Afib

Edit: When I first wrote this, I was really down, so it sounds like it; full of anxiety and doubt and frustration. But I'm basically happy, healthy, lucky. I can sometimes make a bike go fast, and I will again. I have always had fun riding a bike, and I will continue to have fun, riding a bike, and off it. I'm gonna die someday. We all are. OK, so there's the preamble.

I have had paroxysmal atrial fibrillation for the last five or so years, and it was getting more frequent. It's no fun, makes my heart beat crazy, and it's like kryptonite; I have no strength when it's happening, can barely finish the ride if it comes on. It makes me feel awful too, nervous and irritable. It is pretty common among middle-aged endurance athletes, especially cyclists. It turns out a lot of people I know have had it, and treated it with the ablation treatment. Most people who get chronic atrial fibrillation are older, sedentary and unhealthy. The risk of chronic atrial fibrillation is stroke, because the blood doesn't flow through the heart; it sort of pools and swirls around in the atrium, and can clot and cause strokes. The common remedy is drugs that regulate the heart beat, and that slow it down. These drugs are no good for cyclists, they basically slow the heart down and limit its performance. Doctors wanted to treat me with those drugs, but I didn't want that, so I didn't take them. Many athletes with paroxysmal atrial fibrillation are not at risk of stroke. It only comes on with hard riding, and it can be avoided, and it goes away on its own. That's why it's "paroxysmal". It won't kill you - unlike the chronic kind, it's not a stroke risk. But it does have the risk of becoming chronic. Paroxysmal afib is easier to treat before it becomes chronic. Most endurance athletes with paroxysmal afib try the drugs first, then go for the ablation. There are two kinds of ablation, cold and hot. Many electrophysiologists go for the cold kind first, nowadays, using a balloon full of liquid nitrogen to ablate - or burn - the tissue around the entry points for the pulmonary veins in the atrium of the heart. These pulmonary veins are where the 'bad' electrical signal travels across to the heart, messing up the 'good' electrical signal. Once the heart's electrical signals get messed up, it's like a wild fire that spreads, with crazy electrical signals causing crazy heart beats. Sometimes it lasts for a day or two, and it makes me feel like crap, and if not treated gets a little more chronic as time goes by. My heart beat gets lumpy, and when it does beat it bangs hard, and I feel weak. If I try to ride when it's happening I get tachycardia. My normal HR limit is 171. In tachycardia I've seen 250bpm, and at 250bpm I feel like I am going to die, and I can barely keep the bike upright. Not good. It's made me stop riding hard, and even gets in the way on things like the DxLx (a big, all-day ride that happens every summer), where it came on after the first third, and the Axxxx Fxxxx Rxxx (a big, all-day bike ride that happens every April), where it came on after the first chapter. I missed the Boggs 8hr, because it came on the day before the race. I hate it.

Monday I had a cryo-balloon ablation treatment. They cut holes in my crotch, threaded catheters up in me to my heart, poked a hole through one atrium into the other and then, carefully monitoring stuff, burned the areas near the pulmonary veins with cold energy. The procedure itself messed up my heart temporarily, and I've had afib off and on since the procedure, and I feel like crap. Have to be careful of not opening the cuts in my crotch, because they go to the biggest veins in my body, and I'm on blood thinners so... that would be bad. Bummer is; 

1. I can't ride for two weeks
2. I have to take drugs that slow and limit my heart rate for three months
3. I have to take blood thinners (anti-coagulants) for six months - which means I can't fall or bang my head or else I could die
4. We won't know for three months if this procedure was effective. In the case that it doesn't fix the afib, I may have to do a second one, this time 'hot', i.e. using a radio frequency tip on a catheter to burn little lines of dots with heat energy, and then go through another 3-6 months of drug treatment.

But the good news is that, if all goes well, I should be "cured" of atrial fibrillation. I'll know in October.

My son tore a tendon in his shoulder, when he dislocated it riding too fast plus some bad luck on his first pre-ride of the Sea Otter DH course, this April. Tuesday 7/2 he had scheduled shoulder surgery to fix it. He should be as good as before the crash, but he'll have to wait four months to ride a bike to be better. Bummer summer! I was on the waiting list for the heart procedure, and in the strangest coincidence a spot opened up 7/1, and I took it. So both of us are at home now, recovering from surgeries. Kid seems in worse shape than me right now.

Some interesting links:

http://www.stopafib.org/
http://www.drjohnm.org/
http://www.everydayhealth.com/heart-health/3d-heart-images-of-afib-drive-better-health-outcomes-3951.aspxhttp://www.drjohnm.org/2010/01/cyclist-at-atrial-fibrillation/
http://www.drjohnm.org/2011/04/cw-treating-atrial-fibrillation-in-athletes-tough-choices/
http://buzzmachine.com/2006/02/10/dr-blog/