Ectopic Atrial Rhythm

A Runner & Ectopic Atrial Rhythm

My story begins on March 2nd, 2020 on the heels of a back to back half marathon adventure to North Carolina and South Carolina.  I had been fighting a respiratory infection on and off since October of 2019, I had not trained and as a result and I was run down and ill prepared.  Because I’m a moron I ignored all the red flags, jumped on a plane in the middle of the SARS-CoV-2 virus outbreak, flew across the country and ran two half marathons in 2 days.  I returned home banged up and with my newfound arrhythmia now correctly diagnosed as “Ectopic Atrial Rhythm”.

The Backstory (October 2019 – February 2020)

For a little context, from the months of October through middle March I was sick with allergies, colds, other?  I felt awful.  The kids who were 4 and 7 respectively at the time would lovingly bring home every virus from their endearing school friends and generously share them with me (and my wife Amy).

As a result my training was LIGHT leading up to this North/South Carolina trip and I was still sick.  I was doing everything in my power to get myself healthy enough to make the trip.  I flew out on Friday morning very early still QUITE sick but hopeful.  I packed my pockets full of cough drops and just did the best to de-phelgm myself throughout the day.

The Trip (February 28th – March 1st, 2020)

The trip started with a full day of travel from SAN (San Diego) to CLT (Charlotte).  It was a tough flight trying to control my cough the entire way, which I did.  Upon landing I had to drive about 1.5 hours to my final destination which was Ellerbe, NC. 

I got some food and got into bed at a reasonably early time.  The next morning it was ice cold (literally) and not great for someone fighting a respiratory infection.  The race was beautiful but hilly and, I spent a good deal of the race fighting off coughing attacks.

Post race I had a five hour drive to Hilton Head South Carolina and yet another race.  Sleep was great according to my OURA ring, I ran the race (it was warmer), I got back to the hotel, showered, ate and headed off to the airport.  One more full day of travel back home to SAN, this time flying out of CHS Charleston, SC.  Returning home I was REALLY tired.  I got 5.5 hours of sleep that night so I could get up and start the week.  And, this is where the fun began.

So It Begins (March 2nd, 2020 – March 8th, 2020)

The week after the trip I got really sick again.  Whatever respiratory infection I had going into the trip I now had WORSE.  All I know is that it got so bad Amy finally instructed me to head down to the UCSD walk-in clinic.  On Saturday March 8th, I did.  My elevated heart rate was very noticeable but at this point in the process I was able to explain this away with the stress my body was under from both the races and now the resurgence of a virus.  You can see from the resting heart rate data that this hit me hard around Friday.
Ectopic Atrial Rhythm Begins
The nurse that I had at UCSD didn’t much care about my heart rate despite that being the one thing that I cared about.  They gave me a chest x-ray, tested me for the flu, weighed me, took my temperature and sent me off.  
 
Diagnosis:  Respiratory Infection
Prescription:  Z-PAK (Azithromycin) and a Albuterol Sulfate (I was wheezing pretty good).  Over the next few days I started to FEEL better but my heart rate stayed high.

Emergency Room & First Diagnosis (March 12th, 2020)

Visit to Primary Care (3/12):
I got worried so I headed in to the Doctor.  I went to see the nurse practitioner at Scripps Medical Group (Encinitas).
They did an EKG/ECG, did another X-Ray.  They found a slight abnormality on the ECG.  Based on the Tachycardia, they said, “Go to the ER”.  My response was, “REALLY?!?!?” followed by an expletive.
 
Visit to the Emergency Room (also 3/12):
I got to the ER and they did another EKG/ECG, they did blood work to test for 1) blood clots (negative), 2) heart attack/damage (negative), 3) other blood work (all normal).  They did YET another Chest X-ray (normal).
The doctor did come visit me and said there was a small abnormality on my EKG/ECG but that it wasn’t something to worry about.  I explained I was having a bit of chest pain in the upper left area of my rib cage but nothing when I took a deep breath.  We think it might be because of the coughing??  Not sure but I don’t like it.
Diagnosis:  Sinus Tachycardia
Prescription:  REST and Lorazepam for the anxiety.  About .5mg as needed.  Ambien to sleep (10mg).

I Have A Cardiologist Now! (March 26th, 2020 – May 1st, 2020)

I gave my body some time to heal and after about a week, the virus went away.  Great.  But, my high heart rate did NOT.  CRAP!  I asked my wife to call around to some cardiologists and get me in anywhere I could.  Dr. Pingfeng Du to the rescue.  He squeezed me in on the afternoon of 3/26/2020 and I got my first ACCURATE diagnosis of Ectopic Atrial Rhythm.

He ran an ECG (#3) and had me do some blood work to rule out the basic stuff and hormonal issues. All came back normal except for my ECG. That showed Ectopic Atrial Rhythm.  But, he was able to tell me definitively that although this sucked, it wasn’t going to kill me.  That was reassuring.
    • 3/27/2020 – I began taking 25mg of Metoprolol in the PM.
    • 3/29/2020 – By Sunday March 29th, my Resting Heart Rate (RHR) had returned to more or less normal of low 50’s / high 40’s during sleep. Things seemed good!
    • 4/2/2020 – ECG #4 showed that I was still in Ectopic Atrial Rhythm.
    • 4/7/2020 – Echocardiogram showed that my heart is in great shape. Nothing came up at all. Hooray.
    • 4/14/2020 – I went in for another ECG #5 because Dr. Du thought I might have returned to a normal sinus rhythm. Which I did NOT.
Ectopic Atrial Rhythm Return to Normal
Funny last comment, I freaked out when my resting heard rate got down into the low 40’s and discontinued Metorprolol.  That was a mistake, see what happened 48 hours latter,  heart rate jump.  I think I’ll keep taking it.
 
Diagnosis:  Ectopic Atrial Rhythm
Prescription:  Metoprolol Succinate 25mg

The FLARE Up & More Drugs (May 2nd, 2020 – June 1st, 2020)

Dr. Du didn’t give me the “All Clear” and my heart rhythm had NOT returned to normal but I thought I was doing fine.  As a result my buddy Justin and I went out to run a virtual half marathon, you can read about it here.  The race was fine, I wore my heart rate monitor and it was pretty easy.  We didn’t press for time, just cruised but 72 hours later I was BACK in full ectopic atrial rhythm.  Back to Dr. Du I go.
Ectopic Atrial Rhythm Encinitas Half
 
  • 5/4/2020 – I had a regularly scheduled ECG #6 that I went to and it showed once again that I was still in Ectopic Atrial Rhythm.
  • 5/8/2020 – I had returned to full blown elevated heart rate Ectopic Atrial Rhythm. And, it was at this point that I was put on an anti-arrhythmic medicine. I was prescribed Flecainide Acetate which I began taking 5/9/2020. From this date forward, I took the following daily:
    • AM – 50mg of Flecainide Acetate.
    • PM – 50mg of Flecainide Acetate & 12.5mg of Metoprolol.
    • Note: Metoprolol was reduced here from 25mg to 12.5mg.
  • 5/11/2020 – I had ECG #7 here and I was still in Ectopic Rhythm.
  • 5/15/2020 – I had ECG #8 here and I was still in Ectopic Rhythm.
  • 5/29/2020 – I had ECG #9 and this is the first time that I had a normal sinus rhythm! So says the doctor. That was the first bit of good news I have had since this thing had begun.
  • 6/1/2020 – I think it was about this date that the doctor instructed me to reduce my Flecainide Acetate amount from 50mg twice daily to 25mg twice daily.

Going LOW

From May 25th to May 29th my heart rate got LOW.  I reached out to Dr. Du regarding my low heart rate but ultimately no changes to medications were made and the rate eventually normalized back up a little higher.  But, a tad unsettling.

Ectopic Atrial Rhythm Going Low
 
Diagnosis:  Ectopic Atrial Rhythm
Prescription:  We’re adding Flecainide now!

Alcohol, Altitude & Exertion – (June 2nd, 2020 – July 11th, 2020)

Through all of this I found that there are three things that cause my ectopic rhythm to flare up.  They are in no particular order, alcohol consumption, high altitude and physical exertion.  So, it’s worth noting that I had a small flare up during a vacation to the mountains (high altitude). I was drinking 1 – 1.5 alcoholic beverages a day, was hiking a LOT and noticed that I had a flare up. It returned to normal as soon as I got home, stopped drinking and started eating clean again.
  • 6/26/2020 – I had ECG #10! I had returned to ectopic atrial rhythm.

Ectopic Atrial Rhythm AAE

I also learned that it’s unwise to change two things at once.  It’s just bad science.  Relatively new to mountain biking I decided to jump on my bike and summit Black Mountain with my buddy Knight.  Just dumb.  Oh!  I also removed flecainide too.  And, the result was another flare up and jumping right back on the flecainide.

  • 6/28/2020 – Despite ECG #10 being back in Ectopic Atrial Rhythm, the doctor wanted to REMOVE the Flecainide Acetate from 25mg twice daily to 0mg daily.
  • 6/29/2020 – I did a crushing (for me) mountain bike ride to the top of Black Mountain. Over exerted myself and once again found myself two days later in an elevated heart rate zone.
  • 7/2/2020 – I returned back to 25mg of Flecainide Acetate twice daily along with 12.5mg of Metoprolol. The good news is that I am seeing some signs that my heart rate is once again returning to normal.

Ectopic Atrial Rhythm Black Mountain

Diagnosis:  Ectopic Atrial Rhythm
Prescription:  Off Flecainide, On Flecainide, Phew!

Time to Pivot – (July 12th, 2020 – September 30th, 2020)

Up until this point I have not shared how TERRIBLE these drugs make you feel.  But for some basic understanding, Metoprolol is a beta-blocker and works to counteract some of the effects of epinephrine and other naturally occurring chemicals in your body.  It lowers your heart rate and your blood pressure and also put ME in one hell of a depressed FUNK.  The Flecanaide was worse, it is an anti-arrhythmic and blocks certain electrical signals in the body and heart and it felt like someone was grabbing hold of my heart and squeezing with both hands to keep it from beating (it wasn’t, just felt that way).

So, needless to say, thats enough of that.  From here on out, I’m done and will just do the minimum (Metoprolol) until I can get this figured out.
  • 8/15/2020 – It’s worth noting that I ran three half marathons during this time with minimal flareups. I did Wyoming, Montana and Idaho over a 9 day period, two of which were back to back.

The PRE-TRIP Flareup

We had a scheduled trip with another family for 4 weeks to take the kids to some mountain states.  And, we planned on homeschooling them along the way.  So, like a moron (notice a theme?) I decided to stop taking the metoprolol five days out from the trip.  And, surprise, surprise, my heart rate spiked and it stayed that way until October 19th, my birthday.
Ectopic Atrial Rhythm Stop Metoprolol
 
Diagnosis:  Ectopic Atrial Rhythm
Prescription:  Metoprolol, Off Metoprolol, Back on Metoprolol

To Ablate or NOT to Ablate – (October 1st, 2020 – October 19th, 2020)

I had been putting off the inevitable.  I would need a cardiac ablation.  Essentially they go up through the groin, into the heart through the arteries and map the electrical signals of the heart.  Then, they find the ones NOT coming from the sinus node and they ZAP it/them (actually they use radio-frequency ablation to burn and kill those cells).
 
I asked a friend who is a cardiologist for two recommendations here in the San Diego area and eventually setup two appointments with the top two cardiologist specializing in these treatments.  Both are world class but I need to find MY doctor.
  • 10/5/2020 – First meeting with Dr. NOT MY DOCTOR started with the obligatory ECG #11 “Hey, your heart rate is pretty fast, let’s do an ECG!”  Me, “sure!  why the hell not.”  He is clearly a smart doctor and the procedure seems straight forward enough.  But, I want a second opinion.
  • 10/8/2020 – First meeting with Dr. Greg Feld started with (you guessed it!) another ECG #12.  And much to my surprise (sarcasm) it showed Ectopic Atrial Rhythm.  Five minutes into the conversation I knew this was my guy and he sealed the deal when he came back into the room after our meeting to listen to my heart a second time.

THE DECISION

That Friday through Sunday were spent thinking.  My wife Amy and I decided that the procedure was inevitable so no sense waiting, let’s get it done.  Monday morning I called to schedule it.  Next appointment they had?  My birthday on October 19th, 2020.  How fitting.

  • 10/11/2020 – Discontinue all medications in prep for the procedure.

I’m not sure its possible to be more nervous.  The week leading up to this was brutal for me but I managed and even got a decent night sleep the night before the procedure.

I got dropped off at the hospital at 6:00 a.m. for an 8:00 a.m. procedure.  The anxiety really hit me when they put in my IV.  This is no longer pretend.  Fortunately, my anesthesiologist wandered in at the PERFECT time to explain how the procedure would go.  Calmly she said, “You will be given an anti-anxiety medicine first that will make you warm and calm and then the propofol will knock you out and you’ll wake up in the recovery room!”  Phew, thats all I needed to hear, let’s do this.

Dr. Shah was next (Sr. Fellow) and he was awesome.  He explained everything in plain English.  Before I new it the OR nurse was wheeling me into the room.  They applied the sensors which were huge flat patches to my back and chest and laid me flat.  Next thing I knew I felt warm and calm (thanks anesthesiologist!) and then waking up in the recovery room.  Two hours of laying flat and then home.

The recovery was pretty simple but I did have chest pain for a few days.  But the best part?  My heart rate returned to normal inside 24 hours!  Absolutely unbelievable.  And, I have been off the medications since the 11th of October.

Ectopic Atrial Rhythm ALL FIXED

What a wild ride.  Hard to sum all of the last seven months up in a blog post.  But, workouts to begin on October 26th, 2020!  And, time to get life back on track.

Diagnosis:  NORMAL SINUS RHYTHM
Prescription:  NONE!  Bye Bye forever.

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