Exercise Induced Afib

[Rpoole8537]

I've recently been diagnosed with exercise induced Afib. Has anyone else had this diagnosis? What meds have worked that have not effected performance on the bike? What does one do concerning electrolytes? Thanks for your input.

[oldpotatoe]

I've recently been diagnosed with exercise induced Afib. Has anyone else had this diagnosis? What meds have worked that have not effected performance on the bike? What does one do concerning electrolytes? Thanks for your input.

Have you worn the monitor? The MD is sure it's exercised induced?

I have had about 6 instances of AFIB, all converted on their own w/i 24 hours with the 2 standard meds, one for rapid heartbeat, one for irregular heartbeat( don't remember what they are) plus Pradaxa. Only 2 doses.

BUT mine are caffeine/alcohol based....so YMMV. But I'd listen to yer DOC, lotsa of AFIB can equal stroke.

[2LeftCleats]

I have occas. afib which sometimes is induced by exercise. Definitely degrades performance when it happens.

If your heart is otherwise structurally normal you may not need blood thinners, though an aspirin a day isn't a bad idea. I doubt electrolyte imbalance plays much of a role in this assuming they're normal to begin with.

Beta blockers would be the typical thing to slow rapid a fib but may also sap energy and limit your ability to perform at peak output. Diltiazem might help but sometimes impairs cardiac function. A cardiologist might suggest flecainide or sotolol, the latter being a beta blocker with similar issues.

If symptoms are often enough, you might be a candidate for an ablation procedure.

Without more info, it's hard to say more. Best advice is to discuss with cardiology and indicate your preference to avoid performance impairing meds.

[biker72]

I've recently been diagnosed with exercise induced Afib. Has anyone else had this diagnosis? What meds have worked that have not effected performance on the bike? What does one do concerning electrolytes? Thanks for your input.

Yes, back in 1986.
Most folks are just given blood thinners and sent on their way.
I tried virtually everything but nothing worked 100% of the time.
One co-worked had an ablation that worked. Another is on blood thinners.

Beta blockers will slow you down by slowing your heart rate..
Minor crashes can become very serious if you're on blood thinners.
Ablations have the risk of heart damage.

[bobswire]

Have you worn the monitor? The MD is sure it's exercised induced?

I have had about 6 instances of AFIB, all converted on their own w/i 24 hours with the 2 standard meds, one for rapid heartbeat, one for irregular heartbeat( don't remember what they are) plus Pradaxa. Only 2 doses.

BUT mine are caffeine/alcohol based....so YMMV. But I'd listen to yer DOC, lotsa of AFIB can equal stroke.

Same here, coffee/alcohol was the trigger.

[oldpotatoe]

Same here, coffee/alcohol was the trigger.

All things in moderation, I guess. Staying hydrated 'seems' to help, anecdotal, but haven't had an episode for a while, knock on wood. These are no fun.

[DHallerman]

Exercise induced atrial fibrillation?

That's me. Diagnosed in late 2009. Before that, didn't understand why sometimes -- and then often -- on rides, after some exertion, my strength, which seemed like my breathing, disappeared. And for hours afterwards, I could only limp (figuratively) home. I thought it was my asthma, but it wasn't.

So late that year, and in early 2010, my cardiologist tried a mix of drugs and shocking the heart. Neither got rid of my afib. So he suggested that I get a catheter ablation operation, a minimally invasive step in that they don't cut you open, but just go through veins that start at the groin.

He also said that no one in Westchester did the operation -- which is still relatively new for afib, if not other heart conditions -- but that the three major university hospitals in NYC were the places to go.

So in February 2010, I had a catheter ablation operation at NYC-Langone. Took 7 hours, they said, but that's mainly because they need to be very careful working on a beating heart.

And it's been successful. No more the symptoms and problems I had before, and cycling is now good. Heck, the doctor who did the operation said that physical exercise is the best thing for recovering, after a few weeks that is. And the only drug I'm on now for it is one 81g aspirin per day, basically as a preventative for stroke (which bad afib can bring on).

If you have any questions, send me a PM.

Dave, who also had neck surgery in June 2010 so he thinks of that as quite a year

[bobswire]

All things in moderation, I guess. Staying hydrated 'seems' to help, anecdotal, but haven't had an episode for a while, knock on wood. These are no fun.

No fun at all, since it affects your sleep which in turn causes stress and stress can be a trigger too. I gave up both coffee and alcohol, seems I can drink black tea in moderation. I substitute earl grey tea for coffee but no more than 2 cups a day,the rest of the day herbal teas. I can pretty much keep it in control nowadays. I've dealt with it for over 25 years.

[climbgdh]

I was diagnosed with Afib back in 2006 after a first episode during a mountain running race where my heart rate reach 250 bpm. it took my doc several months to diagnose it because my episodes were very infrequent but eventually he as able to capture an event via holter monitor. had my first ablation in 2007 which was unsuccessful but gave me about 9 months of relief. had a second ablation in 2010 which again was unsuccessful and a third one in april of 2013. so far in the 16 months since last ablation i have not had any episodes (touching wood!!). my doctor tried just about every medication...... can't remember all of them. beta blockers were really NOT FUN and severely affected my ability to do the endurance activities that i love so much...... and hence i chose a third ablation. mine initially started as being exercise induced but then it became a regular occurrence ..... exercise or not. it really affected my exercise habits and i basically had to stop any hard workouts for 3-4 years which really had a negative mental effect. now i'm off all medication and gradually..... ever so slowly getting my endurance back. the only definite trigger i could point a finger at was being overtired. i went coffee & alcohol free for about 8 months and it had no impact that i could tell. if i got overtired i could easily push myself into Afib. my cardiologist hopes i get several years of success out of the last ablation and so far so good. there is plenty of great resources online about Afib. It seems to be a regular occurrence for endurance athletes. BTW....... i was diagnosed at the age of 41 and at the time was in the best shape of my life. best of luck.

[SoCalSteve]

Almost 3.5 years after having an 8 hour ablation and I am AFIB free!

Had it for 10 years before that...tried all drugs, nothing really worked and, if anything, made exercising no fun at all.

Get the procedure, it's well worth it.

[Clydesdale]

After several episodes I got a scan and confirmed afib. Diagnosing doc said mine was a little unusual in that it only raised my pulse to about 65 and often lasted 2-3 days per occurrence. All I know was it felt like crap to have it. Riding was tough but if I could get my heart rate up I could sometimes get back in rhythm as I cooled down. I've since learned that was probably not a good solution? Doc took me off caffeine and started a daily aspirin and very low dose beta blocker. Cardiologist said caffeine and beta blocker probably wouldn't do much, but I haven't really had side effects and the few episodes I have had since then all happened when I cheated on the caffeine so I've stuck with it.

I possibly notice the Beta blocker's effect on the upper end of my heart rate but I don't think I lost much overall. Maybe I can sprint slightly shorter than before but not much? I also notice that even on aspirin I bleed much more than I used to... and I miss caffeine.

[rnhood]

Almost 3.5 years after having an 8 hour ablation and I am AFIB free!

Had it for 10 years before that...tried all drugs, nothing really worked and, if anything, made exercising no fun at all.

Get the procedure, it's well worth it.


Same here. I had it for 9 years off and on and the docs put me through numerous drugs - all in the long run to no avail. I refused to take any more drugs and told the doc that I wanted my heart beating normally or not at all...period. So I had an ablation.

No more afib.

It appears to me that the medical establishment in general doesn't want to do much other than prescribe drugs - until you consistently complain that your lifestyle is screwed up.

[Louis]

a first episode during a mountain running race where my heart rate reach 250 bpm

This reminds me of the end of nearly all of my rides. I have a tough hill that I do 95% seated, then at the very end there's a last rise that I do standing. Nearly every time on that last section my Polar HRM goes bananas and flashes 240 bpm (I have the limit set at 180, above which it flashes).

I've always attributed that jump from the mid-170's or low 180's to 240+ to electromagnetic interference from utility stuff by the side of the road. Maybe next time I should stop and physically take my pulse to see if it's anywhere near 200+. (shortly after I crest the rise everything settles down and the display goes back to high 170's then even lower as I recover).

I could also stop on the way down, and see if the HRM goes crazy when I'm going in the opposite direction, and am not working hard. If if never trips in that direction that might mean something (bad).

[malcolm]

Same here. I had it for 9 years off and on and the docs put me through numerous drugs - all in the long run to no avail. I refused to take any more drugs and told the doc that I wanted my heart beating normally or not at all...period. So I had an ablation.

No more afib.

It appears to me that the medical establishment in general doesn't want to do much other than prescribe drugs - until you consistently complain that your lifestyle is screwed up.

Trust me the doc makes way more money off the procedure. And contrary to popular belief most of us only want what's best for you.

[rnhood]

Trust me the doc makes way more money off the procedure. And contrary to popular belief most of us only want what's best for you.

Its not a money thing Malcolm, I think its a risk thing. And its understandable to a degree. If a person is very willing to give up athletics and maybe other things to mitigate afib, I suspect their doc will be happy to oblige and prescribe medicine. If, due to other medical conditions, age or whatever, there is an elevated risk with ablation then probably medicine will also make sense. We are all different, as are afib cases.

I just didn't want medicine and otherwise (or fortunately) wasn't considered a significant risk within my overall health status.

[SoCalSteve]

When the medicine REALLY didn't do anything but make me miserable, spacey, etc...I insisted on the procedure.

I think the risk to lifestyle gains make the procedure definitely worth it. For me the drugs started out doing very little and in the end, did nothing at all.

On a side note, I now drink coffee in the morning ( which I love ) and have a bourbon most nights. I NEVER did either one of those things before the procedure for fear of setting off the afib.

Even though you are under for about 7-8 hours, you go home the next day. The worst part is the catheter removal....ouch!

[malcolm]

Its not a money thing Malcolm, I think its a risk thing. And its understandable to a degree. If a person is very willing to give up athletics and maybe other things to mitigate afib, I suspect their doc will be happy to oblige and prescribe medicine. If, due to other medical conditions, age or whatever, there is an elevated risk with ablation then probably medicine will also make sense. We are all different, as are afib cases.

I just didn't want medicine and otherwise (or fortunately) wasn't considered a significant risk within my overall health status.

Sorry probably overreacted, sensitive area. The risk of ablation is really not that great although all procedures carry risks. Depending on the antidysrhythmic they may have even more risk. We are generally trained to go the least invasive route. I agree consideration of lifestyle should be important. For me personally if I were in that position if ablation were an option I would do it in a heartbeat.
Cheers,
Malcolm

[biker72]

Sorry probably overreacted, sensitive area. The risk of ablation is really not that great although all procedures carry risks. Depending on the antidysrhythmic they may have even more risk. We are generally trained to go the least invasive route. I agree consideration of lifestyle should be important. For me personally if I were in that position if ablation were an option I would do it in a heartbeat.
Cheers,
Malcolm

I'm one of the 10-15% that the ablation didn't work and wound up with a little heart damage. I was made aware of the risk and elected to give it a try.

[biker72]

Even though you are under for about 7-8 hours, you go home the next day. The worst part is the catheter removal....ouch!

I remember it well....:)

[climbgdh]

Trust me the doc makes way more money off the procedure. And contrary to popular belief most of us only want what's best for you.

I know not all docs are created equal but mine definitely steered me towards ablation because he knew it was greatly affecting my lifestyle. It also helped that he is an athlete himself. He did prescribe various drugs but really only as a stop gap...... The end game was always the ablation but because I live in canada I had to wait a few months for the procedure. I did have one procedure done in the US and for that one they used conscious sedation...... WEIRD!!! I remember the entire experience..... And periodically had to ask the nurse for more sedation because when they began burning the nodes in my heart the pain was very intense and highly unpleasant. The next 2 ablations I was completely under and overall it was a much better experience. That being said I hope I don't have to go through another one.

[oldpotatoe]

Sorry probably overreacted, sensitive area. The risk of ablation is really not that great although all procedures carry risks. Depending on the antidysrhythmic they may have even more risk. We are generally trained to go the least invasive route. I agree consideration of lifestyle should be important. For me personally if I were in that position if ablation were an option I would do it in a heartbeat.
Cheers,
Malcolm

Doc humor

[malcolm]

Doc humor

Didn't think anyone would pick up on that.

[Rpoole8537]

I started this thread three months ago, and since that time my afib and Aflutter became quite serious. After three trips to ER, I had an ablation two weeks ago. So far, so good. It was six hours long but doctor said he wanted to be sure he had done all he could do. Tests conducted while I was still under produced no nerve activity. I hope to take my first ride tomorrow in sunny but cold SC. Keeping my fingers crossed.


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[Louis]

Just out of curiosity, post-surgery have you done any tests under medical supervision? I'm thinking something like riding a stationary bike or running / walking fast on a treadmill while they have you all instrumented so they know what's happening?

[Md3000]

Good luck, don't leave us hanging for a few days for a ride report!!!

[dekindy]

Hope all goes well and don't ride alone!

[cderalow]

I was diagnosed with sporadic paroxysmal atrial fibrillation about 5 years ago.

My cardiologist didn't prescribe any meds to help control it, but did teach me several tricks to help get my random episodes under control.

The other thing he recommended was to keep my blood pressure up to avoid potentially fainting from the initial drop when the episodes start.

I've had it happen once on the trainer without any ill effect. Once on the road during a group ride spooked me and I crashed as I was stopping/unclipping and did a number on my NDS heel on the chainrings somehow.

But otherwise it hasn't happened on the bike.

[numbskull]

The risk of ablation is really not that great although all procedures carry risks. Depending on the antidysrhythmic they may have even more risk.

A complicated subject.

The overall major complication rate for each round of AF radiofrequency ablation (significant numbers of patients require several attempts) is published at 4.5 %. http://www.medscape.com/viewarticle/752625. It does not include lifetime fatal cancer risk which is also a concern because of the long radiation exposure times although newer equipment is reducing that. This is harder to quantitate although one study felt it was fairly small ( 0.1-0.2%). The procedure fails about 25% of the time. The long term outcomes of patients who have received RFA for AF is still not well established since the procedure has gained widespread use only in the last decade. The techniques are also still evolving and there is reason to expect that the procedure will become more successful and less risky in the future.
.

Likewise anti-arrhythmic treatment is associated with a risk of pro-arrhythmia (i.e., inducing more dangerous arrhythmias than the one being treated) that can result in death. That risk is lowest in otherwise healthy individuals, but it is not zero. Anti-arrhythmic drugs also fail to control the problem as much as 50% of the time ( though do better in healthier/younger individuals).

Anticoagulation (meds that "thin"the blood more than aspirin) is often needed as patients become older or have other medical conditions such as diabetes or hypertension and carries a 1:100-200 per year risk of major bleeding complication. Such risk is obviously cumulative over time.


There is no "best" treatment for AF. It depends on the individual and their response both to AF and medicines. If a patient has few symptoms, living with AF (and often taking a blood thinner) is usually advised. If the patient has limiting symptoms then rhythm control using anti-arrhythmic drugs is generally advised as the next step. If this is unsuccessful then radio-frequency ablation is usually recommended. Jumping straight to RFA, which has the highest short term risks, is generally discouraged but becoming more common......albeit in the absence of long term clinical trials supporting such an approach.

[pjmsj21]

Funny that I just read this post tonight after today's stress echo for a couple of months of dealing with Afib. My cardiologist had me Metoprolol and Flecainide which seems to have gotten things slowed down and more regular. I have not been riding very regularly at all for a host of reasons including travelling and some really crappy weather.

I really don't have anything to add to these great comments and many of you have more experience dealing with this than I do. So far the Metoprolol hasn't seemed to affect my riding and I am anxious to get more time on the bike....or the Computrainer if need be.

Pat Mc

[Rpoole8537]

I took my first ride outdoors after my ablation. My doctor has me taking Tikosyn, so my HR is still suppressed. I forgot to take my monitor as I was trying to beat the rain, but I could tell that it was under 100 bpm. I rode a spin bike on Saturday and even when I pushed, I was in the low 90's. It was a small push, not a full tilt effort. I will come off the Tikosyn in 4-6 weeks. At that time, I will know more. I had no choice on whether or not to opt for the ablation. Meds did not work at all. This is definitely not where I thought my health would be after 35 years of endurance sports. (I had Afib and Aflutter.) I'm hopeful I can cruise around the farmland in Upstate SC for five to ten more years.


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[DHallerman]

This is definitely not where I thought my health would be after 35 years of endurance sports. (I had Afib and Aflutter.)

It's ironic, isn't it.

I remember the cardiologist (electrophysiologist) who did my ablation -- ran the team that did it -- said that afib is not uncommon among people who do endurance sports. He explained, too, that because people who do endurance sports are in better shape, the symptoms of afib tend to come on later than in those in lesser shape.

But that same thing, years of endurance sports, will help your recovery and here's hoping more strength to you, for you, with time.

[oldpotatoe]

It's ironic, isn't it.

I remember the cardiologist (electrophysiologist) who did my ablation -- ran the team that did it -- said that afib is not uncommon among people who do endurance sports. He explained, too, that because people who do endurance sports are in better shape, the symptoms of afib tend to come on later than in those in lesser shape.

But that same thing, years of endurance sports, will help your recovery and here's hoping more strength to you, for you, with time.

My heart quack said the same thing. Not uncommon with active, healthy, middle aged males.