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Finding the right rhythm

Brett's battle with atrial fibrillation (AF) started with running marathons that would eventually result in medical dilemmas. After opting for catheter ablation, he has returned to running with caution, emphasising the importance of trigger awareness for others navigating AF.

Coping through running

For years I had been a long-distance runner as a way of coping with a very stressful job. In September 2015, I felt dizzy and nearly blacked out after only five minutes of running.

I saw Auckland Heart Group and they told me to wear a Holter monitor for a week. My heart rate and rhythm were recorded, providing the medical team with information about my heart rhythm.

The diagnosis was paroxysmal atrial fibrillation (AF) (an irregular heartbeat problem that comes and goes) and atrial flutter with fast ventricular response of 250 beats per minute. I knew my mother and brother had AF, and I had a sister who'd had supraventricular tachycardia (SVT), which is a heart arrhythmia where your heart rate increases very suddenly to over 100 beats per minute.

Challenging treatments and medications

I was started on metoprolol. I cut down to one cup of coffee a day as I had been drinking up to three a day, plus energy drinks sometimes. I still ran though and completed a marathon in 2017 and did trail runs.

In February 2018 I was an hour into a run on a hot day and I thought I was going to die. My heart was going so fast and I was so dizzy and unwell, I thought 'this is it'. I managed to walk home. I was referred to an electrophysiologist (EP) who recommended ablation and he told me what was involved and the various risks.

Discovering triggers

I continued to run (but not as long or fast) but by 2022/23 I was noticing that AF was becoming more frequent and could even be triggered by climbing a flight of stairs or swinging my legs in a warmup.

Alcohol was also not good. After a run and a red wine in October 2022 I felt dreadful and my heart was going all over the place. One Sunday morning (after having a whisky the night before) I was taken to hospital when my heart was going crazy. They found elevated troponin levels and I was started on a high dose of flecainide.

Six weeks later I was having trouble breathing in bed at night and was again taken to hospital. Their conclusion was the flecainide dose was too high and it was halved. I found things a bit easier after that, but in May 2023, after having a few too many cocktails at a party, I was lying in bed and again my heart was all over the place and I thought the grim reaper was very close.

Deciding on surgery

By mid-2023, I had seen the specialist and decided on ablation, a medical procedure designed to interrupt the abnormal electrical circuit. I was then started on Pradaxa (anti-coagulant), as well as staying on the metoprolol and flecainide.

In late July 2023, I had cryoablation of the pulmonary veins, this creates tiny scars to block my irregular electrical signal, causing the AF. I also had radio frequency ablation for atrial flutter, this means using heat.

The main post-procedure hassle was serous ooze leaking from the wound in my groin (where they inserted the wires for the surgery) but that soon cleared up. I didn't do anything for three months and took it pretty easy.

By December 2023 I was off all medication. I started running again but I now take it really easy, only doing 40 minutes about three to five times a week. I watch my stress levels and make sure I'm well hydrated and get plenty of sleep.

I'm very circumspect with alcohol now and drink very infrequently. At most I have one or two standard drinks a week. In some ways, I wish I'd had the ablation sooner. Apart from some ectopics (abnormal heartbeats now and again), my heart seems to be behaving itself.

Advice and outlook

My advice for others who have been diagnosed with AF is take your medication(s) without fail and know your triggers, whether they be alcohol, stress, dehydration, exercise, caffeine or certain foods or climatic conditions (too hot or too cold). Don't give up exercise completely as it is important for your wellbeing, but don't push too hard.

Realise that medications can only go so far and accept medical advice on the best way forward given your lifestyle, age, other health conditions and overall goals.

Try to follow a heart-healthy diet and keep your weight stable and in a healthy zone.

Sooner or later, you’ll have to make a decision on catheter ablation, and deep down it's something you arrive at along with your EP or general practitioner and other health professionals. For me it was the best decision I’ve ever made.

Please note: the views and opinions of the storyteller and related comments may not necessarily reflect those of the Heart Foundation NZ.

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