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Who is Dr. John Day?

Dr. John Day is a cardiologist specializing in the treatment of atrial fibrillation and other abnormal heart rhythm conditions at St. Mark’s Hospital in Salt Lake City, Utah. He received his medical degree from John Hopkins and completed his residency and fellowships in cardiovascular medicine and cardiac electrophysiology at Stanford University. Dr. John Day is board certified in cardiology and cardiac electrophysiology.

Since 2004, Dr. John Day has appeared as a health expert on all of the major television networks. For several years he had a weekly television segment on the CBS affiliate in Utah. Over 65,000 people now follow him through his newsletter, blog, or social media channels.
In 2017 Dr. John Day published his first book, The Longevity Plan. This book went on to become an Amazon number one best seller and was named best books of 2017 by the Huffington Post.
In 2021 Dr. John Day published his second book, The Atrial Fibrillation Cure which was also an Amazon best-seller and was the top selling book in the entire cardiovascular space for over two months.
In addition to his books, Dr. John Day is the prolific author of more than 100 studies that have been published in many of the most prestigious scientific and medical journals. He also is the founding editor-in-chief of the Innovations in Cardiac Rhythm Management medical journal.
Dr. Day is also a researcher and pioneer in the field of electrophysiology, with a patent on technology that allows physicians to map the source of atrial fibrillation three-dimensionally.

https://drjohnday.com/

Podcast Summary Notes

“Long time, competitive endurance athletes have a higher risks of AFib, which is a marker of premature aging. The faster you solve AFib, the better your long-term outcome. Ablation technologies have come a long way….success rates of 80-90% can be expected.”

What is atrial fibrillation? (https://www.cdc.gov/heartdisease/atrial_fibrillation.htm)

Atrial fibrillation (AFib or AF) is the most common type of treated heart arrhythmia. An arrhythmia is when the heart beats too slowly, too fast, or in an irregular way.
When a person has AFib, the normal beating in the upper chambers of the heart (the two atria) is irregular, and blood doesn’t flow as well as it should from the atria to the lower chambers of the heart (the two ventricles). AFib may happen in brief episodes, or it may be a permanent condition.

Cardiologist vs. Cardiac electrophysiologist (EP)?

To become an EP takes an extra 2 years of trining. EP’s deal with every electrical related to the heart. Treatments: ablation, pacemakers, etc.

What is the connection between AFib and long-time endurance athletes?

It is true. There is a U shaped curve with both ends having a higher than average risks: a couch potato on one end and the highly competitive athlete (very long endurance events and/ or maximum heart rate races) on the other. The more races you do, the more risk you may have…up to 4-5 times higher.
Lowest risk? Regular, modest exercise.

Why AFib for older athletes?

High sustained heart output….stress on the heart for too long might be a cause. Perhaps related to the very low heart rates of the athlete when at rest.
The heart is a pump with valves. Scarring on the heart can take place with athletes…just over using the heart somehow. Little areas of micro scarring …could it be related to blood flow issues, maybe. Maybe the level of cardiac output is just too high, and some people are subsetible to this damage.
Still, the risks to inactive people is higher than for athletes, even though the long-time, competitive athlete has a higher risk than the average person who exercises regularly but modestly.
How common is AFib? 40-50% higher risk up to multiples higher. About 1 in 4 people in US will have some AFib in their lives.

What increases risk? Chronic risk of repeated AFib episodes

Extremely long endurance races
Extremely high HR racing
Family history of AFib (20-30% of cases)
Caucasian have a higher risk
Overweight is more likely….causes higher stress on heart
Diet plays a role. Fast food, over eating, greasy food can increase risks AND be triggers of episodes
Aging…the older you get the higher the risk

Short term triggers of AFib episodes

Alcohol can trigger Afib even in young people with zero other risks
High stress
Caffeine? No, not a trigger, but cut back if you feel sensitive.
Energy drinks, yes!
Exercising in dehydrated or electrolyte (magnesium and potassium) depleted state

AFib begets AFib

— don’t let episodes continue. Heart scars more quickly when you are having episodes…and more scaring means more episodes. And get the AFib to go into remission.
Put it in remissionLose weight. Back off of the extreme athletics. Get an ablation to avoid medications which compromise athletic performance. In general, slow the aging process: optimize nutrition, keep weight in check, optimizing sleep, managing stress, regular exercise while hydrated but not too much or too hard.

AFib is a marker of premature aging. A marker of a person who hasn’t taken care of themselves enough given their genetic status.
Cardiac output drops 20-30% when you are in AFib. And the poor beating leads to blood clots that can kill you. Heart failure is another potential consequence.

Ablation

Out-patient surgery. Run catheter up a leg vein. Surgery over in 2 hours, patient observed for 3 hours, and then back home. About 5 days until returning to full activity. It’s not major surgery; well tolerated. The technology is improving all the time; fewer and fewer people don’t respond well. Sometimes a 2nd session is necessary, but rarely.

Younger (30-40 yo) get 90-95% success rate
Older people — 80-90% successBetter for men, but even women get fantastic results. If they don’t go crazy with risk factors, they don’t get it again.

Just to be safe, people should be prepared to shutdown AFib episodes if they do happen.

Everyone is different, and they should work with Dr’s to figure out what is beset for them.
Wearables: Apple Watch and many others have AFib detection software that is very good. Do that. Don’t worry about the super high tech AFIb trackers…an EP wants to see the tape, not a blip on a device.
Stay hydrated
Take a nap…or go to bed
Exercise to stop a low HR AFib episode (check with DR)
Do some meditation
Bear down, cough — vegal tone
“Pill in the pocket” — work with your dr. Take it only when the rare episode pops up to stop it to avoid a trip to the ER
If all else fails, go to the ER to get the heart shocked back into rhythm.

Right side vs. left side sleeping

Most AFib patients sleep on right side to minimize the sensation of heart palpitations
Maybe left side sleeping contributes to AFib but maybe not. Certainly makes the sensation more noticeable.

AFib and Sleep Apnea

Sleeping on back is bad for Apnea and AFib
Apnea makes is 4x higher risk of AFib
Oxygen levels can fall into 70% range
Many times solving sleep apnea causes AFib to go into remission.
T-shirts with a pouch for a tennis ball to teach you to not sleep on back.

Final Advice from Dr. Day:

For the competitive athlete who cannot give up the extreme exercise and they have done everything else right. Don’t be afraid of ablation. The sooner they get treated, the better their long-term success rate

Two books written by Dr Day:

Newsletter, podcast, blog on Website: drjohndaymd.com

Previous Episodes on AFib:

Episode #10 – Endurance Athlete’s A-Fib, Part 1
Episode #11 – Endurance Athlete’s A-Fib, Part 2

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