Discussion: Atrial fibrillation/flutter

I've recently developed an irregular heartbeat that has been diagnosed as atrial flutter (http://en.wikipedia.org/wiki/Atrial_flutter). In searching the web for information I came across an article from 1998 in the British Medical Journal about atrial fibrillation/flutter in top-ranked middle-aged orienteers like me(http://bmj.bmjjournals.com/cgi/reprint/316/7147/17... ). This study of 300 orienteers showed that about 5% of us get this heart problem. The good news is that it can be controlled and competition can continue.
I think all aging competitive orienteers should be aware of this so they know it when it shows up. I for one have never heard of it.
I would like to hear from any other orienteers who have lone (no other symptoms) atrial fibrillation/flutter.

Interesting. I hadn't seen the article before - good to know about.

Of course I've heard lots about atrial flutter and fibrillation, but not directly applied to orienteers.

However, not that you mention it, I have heard tell of a few younger (i.e. Elite - age 20's and 30's) orienteers who had symptoms suggestive of cardiac dysrhythmia. Mainly palpitations and actual heart rates above 200-240 while doing hard races and hard interval sessions. I don't believe they were ever diagnosed with atrial flutter (the palpitations were mainly transient as I understand and probably had resolved by the time they reached an EKG machine - if they ever had one done). However, based on this study of older orienteers, you might wonder.....

And it's nice to know that the orienteers had lower mortality (probably statistically significant) - that's one of the the "bottom line" numbers that I always like to look at in any study!

Three people I know of who have had atrial fibrillation (though well past middle age, and not all orienteers):
George H. W. Bush (the elder)
Jim Plant
My mother

Jim controlled his with medication, I believe. My mother had some kind of procedure (ablation?) to stop it, and now has a pacemaker.

I'm pretty sure I have that flutter. I talked to my GP about it, but she did an EKG for a minute and of course didn't see it. It was getting kind of worrisome last year. In February I started training (long slow hikes), cut down on caffeine, lost 10 pounds, and the flutter diminished and just about disappeared. I've been "bad" lately though and it's making a resurgence.

I'd love to hear about how one "controls" this.

Mac Macdonald had atrial fibrillation, severe enough that he could not exercise or compete. After trying several medications, he decided to have an ablation procedure (a cardiac catherization where they try to identify the locus of the electrical impulses causing the premature beats and zap it with a laser to ablate or eliminate it). Unfortunately, he had the rare complication of burning a hole through his heart into his esophagus, and developed uncrecognized septicemia about 2 weeks after the procedure and died.

Rich Parker also recently had atrial flutter, but had a successful ablation, and no longer has the problem.

For most people, atrial flutter, where the atrium beats two to three times more rapidly than normal but in a regular fashion, and atrial fibrillation, where the atrium has occassional premature irregular beats, are fairly common. Sedentary people may not even know they have it, or may just feel the "skipped" beat. However, if more severe, during exercise, the heart cannot increase its rate normally and increase the cardiac output, and patients may be limited in their ability to exercise or run and therefore cannot compete as they normally do. Since competing and exercising was important to both Mac and Rich, both decided to have an invasive procedure to try to cure the problem. It is not always successful however. Medications can also control the problem, but they too are not always successful, and the ones that have a higher frequency of success unfortunately also have a higher incidence of toxicity.

I've had occasional episodes of sudden, high, possibly irregular heart rate during exercise, and so have both of my teammates for an upcoming adventure race. I've often wondered if it had something to do with all of us being endurance athletes, so it's interesting to see this article.

My first few episodes happened over a period of several years, and lasted up to 1 hour. All occurred after about 2 hours of exercise in cold weather, either at altitude or in high wind (i.e. lower air pressure). I was sent for a full set of heart tests, and there wasn't anything obvious wrong. The cardiologist couldn't make a definite diagnosis beyond atrial tachycardia, since I never get the arrhythmia at a time when they could hook me up to a machine. She said she couldn't guarantee that continued endurance exercise was safe for me, but statistically, I would have a higher health risk if I gave it up. So I took away the answer I wanted to hear. :-)

Since then, I've greatly increased my volume of endurance training. The incidents remain rare, and usually last under 5 minutes now. Sometimes I get premature ventricular beats as a "warning", and it feels like I'm able to prevent an arrhythmia episode if I slow down for a minute or two. I've often speculated that these palpitations are brought on by a combination of caffeine and race-induced adrenaline.

Something to ask your doc: The cardiologist suggested that I try the Valsalva maneuver if it occurred again, since this can stop some types of arrhythmias. I tried it, and it worked immediately. I captured that incident on a heart rate monitor file, and my HR immediately dropped by exactly one third. You should talk to your own doctor though, as I understand that Valsalva carries some risk and isn't helpful for all arrhthmias. (Wil...?)

I had something called paroxysmal supraventricular tachycardia - it sounds similar to what you guys are talking about. In the ER at MAC they clocked my heart at about 210 while I was sitting in a chair. I managed it with lifestyle changes mostly - less caffeine and alcohol, stress management and increased fitness. Occasionally when I exercise, esp. intervals, I feel like I'm losing control of my heart rate and breathing. In that case I slow down and once I have recovered a bit I can keep right on going - it's scary though and has caused me to back off during training many times. I was also holter monitored for 48 hours and learned only that my resting heart rate was in the 40's. I too was taught the valsalva but wasn't told that there was ever a potential danger with it.

Because the Valsalva maneuver worked for me, the options are narrowed down, and paroxysmal supraventricular tachycardia is one of the stronger possibilities. The Valsalva is widely recommended and fairly safe, but I think there can be concerns for some people because of its temporary effect on blood pressure. As I understand it, it's the same thing docs get concerned about when people hold their breath while lifting weights. Anyway, I didn't want to recommend it to anyone without them checking with their doctor first!

I agree with Superwes that it can be scary. One of the symptoms listed for PSVT is "Anxiety - feeling of doom", and they are not kidding.

I've had about 6-8 episodes of Atrial flutter during running over a period of the last 20 years, beginning around 1986 when I was 32. A couple of other times, I've felt like it was coming on, so I slowed down, and it never came. It's scary when it happens, no doubt about it. But in those 20 years, I've competed in over a thousand running or orienteering races, including more than 25 marathons, so it definitely needn't end one's competitive career. Usually, it would happen during a medium or long run; I'd get a sudden sense of my heart beating faster or harder or just different, and then within a few seconds I'd suddenly feel very weak. Generally, I would walk a bit, it would go away within a minute, and then I would continue running. It's also happened during an intense workout at the track. And once, but only once, it happened during a race: a 5k in Northampton two years ago on a very hot and humid day, with about a half mile to go. And stupidly, in spite of the extreme weakness, I kept running best I could to the finish. This time, and only this time, it didn't go away for about 10-15 minutes. I remember well the odd sensation, long after I had stopped running, of my heart beating at around 180 beats per minute (well over my current max of about 165), but checking my pulse and discovering it was beating exactly half as fast, at 90. That scared me enough to do the doctor thing; but the tests never gave a conclusive diagnosis. It's too rare an occurrence (in my case) to expect it to show up when being monitored. I've had no episode since then, for the last two years. Best I understand, it's related to an electrical malfunction, but not any sort of cardiovascular disease, and not associated with any risk of sudden death. At least I hope not!

Hmmm, I'll have to do a little more reading about this. Wearing a HRM I occassionally get brief intervals where my pulse rate spikes up to around 220 or so when running really hard - finish chute sprint etc.. It usually only lasts about a half minute or so then drops back down to where I expect it to be. I have been assuming its just a glitch in the HRM, but perhaps its something else. I've never felt anything abnormal in the chest though, but in all cases my expected pulse was near max anyway and breathing really hard.

Thanks for all the comments (and more to come?). Last weekend at UNO Camping Weekend I talked to several people who reported intermittent attacks of atrial fibrillation causing rapid heartbeat lasting from a few minutes to an hour or more. From that and the comments above this seems to be the most common form. People are controlling it by slowing down (if it occurs when running), relaxation practices, and medication if necessary.

My case is different as my flutter causing irregular pulse has been going on for three weeks now. It looks like some kind of drug or electrical resetting will be necessary, so Evan's comments are most interesting and scary. I used to compete against Mac and did not know he had died. His cause of death is much too close to my potential cure. I would like to communicate directly with Rich Parker; can anyone send his email or phone?

At the moment I am on Coumadin to prevent the nasty side effect of possible stroke (not a problem if the arrythmia is < 48 hours) and so need to stay out of the woods to avoid causing bleeding and keep my heartrate down to avoid disturbing any clots.

The last e-mail address I have of Rich Parker is rich.parker at worldnet.att.net.

Flutter is different from fibrillation in that the atrial rate is very fast but regular but there usually is a 2:1 or 3:1 block in the ventricular rate, which therefore may be in the normal range.

Atrial fibrillation is an irregularly irregular rate with premature atrial beats and then a refractory period so it feels like a skipped beat. Because of the irregular nature of the beat, the worry is that a clot could form in the left atrium and be discharged into the blood stream and cause a stroke or damage to some other peripheral organ. That is the rationale for anticoagulants.

About 3 years ago I had a an abnormal EKG and that led to a full set of heart tests. When they asked about rapid heartbeats I didn't have any to report. No underlying adverse condition was identified.

I haven't used the HRM much since that period of time, but do recall it spiking a couple of times. Unlike Phil I didn't feel anything definite and upon checking my pulse concluded that the HRM was just acting up. if it happens in the future I'll know what to look for.

After Vioxx was pulled from the market on account of sometimes causing cardiac problems, I just about stopped taking any kind of pills for my aching joints. No way to know whether that has helped.

I have no questions or answers, but a current situation to share.

A day or so after the Sprint Series Finals I suddenly noticed "skipped beats" while taking my resting pulse. This was strange since my fitness level was the best it had been in several years. I had noticed a very rare occurrence of "skipped beats" in the past, but now it was pretty frequent (several times within a minute) and continued a few days (and is ongoing), so I went to see my doctor and was told to do a 24-hour holter monitor. This morning I was back for a follow-up, and it appears that both Premature Atrial Contractions (as expected) and Supraventricular Tachycardia were noted. I have no other symptoms, so the doctor recommends no medication. He also said that the speed of my running should not be affected by these heart irregularities, as there aren't any inefficiencies involved.

My running (speed) workouts have been a little slower since this started, but it appears to be mental, as I get anxious when the heart acts up during the workout, and that seems to cause me to slow. My orienteering performance seems to be about as expected (i.e. not any slower than usual), and I think that is due to the concentration not leaving any time to think about my heart.

I'm running my usual (20+ years in a row) 5-mile race on Thanksgiving Day, so I'll use that to judge my fitness level / ability to remain mentally strong.

i am a former world class age group triathlete, cyclist, runner and open ocean swimmer who has been fit for the past 50 years. last december, i suddenly couldn't jog 2 miles without having to stop and could no longer maintain any kind of speed on my bike.

it took a while, but in april i was diagnosed with AF. in May they used shcok paddles to re-set my heart rate. it didn't work. in July i had an abalation. 3 weeks later after a bike ride i admitted myself to the ER where i had V-tach, which is life-threatening. i was admitted to the hospital where they implanted a pacemaker and defibrillator.

about 4 weeks later, while on my bike, i went in to Vtach again and the defib kicked off. (not a pleasant experience!) back to the ER (it's not good when they issue a Frequent Visitor card at your local ER and the Docs start knowing you by name!)

now i'm taking meds to regulate the heart rate. can't walk up even small hills or go 15 minutes without being out of breath. never feel like my heart is pumping enough blood/oxygen. i've been cleared to workout again, but-----

at this point i doubt i'll ever be able to develop my aerobic fitness. time will tell i guess.

anyway --- a word of caution: if you have an irregular HR pay attention. this can cause SCA - sudden cardiac arrest and death. it is not something to take lightly or casually.

Don, sorry to learn of your problems. But thanks for reviving this important 2-year old thread...I missed it when it was created in 2006.

Can you give us a few more details? Your A/P profile doesn't indicate your age...how old are you? Can you expand on the events leading up to last December's difficulties? To what extent do you follow a "heart healthy" diet, rich in vegetables and fruits, but low in meats, fats, dairy?

I'm also a triathlete and orienteer. I've always thought that our active lifestyle, coupled with sensible eating, would ensure a long and healthy life. Now, after reading these stories and links, I'm not so sure.

This study of 300 orienteers showed that about 5% of us get this heart problem.

This may be due to comparably lower conditioning than cross-country skiers, over 12.8% of a sample of whom develop AF. Fortunately in a subset of the same sample, "[l]ong-term aerobic exercise appears to be associated with reduced all-cause mortality" (31% vs. 40%, P=0.04).

I wrote a long reply, but then noticed the date of the original post, so not sure if anyone still cares...

...but....

I get AF on a weekly basis, and palpitations on a daily basis. It is not, in anyway, induced by exercises for me. Caffeine and, even more so, alcohol have some inducing effect.

AF has only occurred once during exercise. I sat down and it happened to reset itself after about 30s, so I carried on. Only on a few occasions has the AF episode lasted more than a minute. On those occasions I've got to hospital to get it reset there, by some drug via IV drip.