ABOUT 'BEAT YOUR A-FIB'...


"This book is incredibly complete and easy-to-understand for anybody. I certainly recommend it for patients who want to know more about atrial fibrillation than what they will learn from doctors...."

Pierre Jaïs, M.D. Professor of Cardiology, Haut-Lévêque Hospital, Bordeaux, France

"Dear Steve, I saw a patient this morning with your book [in hand] and highlights throughout. She loves it and finds it very useful to help her in dealing with atrial fibrillation."

Dr. Wilber Su Cavanaugh Heart Center, Phoenix, AZ

"Your book [Beat Your A-Fib] is the quintessential most important guide not only for the individual experiencing atrial fibrillation and his family, but also for primary physicians, and cardiologists."

Jane-Alexandra Krehbiel, nurse, blogger and author "Rational Preparedness: A Primer to Preparedness"



ABOUT A-FIB.COM...


"Steve Ryan's summaries of the Boston A-Fib Symposium are terrific. Steve has the ability to synthesize and communicate accurately in clear and simple terms the essence of complex subjects. This is an exceptional skill and a great service to patients with atrial fibrillation."

Dr. Jeremy Ruskin of Mass. General Hospital and Harvard Medical School

"I love your [A-fib.com] website, Patti and Steve! An excellent resource for anybody seeking credible science on atrial fibrillation plus compelling real-life stories from others living with A-Fib. Congratulations…"

Carolyn Thomas, blogger and heart attack survivor; MyHeartSisters.org

"Steve, your website was so helpful. Thank you! After two ablations I am now A-fib free. You are a great help to a lot of people, keep up the good work."

Terry Traver, former A-Fib patient

"If you want to do some research on AF go to A-Fib.com by Steve Ryan, this site was a big help to me, and helped me be free of AF."

Roy Salmon Patient, A-Fib Free; pacemakerclub.com, Sept. 2013


exercise

My Top Articles About Exercise and Atrial Fibrillation

My Top 3 Articles - Exercise and A-Fib 400 sq at 96 resby Steve S. Ryan, PhD

When you develop A-Fib, you have to think seriously about changing your exercising routine. In general, you want to do whatever you can to stay active and exercise normally. Review these articles to help you determine the right choices for you.

1. Exercising During an Episode: “When I’m having A-Fib symptoms, should I go ahead and exercise as I would normally?

2. Returning to “Normal” Exercise Level: “I love to exercise and I’m having a catheter ablation. Can I return to what’s ‘normal’ exercise for me? 

3. Exercise to Improve Circulation: “Is there any way I can improve my circulation, without having to undergo a Catheter Ablation or Surgery?

Do Whatever You Can to Stay Active

Having Atrial Fibrillation doesn’t mean you have to stop exercising, but you have to be smart about it. (In some people, light exercise helps get them out of an A-Fib attack. In others, like me when I had A-Fib, exercise makes it worse.) Do whatever you can to stay active even though you have A-Fib.

Additional Resources

Guide to DIY Heart Rate Monitors: A-Fib patients sometimes want to monitor their heart rate and pulse when exercising. A consumer ‘DIY” monitor can be useful. Continue reading…

Lessons You Can Learn About Intense Exercise: Why Elite Athletes Develop A-Fib. Continue reading…

Intense Exercise: Lessons from Elite Athletes

Intense athletes have to face the fact that they’re more at risk of developing A-Fib and conditions like small heart injuries and fibrosis, and need to monitor their heart health more carefully.

That doesn’t mean you have to stop running or working out, but you have to be smart about it. Did you give yourself enough time to recover after the last race? What did the EP tell you about your overall heart health? Are you taking time to rest, sleep, and decrease other stressors in life?  Is your diet a healthy one, centered on whole foods?

‘Knowing your heart’ is the best tool in prevention. Understand your heart rate: your normal rate at rest, early in exercise, during peak exercise, and in recovery. For more, read my article, Intense Exercise and A-Fib: Lessons from Elite Athletes.

 

FAQs A-Fib Ablations: Exercise Level Post-Ablation

 FAQs A-Fib Ablations: Exercise Level 

Catheter Ablation

Catheter Ablation

18. “I love to exercise and I’m having a catheter ablation. Everything I read says ‘You can resume normal activity in a few days.’ Can I return to what’s ‘normal’ exercise for me?”

Caution would say to start off slow, then work your way up. You could get a Polar (or other) heart rate monitor to keep track of your heart rate.

Your heart is considered healed from the scarring of the ablation after three months (possibly sooner). Often you feel so good being in sinus rhythm after an ablation, that you can’t wait to exercise, to do something physical.

But even though you feel great, it’s better to be prudent and rein yourself in for a short while.

Ed Webb, a very active exerciser, shares his experiences and insights. Ed writes:

“It seems the prevailing opinions seem to lean toward resuming normal activities a week to two weeks after the procedure. In fact that’s what my EP had recommended for me (the first time around). I started light walking and cycling, but unrelated to these activities I also was doing some outside work on my boat (during the fall here in Florida where it can be putrid).

On two separate occasions–I happened to be wearing a heart rate monitor–my heart was a comfortable 85 BPM and then WHAM back into A-Fib!

As I am one of those persistent A-Fibbers, I had to be cardioverted both times. This all happened within a span of 3 weeks after the procedure. Needless to say, I was somewhat discouraged thinking the ablation had been a failure.

My EP wasn’t too concerned and just advised me to hang in there. After the second cardioversion, I finally got the hint and took it really easy for the next month, after which I started a walking regimen where I allowed my heart rate to increase from 80 BPM on the first day up to 100BPM at an increase of 1 beat per day.

Once I hit the magic 100, I got back on the bike and picked it up from there and was fine after that (until 2 years later when I had another onset!). The bottom line is I think this all had to do with not allowing enough time for the scar tissue to heal.

My second time around (which was 2 years ago) I pretty much stuck to the same routine. First two weeks, absolutely nothing. Then easy walks allowing my heart rate to increase a little each day. I walked for a month (starting at 80 and finishing at 105).

After 6 weeks or so, I was back on the bike and doing maximum efforts by the end of 3 months. I have been in sinus rhythm ever since (that sound you hear is me knocking on my desk!)

Anyway, I hope this gives you at least one perspective for your recovery. All the best for your procedure.”—Ed Webb

Thanks to Monique Van Zeebroeck for this question and to Ed Webb for sharing his experiences and insight.

Return to FAQ Catheter Ablations

FAQs A-Fib Treatments: Catheter Ablation Procedures

Catheter ablation illustration at A-Fib.com

Catheter ablation

Atrial Fibrillation patients seeking a cure and relief from their symptoms often have many questions about catheter ablation procedures. Here are answers to the most frequently asked questions by patients and their families. (Click on the question to jump to the answer)

1. “I have a defective Mitral Valve? Is it causing my A-Fib? Should I have my Mitral Valve fixed first before I have a PVA?

2. “With the recent improvements in Pulmonary Vein ablation techniques, should I wait for a better technique? I’m getting by with my Atrial Fibrillation.”

3. “Are there different types of “Pulmonary Vein Ablation”? Are they different from “Pulmonary Vein Isolation?

4. I’’ve heard of Cryo (freezing) catheters for PVA(I) ablations. Are they good or better than the RF (Radio Frequency) catheters for ablations?

5. “How dangerous is a Pulmonary Vein Ablation procedure? What are my risks?

6. “During the ablation procedure A-Fib doctors actually burn within the heart with RF energy. How does this burning and scarring affect how the heart functions? Should athletes, for example, be concerned that their heart won’t function as well after an ablation?

7. “How dangerous is the fluoroscopy radiation during an ablation? I know I need a Pulmonary Vein Ablation (Isolation) procedure to stop my A-Fib—A-Fib destroys my life. I can’t work or exercise, and live in fear of the next attack. Antiarrhythmic meds cause me bad side effects. But I’m worried about being exposed to radiation during the ablation.

8. “I have serious heart problems and chronic heart disease along with Atrial Fibrillation. Would a Pulmonary Vein Ablation help me? Should I get one?

9. “What is an enlarged heart? Does it cause A-Fib?. I was told I can’t have a Pulmonary Vein Ablation (Isolation) procedure because I have an enlarged heart. Why is that?”

10. “I am 82 years old. Am I too old to have a successful Pulmonary Vein Ablation? What doctors or medical centers perform PVAs on patients my age?

11. “Since my PVI, I have been A-Fib free with no symptoms for 32 months. What do you think my chances of staying A-Fib free are?”

12. “How long before you know a Pulmonary Vein Ablation procedure is a success? I just had a PVA(I). I’ve got bruising on my leg, my chest hurts, and I have a fever at night. I still don’t feel quite right. Is this normal?”

13. I want to read exactly what was done during my Pulmonary Vein Ablation. Where can I get the specifics? What records are kept?

14. “What is the typical length of a catheter ablation today versus when you had your catheter ablation in 1998 in Bordeaux, France? What makes it possible?

15. “After my successful Pulmonary Vein Ablation, do I still need to be on blood thinners like Coumadin or aspirin?

16. “I’ve had a successful ablation. For protection against potential stroke risk if my A-Fib re-occurs, which if better—81 mg baby aspirin or 325 mg?

17. Since my ablation, my A-Fib feels worse and is more frequent than before, though I do seem to be improving each week. My doctor said I shouldn’t worry, that this is normal. Is my ablation a failure?

18. “I love to exercise and I’m having a PVA. Everything I read says ‘You can resume normal activity in a few days.’ Can I return to what’s ‘normal’ exercise for me?

19. I have Chronic Atrial Fibrillation (the heart remains in A-Fib all the time). Am I a candidate for a Pulmonary Vein Ablation? Will it cure me? What are my chances of being cured compared to someone with Paroxysmal (occasional) A-Fib?

20. “I’m 80 and have been in Chronic (persistent/permanent) A-Fib for 3 years. I actually feel somewhat better now than when I had occasional (Paroxysmal) A-Fib. Is it worth trying to get an ablation?

21.“Will an ablation take care of both A-Fib and Flutter? Does one cause the other? Which comes first A-Fib or Flutter?

22. Are there other areas besides the pulmonary veins with the potential to turn into A-Fib hot spots? I had a successful catheter ablation and feel great. Could they eventually be turned on and put me back into A-Fib

23. “During an ablation, how much danger is there of developing a clot? What are the odds? How can these clots be prevented?

24. “I was told that I will have to take an anticoagulant for about 2-3 months after my ablation. After all, if fibrillation episodes are reduced or eliminated after an ablation, shouldn’t there be even less need for a prescription anticoagulant rather than more?

25. “I’m six months post CryoBalloon ablation and very pleased. But my resting heart rate remains higher in the low 80s. Why? I’ve been told it’s not a problem. I’m 64 and exercise okay, but I’ve had to drop interval training.”

26. “I’ve heard good things about the French Bordeaux group. Didn’t Prof. Michel Häissaguerre invent catheter ablation for A-Fib? Where can I get more info about them? How much does it cost to go there?

27. “I’m a life-long runner. I recently got intermittent A-Fib. Does ablation (whether RF or Cryo) affect the heart’s blood pumping output potential because of the destruction of cardiac tissue? And if so, how much? One doc said it does.

Last updated: Thursday, September 8, 2016

Return to FAQs

FAQs from Newly Diagnosed Patient

You are not alone. A-Fib.comFrequently Asked Questions by Newly Diagnosed Patients

Newly diagnosed Atrial Fibrillation patients have many questions about living with A-Fib. These are answers to the most frequently asked questions by patients and their families. (Click on the question to jump to the answer)

1.  My doctor says I had an attack of A-Fib. How much trouble am I in?

2.  Did I cause my Atrial Fibrillation? Am I responsible for getting A-Fib?

3.  “Could my A-Fib go away on its own? I don’t want to take any medication. Can I just wait and see?”

4.  “Is Atrial Fibrillation a prelude to a heart attack?

5.  “Can I die from my Atrial Fibrillation? Is it life threatening?”

6.  “Is Atrial Fibrillation curable? Or can you only treat or control it? Should I seek a cure?

7.  “Is there a diet I could follow which would cure my A-Fib?

8.  “Should I cool my sex life? Can I exercise if I have Atrial Fibrillation? Should I exercise?

9.  “I have a lot of stress at work. Does this stress cause or trigger my A-Fib?”

10. “Can I drive my car if I have Atrial Fibrillation?

11. “Is drinking coffee (tea, colas, other products with caffeine) going to make my A-Fib worse or trigger an A-Fib attack?

12. “Is there anything I can do to get out of an A-Fib episode? How do others deal with their episodes?

13. “Should I carry a wallet card or a medical ID? I have A-Fib and take Coumadin. In case of an A-Fib emergency, what information should I include?

14. “I live in fear of my A-Fib. I never know when I’m going to get an A-Fib attack or how long it will last. How do I deal with the anxiety? 

15. “Should I see a cardiologist for my A-Fib and not just my primary care doctor? He wants to prescribe medication. Should I also see a specialist?”

Last updated: Monday, July 13, 2015

Return to Frequently Asked Questions

FAQs Coping With Your A-Fib Day-to-Day Issues

FAQs A-Fib afibFAQs Coping With Your Atrial Fibrillation: Day-to-Day Issues

Coping with your Atrial Fibrillation means a patient and their family have many and varied questions. Here are answers to the most frequently asked questions about dealing with the day-to-day issues of having Atrial Fibrillation. (Click on the question to jump to the answer.)

1.  I like my cardiologist, but he has not talked about me seeing an Electrophysiologist. Should I ask for a second opinion from another cardiologist?”
2. Is there any way to predict when I’m going to have an A-Fib attack?”
3. Should I exercise when in A-Fib or skip it and rest? Can I damage my heart if I exercise in A-Fib?”
4. How long do I have before I go into chronic or permanent A-Fib? I know it’s harder to cure. My A-Fib episodes seem to be getting longer and more frequent.”
5. They want to do an Atrial Flutter-only ablation, will that help if I possibly have A-Fib as well?”
6.  Is smoking medical marijuana or using Marinol going to trigger or cause A-Fib? Will it help my A-Fib?
7.  “During an A-Fib episode, when should I call paramedics (911 in the US) and/or take my husband to the hospital? I’m petrified. I need a plan.”
8. I have a lot of extra beats and palpitations (PVCs or PACs) They seem to proceed an A-Fib attack. What can or should I do about them?”
9.   “How do I know which is the best A-Fib treatment option for me?”
10. When my husband has an Atrial Fibrillation episode, what can I do for him? How can I be supportive?”
11. How can I tell when I’m in A-Fib or just having something like indigestion?”
12.What kind of monitors are available for atrial fibrillation? Is there any way to tell how often I get A-Fib or how long the episodes last?”
13. I’m an athlete with A-Fib and have a naturally slow heart rate. My doctor says I need a pacemaker because my heart rate is too slow.”
14. Can excess iron in the blood cause Atrial Fibrillation? How do I know? If I have Iron Overload Deficiency (IOD), what can I do about it?”
15. Can too little iron in the blood (Anemia) cause Atrial Fibrillation? What can I do about iron deficiency?”
16.Is it possible to have a single A-Fib attack and not have any others? I had a single episode of A-Fib and was successfully converted in the ER with meds.”
17. “My mom is 94 with A-Fib. Are there consumer heart rate monitors she can wear to alert me at work if her heart rate exceeds a certain number?”
18. Can I have A-Fib when my heart rate stays between 50-60 BPM? My doctor tells me I have A-Fib, but I don’t always have a rapid heart rate.”
19. I’m in Chronic A-Fib. Can I improve my circulation, without having to undergo a Catheter Ablation or Surgery?”

20. “In one of your articles it said that having an ablation was better than living in A-Fib. I’ve been taking 75 mg of propafenone 3X/day for seven years and have only had 5 A-Fib attacks in 7 years. If your article means all types of A-Fib [including Paroxysmal], then I will consider an ablation.

21. “Both my uncles and my Dad have Atrial Fibrillation. I’m 50 years old and so far I don’t have A-Fib (yet), but I’m worried. How can I avoid developing A-Fib? Can dietary changes help? Or lifestyle changes?

22. In case I have a stroke, what does my family need to know to help me? (I’m already on a blood thinner.)  What can I do to improve my odds of surviving it?”

Last updated: Sunday, March 27, 2016
Return to Frequently Asked Questions

BYA ad - A-Fib Alerts discount offer 600 x 500 pix 300 res

FAQs Newly Diagnosed with A-Fib: Sex and Exercise

 FAQs Coping with A-Fib: Sex and Exercise

Maze heart You are not alone - with outline 175 pix at 96 res8. “Should I cool my sex life? Can I exercise if I have Atrial Fibrillation? Should I exercise?”

You don’t have to worry about dying while making love. A-Fib isn’t like having a heart attack. Episodes of A-Fib are normally not life threatening

Whether or not you should exercise, is really a judgment call for you and your doctor to make. In A-Fib when you first start exercising, your heart rate tends to be very rapid. Also, the A-Fib reduces your overall capacity to exercise, because your heart isn’t pumping properly.

These observations aside, if you can exercise without your heart rate becoming too rapid and you feel like exercising, you probably should. But check with your doctor. (In some types of A-Fib, moderate exercise may actually help you come out of an attack of A-Fib.)

Consumer Heart Rate Monitors by Polar

Consumer Heart Rate Monitors by Polar

If you want to monitor your heart rate while you exercise, you can wear a consumer or sports heart rate monitor. We like the “Polar” brand. Check out the array of Polar brand heart rate monitors on Amazon.com. Other companies include Timex, Garmin, Acumen, Nike, and Cardiosport. Used by runners and other athletes, they rely on the use of a chest strap to pick up the electrical signals  from the heart and transmit to a special wrist watch. You can set it to sound an alarm if your pulse exceeds a certain rate.

For an in-depth review of DIY/sports monitors, see my report: Consumer (DIY) Heart Rate Monitors and my Shopping Guide to DiY Monitors.

References for this article

Last updated: Tuesday, July 14, 2015

Go back to FAQ for the Newly Diagnosed A-Fib Patient

FAQs Coping with A-Fib: Improving Circulation

 FAQs Coping with A-Fib: Circulation

FAQs A-Fib afib19. “I am in Chronic (all-the-time) A-Fib. I feel tired and a little light-headed, probably because my atria aren’t pumping properly. Is there any way I can improve my circulation, without having to undergo a Catheter Ablation (poor success rate and risky at my age) or Surgery (even more risky)?”

In theory, yes. In Chronic A-Fib it’s not unusual to feel tired and light-headed. Your atria are fibrillating instead of pumping blood into the ventricles. Blood flow to your brain and other organs is reduced by about 15%-30%. But your ventricles still function by suctioning blood from the atria much like a turkey baster sucks up liquid.

To some extent, you can improve the strength and capacity of your ventricles by exercise, such as by walking on a treadmill or at the shopping mall.

You can also improve the oxygen saturation of your blood by using an Oxygen Concentrator ($500-$1,000). While on a treadmill, for example, you can breath in concentrated oxygen through a cannula, a flexible tube you insert into your nostrils. You can measure how much oxygen is in your blood by using an pulse oximeter ($50). The desired range is 95-100% oxygen saturation. (Some athletes with good circulation use this technique to improve their athletic performance.)

Don’t dismiss the treatment options of catheter ablation or mini-maze surgery. Both have high success rates with low rates of complication. With Chronic A-Fib, the longer you wait to cure your A-Fib, the harder it gets.

Be cautious: While improved circulation is good for your overall health, don’t over do the exercising. It could be counterproductive. With Chronic A-Fib your heart is already working harder than a normal healthy heart. Adding even more demand can lead to more enlargement and remodeling.

The Bottom Line: the real question is whether these techniques will improve your A-Fib symptoms of feeling tired and light-headed. I’m unaware of any studies demonstrating the effectiveness of the above techniques for the symptoms of Chronic A-Fib.

References:
¤  The Link Between Infections and Inflammation in Heart Disease. Life Extension Vitamins. Last accessed November 5, 2012   http://www.lifeextensionvitamins.com/cadico6otco.html

¤  Atrial Flutter. Heart Rhythm Society website. Last accessed March 30, 2014. URL: http://www.hrsonline.org/Patient-Resources/Heart-Diseases-Disorders/Atrial-Flutter

¤  “Atrial Fibrillation Educational Material” University of Pennsylvania. 2002, p. 3.[/su_pullquote]

Back to FAQs: Coping with Your A-Fib

FAQs Coping with A-Fib: Exercise While in A-Fib

 FAQs Coping with A-Fib: Exercise While in A-Fib

FAQs A-Fib afib3.“When I have A-Fib symptoms, should I go ahead and exercise or skip it and rest? Can I damage my heart if I exercise in A-Fib?”

This is a hard question to answer, because it depends so much on the type of A-Fib you have and how A-Fib affects you individually. It’s really a judgment call for you and your doctor.

Light exercise: In some people light exercise helps get them out of an A-Fib attack (Vagal A-Fib). In others, exercise makes it worse. When you first start exercising, your heart rate tends to be very rapid and disturbing. If you have A-Fib symptoms, try light exercise for a short time to see if it will get you out of an A-Fib attack. If not, you should probably skip it and rest. Try to exercise when you’re in Normal Sinus Rhythm.

Possible dangers of exercising in A-Fib: When exercising in A-Fib, you may be pushing your heart into higher pulse levels, putting added strain on your atria, getting your heart used to beating in A-Fib and staying in A-Fib longer, etc. But unfortunately we don’t know this for sure.

Some regularly exercise in A-Fib: I have a friend who is in persistent no-symptom A-Fib. He is an active swimmer. His swimming probably improves his A-Fib compromised circulation. He feels better when he can exercise. If you don’t feel bad when exercising in A-Fib, the exercise probably does improve your circulation, in addition to the regular benefits of exercise.

Exercise if you can: In general, with A-Fib, do whatever you can to still exercise. If you can exercise without your heart rate becoming too rapid and you feel like exercising, you probably should. But check with your doctor. If exercising feels bad or brings on an A-Fib attack, skip the exercise. No one’s going to hold it against you if you miss a day of exercise.

Back to FAQs: Coping with Your A-Fib

Intense Exercise and A-Fib: Lessons from Elite Athletes

Exercising with A-Fib

Intense Exercise and A-Fib: Lessons from Elite Athletes

by Steve S. Ryan

A 2009 study stated, “Vigorous exercise increases the risk of atrial fibrillation.” But a close examination of the observational study used to support this statement showed that A-Fib is associated only with men under 50 years of age who jogged/ran over four miles a day 5-7 times a week. This is a level of running usually associated with elite athletes.

Other types of vigorous exercise such as cycling, swimming or racquet sports were not associated with an increased risk of A-Fib.

Why elite runners develop A-Fib

The authors of this study hypothesized that several factors might explain the increased risk of A-Fib in elite male runners under 50 years old.

▪ left atrial enlargement
▪ left ventricular hypertrophy
▪ left ventricular dilation
▪ inflammatory changes in the atrium
▪ an increase in parasympathetic tone (the most commonly cited factor)

“Jogging in particular results in greater enhancement of the parasympathetic nervous system compared to other exercise types.” “Heightened parasympathetic tone has been associated with A-Fib onset in patients with structurally normal hearts; and in animal and human studies, parasympathetic stimulation frequently induces and maintains A-Fib.”

Vigorous Exercise good for most people

The authors of this study recognized the benefits of vigorous exercise for most people. “Exercise has multiple beneficial effects on cardiovascular health that may lower A-Fib risk.” In particular, exercise lowers blood pressure, improves lipid profile and glucose control, decreases risk of cardiovascular disease, has positive effects on traditional risk factors such as hypertension, diabetes, cholesterol and obesity, improves arterial elasticity which tends to deteriorate with age, and extends life expectancy.

(Physical inactivity and a sedentary life style is a far bigger health problem for most people than excessive physical activity.)

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New Swedish study—intense exercise linked to A-Fib

A new study from Sweden is more critical of vigorous exercise and the risk of developing A-Fib. Men who exercised more than 5 hours/week when they were in their 30s had a 19% higher risk of developing A-Fib later in life than those who exercised less than one hour/week. “Vigorous long-time physical activity seems to increase the risk for atrial fibrillation…Leisure-time exercise at younger age is associated with an increased risk of A-Fib.” But this study was primarily concerned with older men aged 45-79 years (mean age=60).

It also found that high levels of leisure-time exercise at an older age did not increase the risk of developing A-Fib. The authors hypothesized that leisure-time exercise may be of lower intensity at an older age.

They also found that more leisurely activities such as brisk walking or cycling at age 60, even if over 60 minutes a day, were associated with a 13% decrease in A-Fib over those who got no exercise at all. An accompanying editorial suggested when it comes to exercising “maximum cardiovascular benefits are obtained if performed at moderate doses, while these positive aspects are lost with (very high) intensity and prolonged efforts.”

(This study didn’t address the interval exercise technique often used in sports training and in gym workouts of varying intensity exercising—pushing oneself to the max, resting, then alternating with less vigorous workouts.)

What about those of who love to compete at a very high fitness level?

Dr. T. Jared Bunch of the Intermountain Heart Institute in Utah sees a number of very highly skilled endurance athletes. They go from marathons to triathlons to 100-mike bike races. Even though they are amazingly fit, they tend to develop A-Fib. The A-Fib develops despite these athletes having normal blood pressure levels and heart function.

There are many potential reasons why. These extreme athletes often develop what is called an ‘athletic heart’. The heart chambers are slightly enlarged. These adaptive changes allow for a higher cardiac output during exercise. However, some of these changes may also promote abnormal heart rhythms by changing the underlying architecture of the atrial chambers.

It is possible that repetitive wear and tear from the intense daily workouts is a factor and results in small areas of fibrosis in the upper and lower heart chambers which promote A-Fib and other arrhythmias. With improved MRI cardiac imaging, these small areas of fibrosis can now be visualized. Also, changes in the autonomic nervous system may irritate tissues responsible for generating A-Fib.

Finally, the personalities that often allow excellence in endurance athletes may also promote heart disease by the way the body and mind responds to stress. In total, endurance athletes put significant stress on their heart.

Should Intense athletes stop running and training?

Should intense athletes stop running and training? No. The intense athlete lifestyle reduces other heart risk factors and improves quality of life, not to mention the personal satisfaction and sense of fulfillment that comes from competing at a high level or winning a race. In the above Swedish study, low activity level people (couch potatoes) had more disease-related deaths.

Dr. T. Jared Bunch gives the following recommendations, which intense athletes can use to help their heart health:

▪ In periods in which they are not training, interval training that allows the heart to recover during exercise, can be used to maintain aerobic function and muscle strength.

▪ Intense athletes who train early in the morning should make a conscious effort to get restorative sleep. For most of us this means about 8 hours of sleep.

▪ Intense athletes who have prolonged training schedules need to pay close attention to maintaining their electrolytes. Loss of sodium, potassium, magnesium, and calcium are sources of heart electrical irritability.

▪ All athletes need to get routine screening of their blood pressure, cholesterol, and fasting sugar. Most of the time these are normal. But in those with genetic risks, they can be abnormal. If treatment is started early, lower doses of therapy can be used that do not impact athletic performance as much as treating the disease later in life.

Editor’s Comments:
Intense athletes have to face the fact that they’re more at risk of developing A-Fib and conditions like small heart injuries and fibrosis and need to monitor their heart health more carefully.
‘Knowing your heart’ is the best tool in prevention. Understand your heart rate: your normal rate at rest, early in exercise, during peak exercise, and in recovery.
If you develop changes in this normal heart rate spectrum or start to feel palpitations, you may need to see an Electrophysiologist (EP) before A-Fib develops. Testing may include an MRI to look for heart function and fibrosis as well as an ultrasound of the heart (echocardiogram) and a heart monitor. Your EP should measure the diameter of your left atrium and monitor for enlargement over time.
That doesn’t mean you have to stop running, but you have to be smart about it. Did you give yourself enough time to recover after the last race? What did the EP tell you about your overall heart health? Are you taking time to rest, sleep, and decrease other stressors in life?  Is your diet a healthy one, centered on whole foods?
The intense athlete might think: “But if I develop A-Fib, I can just have a catheter ablation (PVI), can’t I? I’ll be A-Fib free and can resume my training and racing.” Not necessarily. Even though your pulmonary veins have been isolated, it’s possible to develop A-Fib in other parts of your heart. The conditions (intense running and training) that pushed you into A-Fib are still there. We can’t say for sure that you will develop A-Fib again, but we also can’t say that you won’t.
As an intense athlete you may not want to hear this. But if you develop A-Fib, you may have to think seriously about changing your life style or training schedule. You will find that alternative exercises and programs yield positive benefits. Of these, Yoga and walking seem to have the strongest beneficial effect on A-Fib. For intense athletes, walking is part of life, but Yoga may not be. Yoga is a great way to shape up both mind and body and help with the body’s stress response.
After a successful ablation, the intense athlete, may decide to just live with the risk of developing A-Fib again. (There’s always a possible second ablation.)
If you reach a time in your life when you transition to lower daily intensity programs, your risk of developing A-Fib may start to come down.
References for this Article

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Last updated: Thursday, December 8, 2016

 

 

Can I exercise While In Atrial Fibrillation?

Can I Exercise While In Atrial Fibrillation (During an Episode)?

Exercising while in A-Fib?

Exercising while in A-Fib?

A reader with Paroxysmal Atrial Fibrillation wrote me and asked:

“When I’m having A-Fib symptoms, should I go ahead and exercise as I would normally? Can I damage my heart if I exercise while having an A-Fib episode?”

This is a hard question to answer because it depends how A-Fib affects you individually. Ultimately this is a judgment call for you and your doctor. Let me share my thoughts as a former A-Fib patient.

Let’s start with the basics

The general rules or principles you need to keep in mind when making a decision in your own case are:

•  An attack of A-Fib, as bad as it may feel, isn’t generally life-threatening (with the exception of a very fast heart rate which can be dangerous and cause you major problems). A-Fib isn’t like having a heart attack.

•  A-Fib reduces your overall capacity to exercise, because your heart isn’t pumping properly.

•  As much as possible, don’t let A-Fib stop you from exercising and leading a fulfilling life (unfortunately A-Fib often results in much lower activity and exercise levels, in spite of our best intentions).

Light exercise

In some people light exercise helps get them out of an A-Fib attack (Vagal A-Fib). In others (like me when I had A-Fib), exercise makes it worse. When you first start exercising, your heart rate tends to be very rapid and disturbing. If you have A-Fib symptoms, try light exercise for a short time to see if it will get you out of an A-Fib attack. If not, you should probably skip it and rest. Try to exercise when you’re in Normal Sinus Rhythm.

Possible dangers of exercising in A-Fib

When I had A-Fib I used a Polar Heart Rate monitor which you wear around your chest. It transmits your pulse to a wrist watch which you can set to sound an alarm if your pulse goes too high. When I’d run and the heart rate alarm would sound, I’d usually stop running and walk back.

But sometimes I got so mad at the A-Fib that I’d keep on running in spite of the alarm and A-Fib. In retrospect, I don’t think that was very smart.

If running or exercising in A-Fib feels bad, your body is probably telling you that you shouldn’t be doing this. When exercising in A-Fib, you may be pushing your heart into higher pulse levels, putting added strain on your atria, getting your heart used to beating in A-Fib and staying in A-Fib longer, etc. But unfortunately we don’t know this for sure.

Some regularly exercise in A-Fib

I have a friend who is in persistent no-symptom A-Fib. He is an active swimmer. His swimming probably improves his A-Fib compromised circulation. His ventricles during exercise act kind of like a turkey baster sucking more blood down from his poorly functioning atria. He feels better when he can exercise. If you don’t feel bad when exercising in A-Fib, the exercise probably does improve your circulation, in addition to the regular benefits of exercise.

Exercise if you can

In general, do whatever you can to stay active and exercise normally, even though you have A-Fib. If you can exercise without your heart rate becoming too rapid and you feel like exercising, you probably should. But check with your doctor. There isn’t a lot of research and clinical studies on this subject. WebMed.com says, “Take comfort from the experts. They say that physical activity is usually good for people with A-Fib, but it’s still wise to take precautions.”

Bottom-line: If exercising make you feel bad, skip the exercise. No one’s going to hold it against you if you miss a day of exercise.

Editor’s Comments:
I don’t think this is the definitive answer to this question. So, if anyone has any suggestions or comments, please let me know.
Note: In the WebMD online article referenced above, Dr. R. Morgan Griffin is quoted saying: “It’s very possible to live a normal life (in A-Fib) for many years.”
I strongly disagree with this statement (I suppose one needs to define “normal” life, and the quality of one’s life.) Leaving someone in A-Fib for many years overworks the heart and leads to remodeling and fibrosis which increase stroke risk and contribute to eventual heart failure. Instead you need to aim for a cure. To read more about remodeling and fibrosis, see “A-Fib remodels your heart and is a progressive disease” on our Overview page.
References for this Article

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Last updated: Thursday, July 16, 2015

 

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