times to comment about a recent article in VeloNews magazine regarding the connection between a heart condition known as atrial fibrillation and master/senior endurance athletes who have been training for years. This is considerably outside of my area of expertise (whatever that may be). So instead I’ve done some searching to find more comments by Dr. John Mandrola who is quoted in the VeloNews piece. Besides being a cardiac electrophysiologist he is also a masters category bike racer from Louisville, KY. That’s a good combination for seeking understanding of this topic. If you’re over 50 and been training and racing for years I’m sure you will have some concerns after reading the article above. You can find a more in-depth discussion of this general topic on Dr. Mandrola’s blog here. I’d also suggest that you read the comments  below his blog post along with his answers for a bit more depth of understanding. To follow up it’s best to address your questions to him in the comments section of his blog.

Comments

[Nfkb]

Hello,

Dr Creswell blog is also a good blog to follow about heart conditions and endurance sport practice. http://www.athletesheart.org/

For french readers I've also wrote some blog posts about this there : http://www.nfkb0.com/medecine-et-sport/

Thank you

[Chuck G]

Disturbing article no doubt, but what is most disturbing is that it only presents one side of the issue. No mention was made of the lives of those who have had successful cardiac ablation. As someone who had a successful procedure on the 3rd attempt, I can say that I'm glad that I did my homework and "interviewed" 3 cardiac electro physiologists before settling in to the one that I totally trusted with pushing electrodes into my heart. He was up front about the possibility that more than one procedure may be necessary, and that taking drugs for the rest of my life might be an option (not one that I envisioned). Everyone is unique and has to deal with their specific set of factors, but I can say that it's not all gloom and doom. Perhaps I was one of the very lucky ones, but my ticker has been working flawlessly for the past 8 years (since my last procedure) and I am at this writing about to turn 65, still pushing as hard as I ever did.

[Kevin S.]

Intermittent A-fib plagued me for years prior to being diagnosed and treated by ablation four years ago. I had initially assumed that after a number of years away from endurance sports that I had just "let myself go" and the strange racing heartbeat and/or breathlessness at minimal effort was payback for years of reduced activity while raising kids. This was in my mid-late forties.
Once the irregular pattern was recorded, the first course of action was to try drugs to control it, (ablation was offered but sounded scary as hell) resulting in lack of energy, inability to raise heart rate (chemically controlled) and a generally poor quality of life. A different drug worked for a while, but eventually it started losing its effectiveness and I opted for an ablation. It took two tries, (not uncommon) to correct what was essentially a "timing issue" with my heart and there has been no looking back.
Now at 52, I have XC skied 1000 and 1400kms in the last two seasons, ride 3-4 times a week, race in the local MTB club series with my son, lost 30lbs, and am having a blast.
I can't say how long this will last, but my experience has been very positive with an ablation.

I have other friends who have V-fib (ventricular- the "big" heart chamber) and that has been a death knell to their endurance activities. When the big chamber goes into spasm, the heart essentially stops circulating blood and death can occur in a short time w/o intervention.

Corny as it sounds, every day really is a gift. Go Ride!

[Gary]

I kind of stumbled on your blog since I've been having recovery issues do to my over indulgence in training/working out. I'm 62 and have been an endurance training athlete from the age of 28 through the age of 46, running and then cycling. From 46 on I consider myself more in exercise mode without the competition but still end up from time to time in training mode putting in upwards to 9, 10, and 11 hours of cycling and other exercises a week. After multiple weeks of this I find I've put myself through the paces to a point of exhaustion and experience the AF until I rest and recharge. My challenge has been to find a rate and frequency of exercise and recovery time to keep me healthy without bringing me to the point of exhaustion. Yes, I'm guilty of trying to train like I did when I was competing in my 30's and 40's. Thank you for this article!

[Greg Hinrichsen]

Joe, Thanks for posting the link to this article. It reinforces my opinion that we should take 2 months a year off from serious training, take a rest day every week, have an easy week every month in the training plan, spend most of the year doing easier base work ala maffetone/Mark Allen, and finally take an easy or off year from time to time. I believe a good nap is the best form of immediate recovery from a workout, if you can get away with it! Last year I started doing 2 long bike rides a week 3-4 hours with quality thrown in there too, and my performance in a 56 mile time trial worsened by 6%-not a good year. I am 56. I had a middle distance running track career in my mid twenties. Exercised mostly moderately until age 40 then became more agressive doing a marathon. At the time (40) a doctor said my EKG showed heart damage, but it is my understanding all endurance athletes show this on such tests... Age 48 started doing sprint tris and training 8-12 hours per week. At 50 started winning more races than in all the previous years put together. 2015 I took an easy year, no racing, the last few months just walking 30-60 minutes per day with the odd 1-2 hour ride thrown in there. Heart seems fine with a skipped beat now and then. But the article got me to thinking...we have much to learn about training later in life. I will take rest even more seriously. Thanks again.

[FitnHealthyMD]

Thanks for posting this. As a physician, I treat a lot of people with Afib. Many are not as athletic as the readers here, but many do want to continue their sports/activities, and find the medications that are used to control the heart rate too restricting, as well as the blood thinners that are used. Would love to hear how you folks (the hyperfit!) are managing.

[Joe Friel]

FitnHealthyMD--First of all, this is well outside of my range of expertise. So it's strictly an opinion based on very little research into the topic. And I certainly am not representative of the "serious athlete" market to my knowledge. My opinion is that if I was prescribed meds for a heart condition (or any other medical condition) there had better be great odds that there's a hugely significant benefit or I wouldn't take them. All meds have a side effect, which are sometimes as bad as the reason for the prescription. I'm afraid most people don't look into this and accept meds as being only beneficial. Most of what I read about on this topic implies that the benefits of many heart meds are tiny if at all positive and can perhaps be negative--statins for example.