Hi All, first time poster. Hopefully I’ve picked the best category.
I’m a 56yo road and gravel cyclist in Melbourne. Riding 150-200km a week. I’ve just started experiencing AF episodes, one of which contributed to a crash a couple of months back.
Do any you have a recommendation for a heart specialist here in Melbourne who can help me navigate changes to my cycling and training goals while keeping my heart safe?
If any other members are riding with AF (I’m learning it’s quite common) I’d also love to hear about the online resources you’re using to learn more about it.
AF can often be treated with medications rather than ablation, which is more invasive. Your first step should be to wear a Holter for a week which will hopefully give you a range of ECG’s for a cardiologist to work from. If you have heard historical stories about Holters, they used to be very bulky and obnoxious. Today they are a small sensor the size of a heart rate monitor (just not on a strap) that connects via Bluetooth to a converted cell phone that you just carry in your pocket. You can get single and three lead versions, but for AF you typically only need the single. Also get a stress test and be sure it’s testing you up to your VO2Max – many testing labs only take you up to a light level and consider it done. Keep a detailed log of all symptoms (dizziness, tiredness, pains, AF symptoms, etc.) along with all training, racing, and workouts of any kind. Your cardiology diagnosis is only as good as the data you can give him/her. I’m not from Australia so I can’t refer you to a particular cardiologist, but they tend to be booked out a ways and you can get the Holter prescription from your general physician. Once you have more detail while waiting for a cardiology appointment to come up, you have more of a basis for trying to accelerate an appointment as an emergency issue or for focusing more on cardiologist, cardiac surgeon, etc.
I’ve had a 24 hour halter, and have the results from that. There is a bulk-billed cardiologist there who I will start with in terms of identifying next steps.
I am also keen to do that stress test to help safely establish my max heart rate, as I’m a bit concerned this may have changed now, and thus my HR zones. I probably need to discuss with the cardiologist to ensure that’s safe though.
Definitely start with the cardiologist. How things proceed from there really depends on the cardiologist and your medical history. Sure, they’ll be a baseline EKG done and the likely a Holter monitor for 1-2 weeks. A stress test won’t necessarily be done, and I wouldn’t have one done unless the heart doc wants one. Whether such a test is done depends again on your medical history, signs, and symptoms. I definitely would get clearance from the heart doc before getting any stress test done.
There are a range of meds that can be used to treat A-fib with some having more side effects than others. What a doc prescribes, again, depends. Cardiac ablation might be an option. If you choose that route, then you’ll see a cardiac electrophysiologist. It’s worth noting that cardiac ablation is surgery. You’ll most likely be under general anesthesia and could be out for a few hours depending on your case of A-fib.
Definitely take notes about symptoms, what you’re doing when symptoms come on, how long they last, etc. You can also read up on the kinds of things that can contribute to or trigger A-fib and address those things while waiting to see the doc. Some of those contributing factors are quite surprising.
Hi Mike - hope all works out well. I would very strongly (as a specialist physician myself) recommend Professor Andre Le Gerche at St Vincent’s Hospital Melbourne. His brief Bio:
Head of the Heart, Exercise and Research Trials (HEART) Lab, St Vincent’s Institute and Victor Chang Cardiovascular Research Institute - Cardiologist and Head of Cardiovascular Research, St Vincent’s Hospital Melbourne André completed a PhD at St Vincent’s / University of Melbourne and 4 years of post-doctoral research at the University Hospital of Leuven, Belgium. His research and clinical work focuses on the effect of exercise on the human heart. He studies the range of health from severe heart and lung disease to elite athletic performance. André heads the National Centre for Sports Cardiology that comprises a young team of multi-disciplinary researchers based at the HEART Lab, supported by St Vincent’s Institute and the Victor Chang Cardiovascular Research Institute. He has pioneered novel imaging techniques including exercise cardiac magnetic resonance imaging and contrast echocardiography.
You beat me to it John. Andre is fantastic (I’ve participated in his research studies) and many of my friends (too many) have seen him. He’s a fantastic guy and by all accounts is a world class cardiologist.
Really great to hear, John. I was hoping to find a specialist passionate about cycling and thus (hopefully) more aligned with a care approach which still involves lots of cycling and fitness/strength growth rather than just existing with/tolerating the AF.
Mike, sorry to hear. You’re definitely not alone, and I’m younger than you. I can’t help with cardiologists or EPs in Melbourne, but can provide some words of advice from someone with AF. I was diagnosed at urgent care with an EKG, so there was never a question about the correct DX. I ended up using a Zio patch instead of a Holter on two occasions to get a sense on frequency. I found the Zio patch easy to wear for 10 days and had many long rides with it. Keeping it on is a trick, as is itching.
When I was diagnosed, the doctor said I should give up caffeine, alcohol and exercise. I joked with him, what else is left? That turns out to be questionable advice. For some people, caffeine may in fact be rhythm promoting. And while stopping exercise may reduce AFIB events, I suspect it will cause other problems.
As others have noted, you’ve got a couple main treatment options. One is medications, like beta blockers or flecainide, and the other is ablation. I tried beta blockers, and didn’t care for that. There is also some research to suggest that early rhythm control is good.
I ended up choosing an ablation… and then a second a year later. Neither were easy decisions. I’ve also cut my weekly mileage a bit and really cut back my intensity. Last year I rode over 11000k and I’m feeling good, knock on wood. So there is a future living and biking with this.
Some great advice from those who have already responded. If you’re after another option, I’ve had 2 ablations done by Dr Paul Spark (no joke, that’s really his name) out of the Epworth. First under GA which didn’t work as my heart behaved too much and they couldn’t pinpoint the spot and second fully awake which was an interesting experience! I’ve had zero symptoms since the second ablation and couldn’t recommend him highly enough.
Tried beta blockers first and really disliked the feeling of them particularly when on the bike, they really made me feel slow and powerless.
Welcome to the forums from another first time poster.
Thanks for your thoughtful reply, and especially the useful links. It’s helping with my early learning about AF, and possible treatment options. I’d already made the big step to give up the alcohol, but boy oh boy I hope I don’t have to give up caffeine as well!
Great to hear that your treatment is progressing well, and especially that you’ve been able to adjust your goals and still achieve 11,000km in a year - that’s amazing.
Thanks Steve, all recommendations welcome at this stage so I appreciate it.
Like you and Todd, I can’t imagine that beta blockers will be an appropriate option for me either. It’s really helpful to get these points of view coming through.
One could easily go crazy trying to predict what causes AF events. I had no luck predicting any of it. I happen to know a few cardiologists and one EP, and they all admitted there was very little data linking moderate consumption of alcohol and caffeine, with the exception of the DECAF trial, with AF. If you haven’t been tested for sleep apnea, they will probably recommend that given the correlation between the two. All the best.
Yeah, the data isn’t conclusive yet on whether caffein can trigger an A-fib episode. Still, caffeine is a possible factor that is easily eliminated.
Factors that can definitely trigger an episode are poor sleep and dehydration, things that might be particularly relevant to us cyclists.
I had ablation done under general anesthesia 18 months ago. I’ve not had any A-fib episodes since. I do take a beta blocker, but it’s an extended release tablet. I don’t really notice any negative feeling with it. Of course it keeps my HR lower, but I found that adapting my riding style to a lower HR wasn’t too bad.
As a committed coffee drinker as well as cyclist I was delighted to hear about the DECAF trial on the ABC’s Health Report a couple of months ago. Probably would not take this as license to go crazy with caffeine but one or two cups of coffee a day are likely to be helpful if anything!
Came here to recommend Andre. he is both extremely knowledgeable and sensitive and realistic about the specifics of athlete’s. have been seeing him for a few years after getting a Wenckebach and getting absolutely nothing other than health anxiety from GP’s and normal cardiologists
I 2nd… 14th? Andre Le Gerche. I saw them for tachycardia, the fact they’re an athlete and can and will talk through that frame/lens was super helpful and reassuring to me.
I had the same , age 73 and was on blood thinners and heartrate meds.
The beginning of the next year I had an ablation procedure and that took care of the AF.
I’ve been riding for 2 seasons and not experienced the AF again , however my max heartrate went from 175 to 155 afterwards. I am in the US , so no help for doctors , but I thought you might want to know someone else’s history. The ablation was worth it to me. I got off the meds and so far AF free.