All clear?

For the last few years, I have had a couple of things going on healthwise:  AF and elevated liver enzymes.

The AF now appears to be under control; apart from the two weeks after my first ablation I have experienced no AF.  There have been a few ectopics, although these are relatively calm at the moment.  I am still pootling about on the bike, no racing no HIIT and no intention to risk anything by overdoing it.  I am scheduled to see the cardiologist at some point in the autumn of this year, but only because of the CEASE-AF research project.  If I was a normal patient rather than a participant in a clinical trial, I would have already been discharged to the care of my GP.

The liver enzymes were the second issue.  Originally several different enzyme levels were raised, and it is fair to say that self-medication with alcohol was likely to have been a contributory factor.  After these were discovered my alcohol intake was curtailed and I kept total abstinence between February and December 2017.  Since then I have kept faithfully to less than 14 units per week.  Binges have been few, but occasionally centered around celebrations.

19-03-18 GGT

The graph shows alcohol consumption against GGT.  The red line shows a fall in levels after I stopped serious drinking, with a little binge around the Xmas 2016/17 period.  It then fell quickly until I started amiodarone; it levelled off for a while until the majority of it was out of my bloodstream.  It then continued to fall steadily until now, when it has reached the upper level of “normal”.  My levels over the last year also gave no concern; although above the textbook normal level, they were described as satisfactory.    The Doctors comments this time are, “Satisfactory. No further action“.    I suspect that the GGT level will continue to drop very slowly, but it looks like I have no need for testing in future.

So, I have now effectively been signed off for both health problems.  I will not be able to increase my alcohol consumption in celebration but I am relieved and very happy.

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Continuing improvement

derby-velodrome

Six months ago, I attended a skills assessment session at Derby Velodrome;  I was judged to be competent and so I received my velodrome permit back.  However, during the session I had a momentary HR spike of 201 for no obvious reason.  I had also seen a few spikes on recent rides of 170/180; I wasn’t sure whether these were problematic, i.e. a brief incidence of flutter or just a rogue reading.  I decided to leave the velodrome alone for a few months and monitor my HR.

I had experienced no recent problems, no HR spikes and the incidence of ectopic beats on my kardia is almost down to nil, so I decided it was safe to return to the velodrome last week.  As usual, I didn’t push too hard; on one exercise I decided to cut it short and recover; overall it was enjoyable and I think I could go a little harder.

In addition to this, I was on annual leave and drank more than I should; not really excessive, no binging, but 22 units over the seven days.  I am very pleased to note absolutely no ill effects.

I am beginning to feel almost normal.  I am a little unfit and a bit weightier: 2Kg more than when I became symptomatic, but I think this can be solved by a little extra exercise over the next year.

Three years since self-diagnosis

It is now exactly three years since I realised that my breathlessness and general lack of fitness was not related to aging, but due to a medical problem. I made an appointment with the Doctor, but could only get in to see a practice nurse, and had to wait four weeks. A few days prior to the appointment, I developed a noticeable persistent arrhythmia. I was referred for an ECG and told not to exercise.

After a month (and some considerable chasing) it was confirmed that I had AF. I was called in for a full blood count and put on the waiting list for an echocardiogram. This took place in June 2016 and confirmed that I was in AF and that my left atrium was significantly enlarged (37 mls/m2 compared with a healthy max of 28)

Another month and I saw the cardiologist (luckily, he was an EP). I was put on Bisoprolol and Rivaroxaban. At this point, my symptoms worsened; I suspect the Bisoprolol was the cause, rather than any progression of my AF.

I had a successful cardioversion in October 2016, although it only worked for a couple of weeks; it felt marvellous while it lasted.

In November 2016 I saw the cardiologist (not the EP this time). The treatment plan was to be another cardioversion, this time supplemented with flecainide, followed by a referral to Sheffield for an ablation. I was more than happy with this.

In January 2017, I met the EP who suggested that I was a suitable candidate for a medical trial. The treatment was in two stages: First a Mini-maze; entry made through the chest wall, the atrial appendage clamped off and a scarring pattern made on the outside of the heart. This was followed six months later by a catheter ablation on the inside of the heart that completed the maze box set, a CTI line for flutter and cleared up any rogue signals. In between, I was amiodarone for six weeks to stabilise me.

The Mini-maze, in April 2017 was rough; it took me quite a few days to get over and three weeks before I was able to go back to work. It was pretty successful, My Kardia said I was in AF for a lot of the following week and I had some minor arrhythmia over the next few months and ectopics which are symptomless; I took regular Kardia readings, but the cardiologist said they were nothing unexpected or untoward.

The Amiodarone caused no problems except for a scorching summer clad in long clothing, hats and factor 50.

The catheter ablation in October 2017 was a doddle: it was done under GA and I missed all of it. Immediately afterwards I was full of life and felt 100% recovered. I came off all medication in November 2017.

I took it easy throughout 2018; I exercised, but kept to sensible limits. I returned to club cycling in September, but with the beginners’ group rather than the racers. I am still taking it steady with the social group, not wanting to risk my recovery.  I am definitely enjoying life.

I still have a few bouts of ectopics; some of which confuse my Kardia into unclassified and the occasional AF diagnoses, but generally I have been in good health and I have been in NSR 99.99% of the time. The cardiologist in charge of the trial suspects a 80% success rate over 20 years (i.e. no significant AF in that time) I think this is probably overoptimistic, but am very pleased with the treatment.  

See below for my current ECG.

19-01-30

Rogue beats

On four occasions over the last few months, I have experienced a few rogue HR peaks during a ride; these are only momentary and don’t show on the Garmin until I download the data.  I am not sure whether this is a fault of my HR meter or my own internal wiring, but I have been monitoring every ride recently.

The first instance was on 25th October; one spike of 173 for a split second while on the rollers. This was a strange session, there were also dropouts so I think that this was possibly a sensor error.  On 4th November, I experienced a spike of 169 for a split second on a road ride while not making any particular effort. On 2nd December there was a spike of 167 for a split second while climbing; however, this was close to the top of the climb and my HR was actually falling at that time.  On 28th December I had the most worrying one; an instantaneous spike of 181 during a steady flat ride on the trails. 

I have been very patient and have not attempted to recapture any former glories; half my rides are still flat, and in spite of that, my average over a year is 1.6 mph lower than it used to be on rides through the peak.  It looks like I will have to continue steadily, monitoring what is happening, hopefully, it is not serious, but it has put a damper on what was a much better year than I could have expected after the two ablations.  Here is my annual Strava summary.

Back with the Cardiologist

This was my regular six-monthly review as required for the clinical trial.  Today there were worse than usual traffic and parking problems getting to the NGH so I arrived a couple of minutes late for my X-ray.  No problem and ECG and BP were all taken before my actual appointment at 9:30 a.m.  I had a nice chat with the Arrhythmia nurse about how my recent work stresses were affecting me.   I was finally invited in to see him at 10:20 a.m.

He seemed quite happy with the ECG and X-ray.  I showed him a few Kardia readings since the last visit; he was pleased I was keeping records and said that he had just ordered twenty for the use of patients in monitoring their AF.  He said that every reading I had taken was relatively normal, except for one.

18-08-12 HR

This was taken in Florida, on a day when I had drunk a lot of coffee.  He suggested that if this happens again, I should get someone to punch me very hard in the chest and phone an ambulance.  He had previously said that coffee is not a problem, but his opinion now is that I should avoid it.

Apart from that, everything is fine and I should come back to see him in twelve months.

220 – age

Reported on Health Unlocked

18-11-08 HU

 

https://healthunlocked.com/afassociation/posts/139119844/exercise-and-af-from-patients-day-2018

A forum member reported  that a doctor  had suggested at a conference that exercise is a good idea, but if the HR goes above 220 – your age, you should stop.

This adds to my thoughts that the medical profession has no idea how to treat athletes with AF.  Firstly, I have to assume that the doctor was considering 220-age to be Max HR, which is nonsense.  If this is the case, their advice is that a high intensity level of exercise is not a bad thing unless (until) you have an AF attack, so I should be allowed a HR up to my previously tested max HR was 187 (20 beats above the 220-age calculation).

My cardiologist suggested that I am OK to exercise hard, but had forbidden me from taking part in racing or interval training.  I have translated this to mean that I should keep my HR below 165, my previously defined aerobic limit.

165 is actually 220 minus my age, but this is entirely a coincidence.  On the plus side, either way, I am not pushing myself too hard.

Rollers

I experienced a 16 second spike in HR up to 173 during a rollers session last night.  I am not sure whether this is significant, as the HR also dropped out a couple of times.  This is potentially an issue with the sensor rather than my heartbeat, but given the other spike on the velodrome recently, I will keep it under observation.

2018-10-25 Garmin

One year post treatment

This was a post written specifically for the HealthUnlocked AF forum, https://healthunlocked.com/afassociation

I have noticed that most “cured” sufferers disappear from the forum when they no longer need the support.

18-10-02 HU

In early 2015, I was a 53-year-old club cyclist, quite fit and athletic but my performance levels had reduced from the previous couple of years.  At first, I thought I was starting to feel my age.  This gradually got worse throughout the year, until I became convinced there was something medically wrong with me.

I was diagnosed with probable AF in February 2016, which was confirmed shortly afterwards when it became persistent.  I continued in decline through the year, worsened by my bisoprolol prescription.  A cardioversion in October helped and I had an amazing recovery, but only for two to three weeks before going back into AF.

In 2017 I had a hybrid ablation; a mini-maze in April and an RF catheter ablation in October.  The first stage isolated the pulmonary veins, the ligament of Marshall, (apparently it is on the outside of the heart, no-one knows what it does but it can be a focus for AF) and blocked off the Left Atrial Appendage.  The second stage did a CTI line for flutter, completed the box lesion set on the rear atrial wall and repaired a connection breakthrough on two pulmonary veins.  Within three days I was feeling much better, after six weeks I was completely off medications.

I have been largely AF-free since a few weeks after the first ablation; with one work stress related episode in May 2017 and one alcohol related blip on New Year’s Day.  My Kardia showed many ectopics throughout the year; on average there was one or two per thirty second trace.  Until my AF became persistent, I don’t believe I had ever had an ectopic beat, and I took my pulse very regularly.

in April 2018, my Kardia decided I was having a few episodes of “Possible AF” episodes and it decided I was having another couple in early May 2018, but the traces looked fairly normal to me.  In late May, I took printouts of my dodgy readings to my 6-monthly review; my cardiologist confirmed they were not AF and nothing to worry about.

Through the summer of 2018, I had a few noisy or chaotic Kardia readings, but never for long and not accompanied by any symptoms.  The ectopics have continued but I have grown to be able to ignore them.

In August, I went to the USA on holiday, and drank excessively; 20 units in a week, (before AF, I would have considered this level to be quite restrained).  This did not appear to have any effect, but one day I had several coffees and was rewarded with a bout of some sort of arrhythmia, which was called “unclassified” by the Kardia. Abstinence brought things back to normal very quickly.

I know AF is all about management of “quality of life” and there is no cure, but I think I am now as close as I could be.  I managed to hold back from excessive exercise for months after the two procedures; I am not sure if this was really required but it did not seem worth the risk at the time. I walked and cycled throughout my recovery and have now started to cycle out in the hills with the club again.  I am still being cautious; I am taking it steady with the social group rather than my previous racing buddies, but I am enjoying it.  I still weigh two or three Kg more than I should (at 79.5Kg. my BMI is 25.1), but I was 84Kg around this time last year.

I know everyone is different, but I would say that you should not be apprehensive about ablation.  If one is offered, I would go for it, sooner rather than later; AF is a progressive condition, and I am convinced early ablation helps.

GGT approaching normal

My latest liver function test results have just come back. My GGT is the lowest since the issue was first discovered. It was 217 (against a recommended 8-61) in April 2016; this was after a period of significant alcohol use.  It dropped slowly under reduced consumption, held steady during a period of abstinence while taking amiodarone and has further reduced now I am medication-free and sticking to guidance levels of 14 units per week. At 71, it is only just outside guidance limits.

18-09-26 GGT

Sunday Club run to the hills

18-09-23 GH1

After the previous week, I was unsure whether to head out on the hilly ride with the steady green or slightly more ambitious blue.  When I arrived at the start point, there were very few riders, due to the Majorca trip, so the faster riders amalgamated into a blue ride.  I decide to stick with green, in case the pace got a little carried away.

It was a pleasant ride with two new members (actually members of Mansfield Road Club) marred only by one of them doing the slow motion clipped fall twice.  She later went to the hospital, and has to return on Wednesday for a scan. Overall quite slow, but I rode in and out and so made it a nice 45 miler.

18-09-23 green H1