Anyone got any advice for a Lone AF. I have had 6 episodes over 8 years and each been triggered by exercise which I do almost daily.

[Marky54]

I have been cardioverted this week and they have put me on Bisoprolol. I am worried that this could increase the frequency, as I become dependant. My previous episode was 2 years ago. Has anyone got any advice or in a similar situation as me?

[BobD Volunteer]

Hi Mark, you will not become dependant on the drug as it doesn't work that way. What you will find is that AF begets AF so the more you have it the more you will get it. There is evidence than an early ablation has more success than leaving it till you are almost permanent so I think you should read up on the subject of AF and all its little foibles from the many fact sheets on the main AFA website. Ask any question here of course but knowledge is power. GPs and general cardiologists are remarkable ignorant of the finer points of AF so it is important to see the right people. An electrophyiologist is a cardiologist with special interest in rhythm disorders and there is a list by area on the main website should you wish to go that route. Oh and yes excessive exercise as in endurance athletes etc is a known cause of AF as the changes to the size and shape of the atria brought on by the demands of exercise make the rogues impulses easier to propagate. Everything in moderation eh?

BobD

[Marky54 in reply to BobD]

Hi Bob many thanks will look into this, I have had all the tests with no underlying problems found last year and I was kind of dismissed, which is a little frustrating.

Thanks for your advice

Mark

[BobD Volunteer in reply to Marky54]

Interestingly another group of young [people prone to AF is fast jet pilots presumably because fighting G forces gives the heart a lot to do. Comforting to know that the Eurofighter Typhoon flying over your head may be flown by somebody with AF isn't it?

[Hidden in reply to BobD]

Living in an area where they practise low flying I have to say, I"m not entirely sure!

[Langara in reply to Hidden]

Hmm - I recall one of those low fliers crashing in the Conwy Valley some years ago!!

[Hidden in reply to Langara]

I found out after we moved here that the crash was just down the hill from us... I'm sure the pilot was as fit as a butcher's dog though also not entirely sure that's any sort of comfort!

[Terjo]

Very interesting and informative blog, I'll keep it for reference as I have mad mountain biking grandsons! Terjo

[Marky54]

Many thanks ectopic, I have spent the afternoon reading about the subject, the information I will pass on to my GP when I request a referral to a electrophysiology specialist

Mark

[Hidden]

Hi, mine started in 2004 and was triggered by an extremely bad virus when working overseas. I did not have another episode for 2 years then again I was hospitialised because of the AF after walking hard for 10 KM through the bush in the tropics so bought on by exercise. The 3rd on was bought on by stress in 2009, and the last one in 2012 was bought on by another virus, however I am now in a constant AF with 120 - 130 BPM but am learning to live with it, I take verapamil to hold the AF at bay but am aware that the more I stay in AF the more likely my chances are of having to have the ablation, the specialists say that once you have an episode there is higher chances you will continue. Sorry

[Marky54]

Hi Soozie

Many thanks it seems I am stuck with this but I want to try limit the episodes, I have not seen a specialist in this problem so hopefully i can get some help. After this last AF the Dr told me to keep my heart rate below 120 but this time last week I was running with HR up to 170, so they want me to become almost sedentary, not good times.

Thanks

Mark

[MarkS]

Hi Mark

I also had lone AF. I first had this about 20 years ago (or at least that was when I first became aware of it). I had been a rower plus a general sports nut. Endurance exercise such as rowing is associated with lone AF.

The AF gradually got worse over the years until I was getting AF every 3 days for about 24 hours. I decided to hold off on an ablation as techniques were improving rapidly.

I was surprised when I went for a check-up to find that the AF was up to 80% (the effects had been very well controlled by diltiazem). It was at that point that I decided to go for an ablation.

Prof Schilling, who carried out the ablation, said the chances of success were pretty much the same as long as you were still paroxysmal (i.e. able to self-convert) regardless of the amount of time in AF. The chances drop once you become permanent.

That ablation was successful (3.5 years now and counting). I still exercise daily (cycling, kayaking, sailing and swimming) but generally limit sessions to less than 30 minutes and don't "push it" (ot at least only sometimes!).

I would suggest you could consider limiting your exercise, but, importantly, still carry on exercising. Being fit really reduces the effects of AF.

When you go for an ablation is up to you. You currently have less than one episode a year. Do you really need to be on bisopralol? Beta blockers can have bad effects of exercise capability. You could wait and see how rapidly your AF progresses (it will get worse, it's a question of how rapidly) as ablation techniques are still rapidly improving and success rates going up.

You could also look at Hans Larsen's website for lone AF: afibbers.org/ but don't get too hung up on supplements!

Cheers

Mark

[Marky54 in reply to MarkS]

Hi Mark

Great advice I have been taking part in sport and exercising on a regular basis from 14 Yrs to now 52, 6ft 3 never been over 84kg and want to keep going. The ablation looks like a consideration the reports suggested by ectopic are good reading and I have decided to take the bull by the horns firstly with my GP by asking to see a electrophysiology specialist. The beta blockers do worry me a little, as the last time 2 years ago I just walked out of hospital and carried on.

I will have a look at Hans Larson's website many thanks

Mark

[Vivante]

Too much exercise can cause problems, you need to cut back. I was taking seven classes a week plus doin my own practice and yoga days. IN 2000 after attending in-service training, which we must do, I came home and thought I was dying. It turned out after so many tests over the following 2-3 years, I was born with a hole in the heart, plus other medical conditions. Exercise is good but too much can cause harm. Cut back a bit. I now have two classes a week and concentrate on working with people who has medical conditions.

Take care.

[Langara]

From what I have read here it seems that exercise is a finely balanced scale between what is good and what is bad for you. Seeing as we are all different I am wondering how one knows exactly when the exercise scale tips from good to bad, unless it is when one feels ill and by then it is probably too late.

[MarkS]

Thanks, Soozie. I wasn't aware that exercise halves the chance of remaining free of AF. Do you have a reference for that?

The factors I'm aware of which affect long term outcomes include LA size and fibrosis, high BMI, obstructive sleep apnoea, duration of AF before ablation (paroxysmal or persistent), age, sex and hypertension.

At 6'6" you must be almost a dead cert for AF!

[Marky54]

Many thanks everyone lots advice for me to consider this time last week I had forgotten I had AF now it's back I need to look after myself everything in moderation seems like the best way forward

Thanks again

Mark

[MarkS in reply to Marky54]

The best advice I had was to forget about the AF and not to obsess about it. I gave up checking my pulse every 5 minutes and became a lot more laid back about it. Then I found that most of the time I couldn't tell if I was in AF or not and I wasn't in a hurry to find out. I just carried on regardless.

[MarkS]

Sorry, Ectopic, I picked up the wrong name.

I've searched for the references. There's one about ablation success in athletes:

intl-europace.oxfordjournal...

which indicates that ablations are pretty much as successful in athletes and that controls, endurance athletes and non-endurance athletes were equally likely to be AF free after 3 years.

However this study:

medscape.com/viewarticle/58...

which makes reference to Heidbuchel, indicates that where there's flutter as well as AF, the risk of occurence is almost twice. This is summarised in this paper:

ncbi.nlm.nih.gov/pubmed/163...

However this is where there was an ablation for Flutter, which is slightly different from AF. Also the twice risk was where endurance exercise was continued.

As the second article states, further studies are needed to clarify whether a threshold limit for the intensity and duration of physical activity may prevent AF, without limiting the cardiovascular benefits of exercise.

In the meantime I would suggest 30 minutes of moderate exercise a day should provide CV protection without inflaming the body too much and causing AF recurrence (I hope!).

[MarkS]

I'm 62 and I tick over at about 120 bps though occasionally go higher. I have a standard circuit (7.5 miles and moderately hilly) which I aim to do in under 30 mins. Sometimes I do longer rides with friends of up to 2-3 hours but we take those easier, stopping off for tea/lunch.

5 years ago I did the Hayling-Paris ride. That was quite hard - mainly on my bum! It was extremely hot and we were riding 100+ miles a day. I was on sotalol which made it worse. I'd find the cycling easier now but I would still get the discomfort from the seat!

I hate to think what my lifetime exercise hours have been - must be easily over 15,000. However I feel good now I've adjusted to a lower exercise level. Both my parents had AF so that could contribute to mine. I'm lucky my ablation is still holding.

What do you do daily? Have you managed to reduce your training hours?

I think the Over Training Syndrome is a major issue now, particularly with the advent of extreme endurance events (Ultras, Ironman, etc.). Dr John Mandrola mentioned this in his last blog.

[Marky54 in reply to MarkS]

Hi Mark

Still a bit sore so going to give myself a week off just cycle to work about mile each way. Then gradually build on this, I normally do 40 mins 5 days Monday to Friday possible a little on Saturdays.

Thanks for the advice

Mark

[Vivante]

I will take a look at the report. It seems interesting.

Many thanks.

[MarkS]

Yup that's the trouble with the NHS. I've had to pay to go privately to get any decent treatment for sporting related ailments. Last year I fell off my bike on a pothole and got a huge lump on my hip. It was really painful for 3 weeks until I saw a physio. She sorted it out in half an hour - basically using a kind of rolling pin to get rid of the lump.

My times are on a road bike. If I use my mountain bike they're a lot slower. Doing the South Downs Way my average speed is 4 mph!