Four years clear

The first part of my hybrid ablation took place on 7th April 2017.  I have been largely free of AF since 11 days after this.  I take a daily 30s reading from the Kardia and have experienced the occasional reading of AF, particularly in times of stress or illness, but this has never been accompanied by symptoms.  I have regular ectopics, but only notice them during testing.  There are more ventricular ectopics than I used to see, but I can’t feel them and the overall burden is gradually reducing so I am not worried by this.

I have had a few life issues recently, my partner came close to death and had to have an emergency hysterectomy; she is now back to normal.  My company was expected to close, but now this is resolved and my job is safe.  Unfortunately, this has not resolved the work-related aspects of stress as we now have to bring the organisation back to profitability while managing the demands of Covid, and there are fewer people working to cover a wider range of tasks.

My HR is pretty much back to normal; the resting HR is about two or three beats above what it was in 2015, but this is likely to be a relative lack of fitness.  My Garmin is calculating a higher level of stress than it was just after Xmas, but not a dangerous amount.

A few days ago, I was a little nervous about posting this as I have had a few issues with my Garmin HR recorders recently.  My chest strap was malfunctioning and my watch has a general tendency to record short spikes in HR during my walks.  It has done this since I first used it, but I put it down to the inaccuracies of a wrist monitor.  Here is a recent example.

Overall, the trace is twitchy, but at points a, b, and c my HR drops for no valid reason and then gradually returns, which does not make sense as these were not points where I sat down for a rest; it was a nonstop walk.  Point d is the opposite, a sudden rise for no reason and then a gradual return. 

This contrasts with a bike ride which has much smoother, more gradual transitions which are in logical places.  Here is an example, taken with a new strap and sensor.

The rises and falls are based on effort put in due to riding around the peak district; a good example can be seen here at around an hour where my pulse dropped from 155 from climbing a shallow hill against the wind to less than 100 as I freewheeled down the long hill into Hathersage following a Sunday driver at less than 30 mph.

The chest based HR is obviously the correct one and my heart is not misbehaving.

My cycling is still slower than it was and hills hold much more difficulty for me, but I can manage 15mph (and still rising) around the peak district averaged over the year. The weather is now improving, and I will be heading back to the club for group rides in May.

Not a problem

I have had issues with Garmin chest straps many times over the years, so last time I bought the Polar version, which has proved to be very robust.  I did have to cut down the water seals around the contacts to allow the Garmin sensor to fit.  Recently,  Polar have adopted Ant+ as a secondary signal to Bluetooth, so on this basis I bought the Polar sensor to replace the Garmin one that I think has failed.

After the first couple of rides it seems a big improvement on my Garmin/Polar hybrid, no dropouts, no sudden unexplained rises, just an accurate trace. I will use this for a few weeks and then revert to the original to test it, but it looks like the problem readings last week were hardware rather than heart related.

Problems?

Over the last couple of weeks, I have had a few rogue heartbeats while out on the bike.  Nothing particularly worrying, just the occasional high spike for no real reason.

Yesterday I had this on a 20 mile ride

Fairly unusual.  My HR was very low and with a couple of dropouts for the first three and a half miles.  It went steadily higher, and remained high irrespective of effort or gradient. At around 19 and a half miles, the rate suddenly dropped back to what I would expect.  This was similar to some of my pre-diagnosis rides.  Here is an example from July 2011.  The first third of the ride was normal, but the latter part was dominated by AF. 

There were no dropouts prior to the HR rise and during the period of raised HR, I was experiencing shortness of breath and weakness.

I am hoping today’s trace may not be AF related, I suspect that there may be issues with my HR monitor; my watch did not show the same variation.  I tried to change the sensor batteries, but the years of sweat have finally welded the screws tight.  I have ordered a new sensor and am hopeful that next week will see better traces.

Long Period of Stress

My partner was taken into hospital with serious abdominal pains on Saturday 6th April, which ended in the decision seven days later to perform a hysterectomy.  She had a further ten days in hospital and is now looking forward to at least two more months of invalidity.

Originally, the pain came on so suddenly and was so severe that it seemed profoundly serious.  As the hospital staff seemed to find so many possible causes, there were a multiplicity of consultants involved in the clinical discussions which took a week to resolve (with her taking morphine for the pain).  During this time, I was not allowed to visit due to Covid protocols, but the consultant kept me partly informed; although I did not know how serious it was until after she returned home and I could read her medical notes.

She has now regained her appetite and although restricted in exercise she is able to walk again; up to five miles this week. 

During her hospitalisation, I also took a little self-medication in the form of alcohol.

Another issue affecting me was my employment situation; for the last three years we have been up for sale or closure.  We finally had an announcement yesterday.  We would not be sold and will remain open for business.  I wasn’t particularly worried, there are other jobs I could go to, even in the current situation, but it was good to be able to get over the upheaval of the last few years.  My only problem now is how to rebuild our client base, as we lost of lot of customers, because they didn’t know how long we would remain operational.

In spite of all this, and my Garmin estimated my stress exposure to be double the normal, I experienced very few heart symptoms, my resting HR was elevated by a couple of beats and my BP was slightly higher, but I only sampled four ectopic beats over the period; if anything, this is fewer than normal.

Asthma and Patellofemoral Pain Syndrome

As a child, I suffered badly through hay fever, which turned into asthma when I was around twelve years old.  After an incident when I blacked out, I was prescribed two inhalers and told not to take part in school sports.  I was not particularly good at team sports, so was happy to avoid the football, but I did miss the cross country running.  I can’t remember how I discovered this, but I was able to cycle without difficulty.  Eventually, I noticed that during exercise I had no hay fever or asthma symptoms.  I was able to come off the medication and the following year, I joined the local bike club.  As I grew older, my asthma never resurfaced, except for an tendency to persistent upper respiratory tract infections; although this only occured at times when I had allowed my fitness levels to fall.

By 1990, I was cycling thousands of miles per year, as well as making regular visits to the gym, swimming, playing squash and running.  I was extremely fit and healthy, eating well and totally alcohol-free.  Several times a week, I used to run six miles or longer and completed a couple of half marathons over the previous year.

At the time, I was working for a company who were exploiting a new business opportunity in Ireland.  They had made a decision to sponsor the following year’s Dublin marathon.  One of the directors was a reasonable runner and offered several of us the chance to run the marathon as a works team.  I was very enthusiastic and started to gradually increase my running in preparation.  All was good for a month or so, my mileage was steadily increasing, as was my average speed. 

Eventually, I started to feel a little pain in my knee.  I eased off the exercise a little, but the pain was getting worse.  I took a few days break, but the pain was still increasing, so I made a doctor’s appointment.  The doctor asked me if I took regular exercise and how much over the last week. He seemed shocked at my answer: three days in the gym, 150 miles cycling, 24 miles jogging, 64 lengths of the local pool and two games of squash. “And you’re surprised you’re having problems?”, he responded.  His advice was to stop exercising entirely and take a few Ibuprofen, which seemed to make sense.

Unfortunately, this put me into a downward spiral of discomfort and pain and I ended up back at the surgery three weeks later.  Luckily, this time I saw a locum with a specific interest in sports injuries.  He considered that my sudden increase in running and reduction in cycling had allowed my quadriceps to atrophy resulting in my kneecap wobbling in its guide (trochlear groove) and causing inflammation.  His recommendation was that I go back to the gym and concentrate on leg extensions and also return to cycling.  This was surprisingly successful and had me back to normal within a fortnight.  I never jogged again. 

Ten years later at the Glastonbury festival, I was kneeling in the tent cooking some food.  A few hours later, I had incredible pain in my left knee which felt the same as my previous exercise induced problems.  Luckily, I recovered from this the next day.  Over the last fifteen years, I have had just a few mild instances of this, always connected to kneeling, but nothing that has caused problems over an extended period of time. 

In November, we had a lot of carpet replaced; two flights of stairs, a landing, three bedrooms and an office.   Prior to fitting, I had to dismantle the furniture and remove all the old carpets and accessories.   I foolishly spent a lot of time kneeling during this process.  The recovery then took a long time and involved a lot of paracetamol; ibuprofen would have been better, but I have since discovered it is not safe for those with arrhythmia.  I have also had a light but persistent productive cough, which I think is related to the relatively light level of exercise I have had since November.  My Garmin account has certainly noticed and informed me of a drop in my VO2 max.  I am now actively exercising while but avoiding the icy roads.

Overall, I seem to find myself in a position of dependency; if I stop cycling, I will develop knee problems and asthma. This is not a problem at this stage of my life, if anything it is a good excuse to get out on rides.  I am concerned about what will happen as I age; if something happens to prevent me exercising, will I fall into a spiral of pain, asthma and inability to walk?

New year update

Icy roads prevented me from exploiting my time off over the festive period, particularly as one of my clubmates managed to break his hip in an icy fall on Xmas eve.  I still to managed to hit 3068 miles this year, which is the most I have done since 2002. Veloviewer also includes 311 miles walking, which is also a record.

New Strava record

I have a new record on Strava.  I have just passed 3000 road miles for this year; this is a little short of the target on 3500 I gave myself and nothing compared to the mileage I achieved in the 80s (pre-GPS so officially it didn’t happen).  

I still have ten days left until the end of the year, so I will probably beat the number of total miles (including velodrome, rollers and family rides) which only stands at 3099 miles. This is nothing special for a club rider, but I think this is spectacular compared to the future I expected on diagnosis if AF.  

This time it really is the three yearly review

I set off for the hospital with an hour to spare for a 40 minute journey, forgetting that today was the first shopping day after lockdown.  Sheffield traffic was mad, but I still arrived with time to spare.

The meeting was fast and efficient as usual: ECG, HR 70, BP (131/86) and weight 83.4 Kg.  The nurse was very happy with these, although I was less happy about the last two.  The consultant turned up, looked at the ECG, seemed very pleased, thanked me for my help with the research project. 

https://clinicaltrials.gov/ct2/show/NCT02695277

I asked how it was going.  Apparently, significantly fewer numbers than expected were recruited (at least in the UK, 15 instead of 45) and the completion worldwide has been delayed by Covid (a lot of research effort was diverted to the vaccine).  The finish date was expected to be November 2020, supposedly the date on which the last subject has their final interview.  In July when the last update was published, it was expected that recruitment of new subjects would take place which could push the trial back another few years.

In spite of this a preliminary analysis is being prepared which may suggest that the trial was overwhelmingly successful, if so, the trial will be stopped and the recommendations published.

Not the three yearly review

Yesterday I had an appointment with the cardiologist; last year he informed me that I would no longer need the annual halter monitor, ECG, blood tests etc, and that the last two years of the CEASE-AF study would be completed by telephone interview.  My staff were running two remote courses this day (one on Teams and one on Zoom) and I normally log in with the trainer prior to the course to ensure that the learners are able to access the system.  The trainer on the early course had a disastrous start, his system just would not work.  I ended up embroiled in his difficulties and missed the call from the doctor.

I picked up a voicemail message from him later, in which he appeared confused as to why he was calling me and said that he had asked his assistant to contact me over the next couple of days to make an appointment to come and see him.  I am sure I will get another phone consultation.

I am still getting a few readings of high stress from the Garmin, but these seem to have no bearing on whether or not I feel stressed.  I have also had one very high reading where I have appeared to be stressed during sleep (this was a possibility; it was the Sunday night before a difficult week).  I was going to ask the cardiologist whether I should take this information seriously.

My cycling is continuing to improve.  I am not consciously putting more effort in to it, I am keeping below the 165 HR and I am continuing to spin uphill rather than attack with power.  There is a steady improvement in my average speed.

I have been recording data since I bought a Garmin in June 2008.  This graph shows the average speed for each month in blue with a 12-monthly average trendline in red.  This prevents the higher (and faster) mileages in the summer months from artificially inflating the annual statistics. 

The graph holds relatively steady until around March 2015.  There is a slight downward trend, but this was mainly affected by increasing ride distances and group rides with slower friends.  I now know that Mar 2015 was the start of paroxysmal AF which slowly worsened until I entered persistent AF twelve months later.

My average speed dropped off a cliff at this point, but has been steadily improving since January 2018 after my recovery from the two ablations.  My current average speed on this graph is 15 mph and I think (hope) it is still rising.