Top ten answers to recent questions on the athlete with arrhythmia…

Many of my athletic colleagues have shared their arrhythmia stories, both publicly and privately.  The volume of these correspondences have surprised me.  It is clear from reading many of these stories, that a few points of clarification are needed.

I was furhter inspired to write more on the athlete conundrum after reading this Facebook status update… Got 100 miles in today. That makes 26 months in a row where I have completed at least one century ride. 30 months in a row will be my new personal record streak.

–It is difficult to give medical opinion over the internet.  I resist as much as possible.  A visit in an exam room–a doctor-patient relationship–should not be understated.

–I do not know how much exercise predisposes one to arrhythmia.  Likely, this will always be unknowable.  There is much individual variation in our tolerance of chronic wear and tear.

–In some, who knows exactly how many, excessive exercise will not result in anything untoward, like the cigarette smoker who mysteriously lives to ninety.

–In other athletes who develop AF, the amount of exercise is unrelated. Meaning the arrhythmia would have developed even without any degree of excess exercise.

–Catheter ablation of AF in an experienced operator’s hands will always statistically win out over present day medicine.  Yet another study confirms the superiority of ablation for the suppression of AF.  In a summary statement concerning this most recent trial, Dr Fred Morady provides sound advice on the current role of AF ablation:
Despite these flaws, it does seem likely that RFCA is more effective than ADT (meds)  for preventing AF. But this does not necessarily imply that RFCA should be first-line therapy for AF. Even if the efficacy of ADT is only about 30%, why not try ADT first and reserve an invasive procedure for patients who are not satisfied with their response to drug therapy?  

–Recurrence of AF after ablation is common.  Successful electrical isolation of the pulmonary veins is technically achievable in nearly all patients, but the recurrence of conduction through these lines is all too common. Electrophysiologists everywhere struggle with this phenomenon.  Patients considered for ablation in 2010 should know that successful elimination of AF often requires multiple procedures.

–Worrying about developing AF is like worrying about grey hair or wrinkles. Keep riding, or running, or whatever you do.  Not drilling yourself into an inflammatory storm shouldn’t be solely to avoid AF.

–By far, the best arrhythmia treatment advice I can give over the internet is to seek an opinion from an expert in heart rhythm disorders, possibly even multiple opinions.  Most cities have at least one electrophysiologist skilled in all aspects of treating arrhythmia, including ablation.  For example, if your doctor cannot–or does not–ablate AF, he/she is less likely to offer a non-medical option.

–The ideal heart doctor for an athlete would be one who exercises vigorously. An athletic-minded doctor knows our goofiness.  They get it.  I once had a very smart un-athletic colleague tell me, “the guy (patient) just rides bikes.  It’s not like riding bikes is hard.”

–Get another opinion if: your doctor recommends not exercising as a therapy.  (Please note, however, there is a difference between exercise and competitive racing.)

Be a master of the obvious.

JMM