For two years ago a had some unusual heart rhythm issues.
Extra beats, heart rate wouldn't drop to normal levels after the effort would end.
After the ride ended I had extra beats, but after a few hours the heart rate would be normal.
In 2024 I went on a 200kl brevet with 2600m climbing that I couldn't complete.
The uphill that I usually do without stopping I was forced to stop 5-7 times on that particular Brevet.
As soon as I started my pulse would go up to 130 bpm and stay there no matter what the effort was.
Eventually, even on the flats I had to frequently stop. I abandoned the brevet at 120k.
I continued to have these occasional arrythmias, but my efforts on uphill were more or less the same. Resting pulse was at 52 bpm.
Every year in December I would go to my cardiologist ECG and ultrasound. No Afib was detected.
In June 2025 my resting pulse increased to 72 bpm from 52, and on the flats with a usual pulse of 100-105 bpm it increased to 125 bpm constant. On the uphill my pulse would increase to
40-150 bpm, but when the effort ended the rate would drop only to 125 bpm and stay there.
I went to my cardiologist and the ECG showed Afib.
He put me on a beta blocker and anticoagulant, and then I did a cardioversion that lasted 2 days.
Then I started the flecainide 100mg twice a day, and stopped the beta-blocker which was reducing my resting pulse below 50 bpm.
Since then I have not had any Afib, and my resting pulse is back to normal 52 bpm.
I am riding medium to hard (Z4) on the uphill sections, and normalized power has not dropped in the last 6 months.
However, I cannot raise my heart rate above 145-150 bpm, and at 140 bpm the effort seams much more than it use to be.
My pulse drops to normal levels of 80 bpm when the effort is completed.
The cardiologist recommended that I should stay on flecainide 100mg twice a day and the anticoagulant since it seems to be working.
All the above history is to lead up to the following visit I had recently with the electrocargiologist.
None of the cardiologists had mentioned anything about a pacemaker.
Recently, I went to an electrocargiologist and he said that if I stayed on flecainide after 5 years I would definitely need a pacemaker. Since I am in good shape he wouldn't recommend going down that path.
Instead, he recommended halving the flecainide, and see what happens. If the Afib does not return try eliminating it completely. If the Afib returns which there is a high possibility as the age increases an ablation would be a better choice.