Cycling with Atrial Fibrillation

I'm 44, and have had recurrent bouts of AF since I was 38 or 39, when I went through a phase of having it every few months when running, with spells lasting 3 - 48 hours. I switched to cycling, and I've had it much less often since then; I was put on Bisoprolol (1.25 mg, upped to 2.5mg a day after it came on one Saturday morning while running across a field to watch my daughter in a cross-country race) and I then had just short of 3 years without an attack, before going into AF again for 20 minutes on a ride back in February, while pushing myself up a hill (and after a hard turbo session the previous day, which I think was a crucial trigger).

It's a pretty individual condition, it seems to me, so it's hard to generalise from any single case, but I've been fortunate so far, in that it's not stopped me from getting out and riding: I did a number of hill climb events over the last few years (not this year, though, as I'm keen to keep to AF at arm's length, in the light of having had it again this year), and I've done lots of long rides, e.g. including the bloody brutal Etape du Tour in July. Over the last year, though, I've found that I've dialled back the efforts, because it's more important to me that I stave off the AF than that I push myself hard up hills and the like.

It's definitely something of a Sword of Damocles, and so one has got to be prudent: it's a serious health condition with significant associated risks, and with a tendency to worsen if it's allowed to become more frequent, so you should avoid doing things to exacerbate it; and figuring out just what you can allow yourself to do, and adjusting to having it, really does take some time, and it's very much worth erring on the side of caution along the way. But, while it can feel like a real kick in the teeth to receive the diagnosis, if you're lucky you may well still be able to spend a great deal of time on the bike, but you may need to/want to keep an eye on things that you didn't worry about previously. (I've been through phases where it's pretty constantly on my mind while cycling, so I'm checking the regularity of my pulse all the time; but it eventually faded into the background.)

Very best of luck with it all.

(One thing: the real experts on AF are electrophysiologists, rather than cardiologists, as the former specialise in cardiac electrical disorders, which is what atrial fibrillation amounts to; electrophysiologists are the people who perform cardiac ablations, for instance. These sorts of details are likely to become familiar to you, I'm afraid!)   

I was diagnosed with AF in 2002 at age 67. Initially drugs and then a cardioversion were successful until 2009. During this time I continued to ride audax events at distances up to 300k.

In 2009 a relapse and another cardioversion was unsuccessful. I was discharged with the advice "learn to live with it"

I have done this by reducing my riding speed, fitting lower gears, taking hills slowly and having rest stops on the steeper ones. I get out twice a week for rides of 45-50 miles and am now the oldest rider in our club who has not got an electric bike (but am keeping a close eye on how these are being improved.)  

I come from a different place than most of the above accounts in that I was a non-cyclist when I had  a heart attack and cardiac arrest and sufferd from ventricular fibrillation. Of the major risk factors I think I was guilty of inactivity and so was not at all fit even before my attack.

Immediately on leaving hospital I struggled to walk a hundred yards and in fact needed a wheelchair to be carried to the car.

For 3 months I was restricted to gentle walking and then I took up cycling 3 months after my attack and progress was slow  but now six years later I consider myself to be much fitter than most 59 year-olds.

I imagine without my condition I would be a bit quicker under stress but I find I am aiming at endurance rather than explosive speed and I can happily do 50 or 60 miles in a day and average about 5,000 miles a year.

I have an ICD implanted which is comforting and not in any way a problem except that it needs a battery change every 6 or 7 years or so and in fact I am due in hospital for the first time next Wednesday.

I have various medications including beta-blockers and statins with no side-effects at all.

I realise that you are entirely different, being fit before your problem, but I now consider myself to be far fitter than in the ten years before my attack.

Starting from a much better position you should be able to carry on cycling perfectly well but my advise would be to take it slowly at first and build up your strength gradually.

Perhaps because I had an actual heart attack I found I was offered a lot of help including rehabilitation courses. Everyone encouraged me to continue cycling, not that I needed it, and whilst I was restricted, under supervision, to keeping my heart rate below 110, I was told that I didn't need to worry about it whilst on my own. I found in the early days I cycled until I was forced to stop but now I never reach those levels.

Lennard Zinn over on Velonews has the condition and has written about it a lot.

Here is one article but there are more on the site if you search.

https://www.velonews.com/cycling-to-extremes-heart-health-and-endurance-...

I was diagnosed with AF in February 2016 when it became persistant.  Before that I had the occasional problem keeping up ewith my clubmates on hills.  I just thought I was getting older and less fit.  AF is quite debilitating, any exertion caused my HR to rise significantly (up to 250) but with greatly reduced blood flow. 

I was on Beta blockers and anticoagulents from July 2016 and had two operations in 2017 in April and October.  I finally came off all medication in December 2017, with instruction not to overdo the exercise.  I had been restricted to flat trail rides throughout 2016 and 2017, but from January I stepped up the mileage a bit.  By April I was back out in the hills and have gradually increased my cycling to include 30 miles on the trails each saturday and 60 miles out on the road for a sunday club run.  I am still about 2mph slower than I was in 2015.

I wrote a blog about my treatment and recovery; you might find some of it useful.  https://afibandcycling.wordpress.com/

Another good resource is Health unlocked's AF forum.  https://healthunlocked.com/afassociation

The Heart Rhythm Alliance  http://www.heartrhythmalliance.org/afa/uk/atrial-fibrillation also have some useful resources thast would be worth a read before you see the doctor.

I would guess the cardiologist (Electrophysiologist is who you really need) will start you on betablockers, an anticoagulent (ask for a NOAC like Rivaroxaban), schedule you for an echo cardiogram to see if there is any structural damage to your heart, a cardioversion to put your heart back in rhythm, the result of which will determine the next approach.  I personally pushed for early ablation, waiting lists are long.

I was diagnosed with ventricular fibrillation at the age of 50 and ended up having a defibrillator fitted in my chest. As a result I have had to change how I ride, I cannot attack hills, chase people I see in the distance or make big efforts. Now I change down a few gears when the road goes up, let people ride off into the distance and kick back and enjoy the scenery. It was a hard adaptation to make but I reasoned it out by thinking that it was better to ride differently rather than not at all. My medication (beta blockers) also affect my ability to ride hard, they reduce my cardiovascular capacity so if you are put on medication ask what the side effects may be, beta blockers can also give you terrible nightmares but these have eased over time. Be guided by your cardiologist but tell them how important cycling is to you but hopefully you will be back on the bike soon. Also ask about using a pulse monitor, I can’t go near them because of my defibrillator but it might help you if you have to monitor your effort. I could bore you to death about how this has affected me so if you want any more detail drop me an email on Stephen.bulpitt [at] yahoo.com

I hope things work out well for you 

Hi I was diagnosed with permanent afib in Jan 2016 after overdoing it on the turbo. Same sensations as you. I was 46 and very fit. I live in France so the service here is super quick and efficient. I was put on drugs which were awful (worse than the condition) so I refused to take them and was cardioverted back into rhythm. My heart was given a full MOT by the cardiologists and other than being enlarged from years of training there was no risk to me to continue cycling. This lasted from March 2016 until March 2017 and I was back training as before until one night i was having a beer with friends and it popped out of rhythm permantly again. After test etc again this time they gave me a catheter ablation in May 2017 and another cardioversion. While they were in there they did some investigation and found out my heart was scarred from the increase in size and this was probably causing the Afib.

Since then apart from a few hour long episodes of AFIB (after overdoing it on the bike) which have become less and less frequent I have been OK.

Cardiologist told me to keep riding but to keep my heart rate lower and to do shorter rides and make sure I rest well. I have recalibrated my riding and I probably do half as much as I used and focus on quality over quantity hopefully to a level my heart can cope with.

As my Cardiologist said "You need to slow down you are not 21 anymore" !! I wear a heart rate monitor now to make sure I dont over do it and successfully climbed the Col de la Bonnett this summer. I never thought I would be able to do that 18 months ago.

So yes as long as you are given the all clear my your medical team then you can carry on riding. It might be frustrating at times and I found that by recalibrating what I could do I have been able to continue.

Oh I also stopped using Strava as I think trying to beat my mates up the climbs / ride further than them contributed to the problem 

This recent article might be of interest:

https://cyclingtips.com/2018/11/219-beats-per-minute-the-day-my-heart-sh...

Yep, had a similar conversation just the other week, AF is common. Good answers above, I don't have anything to add other than chin up, you'll be back on the road soon enough.

I had a mild bout of AF for the first time last year, then a much more severe bout during the Tour Aotearoa this year (I'm a Kiwi).  After being collected from the local hospital by my wife, I saw a cardiologist, who put me on daily medication which he said he'd normally only provide to people for use when they felt unwell.

I don't feel as willing or able to push myself as before, so am having to think more "ride like a diesel" as one of my fellow TA riders put it.  My son now has the SRM and go-fast bike.

But you can still ride.  Google AF and cycling - and talk to your cardiologist. 

I don't ride with it, but I've coached 2 people with it and know 4-5 cyclists with it.

First of all let your cardiologist know your background (level and frequency of exercise) and your expectations of what a complete recovery looks like. If the answers to questions seem vague, ask and ask again until you get an answer  you understand in language that you understand.

Without exception the cyclists I know who have been to their GP with AF have been told to stop any form of strenuous exercise, and then once seen by the specialist have been told to carry on doing what your doing (for one of them that meant cycling the length of NZ the following month). 3 of the 5 have medication to help with it. Only one of them (who is 80) has any restriction on his exercise. He's been told to keep his HR below 150 (about 80% max) as I think he has complicating factors. He keeps to this advice except once a week when he races for about 60 mins. I think it is rather self limiting out on the road so to speak, as if you try to go harder you go into AF, with varying effects for different people. 

In short, from my contact with people with AF, generally they are able to continue cycling without major restriction, though in some cases the nature of the syndrome has placed its own limits on what they can do.

Good luck

No reason why you shouldn't be back cycling once investigated and treated (and under guidance).  An echocardiogram will confirm how well the rest of the heart muscle functions.  

You may be given treatment to restore the normal rhythm (cardioversion) either using drugs or a electrically (under anaesthetic).  If that is likely to be unsuccessful the treatment would concentrate on rate control as your symptoms are likely to be due to the ventricular rate being too fast even at rest, as well as being irregular.

Atrial contraction contributes only 15% to ventricular filling so even if you lost that permanently and the rest is ok you should be able to cycle.  I'd be amazed if there aren't a boat load of cyclists who could confirm that permanent AF does not stop them exercising.  

Caveat: I'm not a Cardiologist.  It is very common though and its management is very well established.  Just be patient with the system and ask as many questions as you can.