Fit to Drop? Atrial fibrillation in athletes

Wednesday, 18 September 2019

Atrial fibrillation is a condition where the upper chambers of the heart, the atria, quiver rapidly rather than beating properly in rhythm with the ventricles. Blood is no longer circulated efficiently around the body and risks pooling in a small pouch within the heart called the left atrial appendage. Here it can thicken or become ‘sticky’. If dislodged, this blood mass can be transported to the brain and cause a stroke.

In younger athletic individuals, the problem can arise as a result of their lower resting heart rate. The long interval between beats (called an increase in ‘sympathetic tone’) can predispose atrial fibrillation and is sometimes coupled with ‘remodeling’ of the heart, which also can contribute to atrial fibrillation prevalence. This reason, amongst others, is why CVS regularly monitors the heart health of many high-performing sports teams and athletes.
Ian, a cardiac sonographer was 23 and playing a lot of footy. During a big sporting weekend he suddenly felt his heart ‘take off’, describing it as being ‘like a blowfly in jar’. He was also experiencing shortness of breath, light-headedness to near-collapse and vomiting. He wrote it off as a side-effect of stress, and went to work as normal on Monday. When he got out of breath though with the exertion of eating his lunch, Ian knew something was seriously wrong. After an ECG, it became clear Ian was in atrial fibrillation and Echocardiologist Dr Philip Currie took over.

Firstly, Ian had to have a transesophageal echocardiogram – a specialized ultrasound to look within the heart at a much higher resolution – to ensure a clot hadn’t already formed within his heart as a result of the atrial fibrillation, as shocking his heart back into rhythm could have dislodged it with dire consequences. Fortunately this wasn’t the case.

Once returned to normal heart rhythm, Ian still needed treatment for the problem to minimize future risk. This has been complex, including blood thinners and other medication, pulmonary vein isolations (ablation) – a procedure to scar or destroy the heart tissue that generates ectopic electrical signals and insertion of a loop recorder under his skin – a USB-sized device to record any further arrhythmias.

While the problem is now managed, Ian is very aware of triggers that can set palpitations off again, including dehydration, sleep deprivation and stress, so lifestyle management is now part of his regime. He will also remain at higher risk of such episodes in the future, having shown a predisposition towards atrial fibrillation.
If you, or someone you’re with is having sustained heart palpitations along with symptoms such as those Ian experienced, you should seek urgent medical assistance.