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Effect of Flecainide on Exercise?

Hi. I am a 41 year old 'well-built' active male. I have had the 'odd' episode of palpitations for a few years (usually after a night out or pushing myself physically/over doing it) but was only diagnosed with PAF this year having completed the London Marathon. Since diagnosis, episodes have quickly become much more frequent and long lasting (from a day of palpitations every 5-6months to episodes lasting 3-4 days every few weeks). Initially I turned down any offer of tablets as I was told that they would affect my training. I am waiting to see a specialist about ablation. In the meantime I have just had an MRI (awaiting results) and after my worst episode ever last week, I have now given in and have started taking Flecainide (2 x 50mg per day). I ceased running/cycling last week and am currently seeing how I get on with the Flecainide for a few weeks before I do anything else physical. I am worried about starting to run/cycle again now in case I can't do it, or something happens to me! Also, I don't know if it is in my head, or coincidental, but I don't feel 'great' since taking the drugs, I feel slightly 'nauseas' - I think. I would be very interested to hear from anyone who has shared a similar experience, anyone who has exercised whilst taking Flecainide and anyone who has had successful ablation and now exercises without any 'significant' issues! Thank you very much, yan :)

98 Replies

I am on a much higher dose than you 150 mg x2. About 6 weeks after starting flecanide I had a stress test to see how my heart behaved during exercise . When it was established that there were no dangerous rhythms caused by flecanide I was able to exercise within limits.

I also feel nauseous in the mornings especially. My balance is also affected. By about mid day I feel fairly good but then at night time I have double vision!

Because of. All these side effects I am having an ablation to see if it can be " cured " then I won't have to take it. Having said that, flecanide has stopped the A.F. and for that I am very grateful.

I hope you come to a compromise with flecanide and exercise. Good luck.


Thank you for your response. Your side effects sound dreadful you poor thing. Yes your dose is much higher than mine though I have only been taking the meds for less than a week so am yet to see if they will stop another episode of AF at this dosage. At the moment, especially at night, it seems almost as if my heart is trying to battle the meds, meaning that I seem to be getting odd short bursts of AF but then it is stopping. Time will tell. I wish you every success with your ablation. Thank you and take care.


I was told that with a few of the medicines (particularly Bisoprolol) the body can take 4 to 6 weeks to normalise and settle down. In my case my Bisoprolol baseline has been changed three times from 2.5mg to 5mg to 7.5mg but on each occasion it was in a 1.25mg steps a few weeks apart.


I was told that with some medicines, particularly Bisoprolol, that it can take up to six weeks for the body to normalise, adjust and stabilise. In my case with Bisoprolol I have had three normal levels (2.5mg, 5mg, 7.5mg) but on all three occasions it was only increased by 1.25mg at a time and the second 1.25 mg was three or so weeks later.

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I'm convinced my AF started as a result of aerobic exercise. I used to do this every morning and about half an hour after exercise felt dizzy and faint and a bit like being on a rollercoaster. I really pushed myself to the limits and I remember the reporter Andrew Marr saying that's why he thinks he had a stroke in the gym because he pushed himself too much - not sure if the stroke was as a result of AF though. Maybe somebody on here knows. The cardiologist I saw said I should try exercising and to see how I felt afterwards but it spooked me enough that I took up walking instead. I hope these issues resolve for you very soon. Best wishes Sarah

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Up until recently, like you, I used to push myself too on most runs I did. I can understand exactly what you are saying about getting spooked, that is where I am at this time, for now at least. We shall see. Thank you for your message and best wishes to you also, yan

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You are up to 5 times more likely to have a stroke if you have AF than someone who doesn't because the heart is not pumping all the blood out as efficiently as it should. This little amount of blood that has been left can clot and then be fired out into the bloodstream causing stroke. Hope this helps to see why it is so important to take anticoagulant drugs if you have AF.


Hi yanbart,

I am well past participating in these sort of athletic interests however I read a lot. From the reading, media at large, it is becoming increasingly clear that with some people, (perhaps those that have a predisposition to heart issues) and certainly those that indulge in extreme activities, sports, athletics, perhaps even gymnastics, pilots flying fighters subjecting their bodies to extreme 'G' forces et al - are pushing their bodies to degrees which the body and its on board systems are not designed for.

And without wishing to scare you s.....s a few years ago now a young woman athlete died during the London Marathon and it was reported that she had been treated for AF. There is at least one Australian international competitive cyclist who is being treated for AF.

As for the Flec you are taking - read the slip of paper in the packet, that will tell you about possible known side effects and if your experiences tick the box go back to your GP/Cardiologist/EP, whoever, and ask for a review and something different.

I wonder to what degree AF is a sign of our times. My fathers side of the family seem to have a predisposition to AF but the actual 'things' that cause the heart to 'chuck a wobbly' are so different in all of us. For me, although I cannot scientifically/medically prove it, came from electromagnetic sensitivity (carrying my cell phone in my shirt pocket for a few years), then came palpitations for a couple a years, then came AF. As I understand the heart it is a muscle, it has mechanical components, and it has electrical components - it is not unreasonable to conclude that if that muscle is subjected to extreme conditions, then at some point it will jack up and act in an unusual way. What happens if you don't warm up properly and cool down properly when indulging in your sporting interests. What happens when your calf muscle gets the cramp. Why should the heart be any different.

Just a point of view of course and with no basis other than logic ! Good luck on your journey.


Thank you for your reply. You talk a lot of sense. One of the first things my cardiologist said to me at our first meeting was that "I might just be someone who is not designed to run marathons"...this was back in August when things were a lot better for me. He advised then that I don't run the 2016 London marathon and I did give up my place. I regretted it soon after as during a 'good spell' I thought I was invincible once again. However, at this moment in time, I think I am quite relieved. The difficulty for me was/is that he said I could continue to run/train but not as much. The trouble is, where do you draw the line? As for the young lady that died in the marathon, in a small world, her parents live in the same village as me! They denied that she had any heart condition. However as with this type of tragedy there are often rumours and things said and nobody really knows. Thanks again and take care. yan


Gosh yan, it is a small world indeed - re the young lady who died in the marathon. My media reading is limited to the Daily Mail and/or The Times, it was in one of those that I saw the report on her death and her health. But I take your point, nobody really knows. Still a co-incidence that I wrote on such a thing. The memory of the article stays with me because 2 of my 4 children (early and mid thirties) indulge in 'extreme sports' . One had AF the other has not. The 'has' is my daughter now aged 33, the 'has not' is my eldest son and I neither encourage them or discourage them in their chosen fields. My daughter indulges in Thai Kick Boxing. Her AF came about through her 1st pregnancy (over 5 years ago) and when her second child was born (over 3 years ago) her AF returned. Following care from her Cardiologist she is now clear. Don't know exactly what treatment she had, and of course don't know how she will be in say 25 years time. But for now both of them are enjoying their activities. There is an accepted link between 'Stress' and AF too. And, as I'm sure you'll be aware, stress manifests itself in so many different ways in so many different people. 'Stress' in itself is a world of its own. As my daughter is tiny in stature and in some ways 'delicate' her Obstretician (spelling ?) blamed body stresses during pregnancies for her AF. Yet the stresses from her kick boxing do not exist. But then we come back to genetics and the matter of predisposition that I talked about earlier. I mean there must be a predisposition in her to AF in the first place. Lots of women get pregnant and have no side effects while some others get AF. Lots of luck on your voyage of discovery which is what AF can be about.

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Yes it is a small world indeed. I remember the day after it happened. The press were buzzing all around the primary school trying to interview people who knew her. They approached me but I declined to speak, it seemed very impersonal. She was very well known. Very popular. A mobile hairdresser with a big personality. Her sister now lives on our street. Her parents are lovely and are still devoting their time to raising money for charities she and her brother (who also tragically passed away) used/supported. Horrible. It is only natural to worry about your children, my Mam worries sick about me still and I am 41!! I'm still her little boy. I agree with you about stress. In 2011 I succumbed to the dreaded Anxiety and have been taking pills for that to this day. In fact I was unsure if that drug was another thing that contributed to my AF but nobody seems to think so. Best wishes, and thank you once again, Ian


I didn't make any changes when I was on flecainide and just stuck to my usual routine as far as exercise goes. I like to get in at least twenty five minutes each day of brisk walking that's steady and uninterrupted, just to keep the heart in good nick.


That's good to know. Thank you.


Firstly Yan discuss with your cardiologist increasing the Flecainide to 100mgs x2 per day. I started on your dose 18 months ago and was still getting 9 breakthroughs in a month of varying lengths but the higher dose stopped it completely. No side affects though initially didn't feel that good - see more below.

Second you will have to be patient its quite a slow and steep learning curve for you and your body. Don't indulge in any heavy exercise until you are stable and then slowly test it. I think my AF was made regular by me adding short sprints to my exercise regime. Think/research carefully before opting for the ablation as the quick solution although age is in your favour.

Lastly, I didn't 'feel better' until I started taking Magnesium (actually Nutri Ultra Muscleze a compound which has lots of other relevant stuff like Potassium and Taurine ) and CoQ10 under the guidance of an experienced Naturopath. I also looked at other contributory causes and fixed those e.g. lifestyle incl work stresses, dental health, diet.

Good Luck, hope you find something above that helps. If it all sounds too much don't be put off it is worth it.

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Thank you for your reply. Yes, I think the problem I have at the moment is that I just want a 'quick fix' and to carry on as I was before all this started. The last few months though have shown me that it's not at easy as that and I think, as you advise, I need to slow down a bit and be patient. It is good to hear that I can increase my dosage if needs be and that it 'shouldn't make too much of a difference'. I have heard a lot of good things about Magnesium too and have just ordered from Amazon some 500mg capsules of Magnesium Oxide (Lindens). I am not sure if this is the correct type, or dosage, but the reviews on Amazon seemed good, albeit were not given (I presume) by people suffering with AF. Thank you.


My Naturopath recently prescribed extra Mg and sent me Mg Citrate from Klare Labs. I think the compound and the supplier are important. As usual the best are not as readily available, so you have to develop overtime good advice sources.Free advice from the Nutritionists at Regents Park, London.

Do also consider CoQ10 with advice as I believe they do work together to produce better rhythm - in my limited knowledge Mg to relax, CoQ10 to strengthen.

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Thank you. Do you know if there is a difference between Mg Oxide and Citrate? I will look up CoQ10 as I have heard of it. Thanks again


If you search for Magnesium on this site you will get a lot. What I have picked up from a Dr Carolyn Dean book is Mg Oxide is the cheapest but only 4% is absorbed. Mg Citrate is the most commonly used.

Don't forget old fashioned Epsom Salts in your bath, which has been recommended.

If your stomach gets sore from capsules try a quality magnesium oil to rub into your skin e.g. Ancient Minerals brand.

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Thank you, really interesting. Yes, 4% take up is poor. I shall look for the Mg Citrate next time and I hadn't even thought about Epsom salts!! Thanks


Hi yanbot , I only started on 50 mg twice a day but it didn't hold back the af was put on 100mg twice a day , I didn't run for a couple of months the flec and bisoprolol made me feel rubbish until they seemed to settle in and gradually I felt able to run again , my ep suggested I only jog and not push it , I only do a steady jog now any things better than nothing 😊, I'm now about 11/12 weeks post rf ablation it's been a long year for me I'm still on the meds at the mo , I think you'll be ok once the meds settle in take advice from a ep or cardiologist about the exercise , I was told its probably the running that caused it in the first place, just take it steady and don't push it go for enjoyment rather than another pb cheers Paul

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Thanks Paul. My cardiologist at our initial meeting (I have only seen him once so far although saw another one recently in A&E) suggested that my marathon training might have caused my issue - a bit like you. Although he kept talking about endurance athletes, and I was there thinking that I am not an endurance athlete, I am just a normal bloke who has trained very hard for 6 months to run a marathon!! I will wait for the tablets to kick in as you suggest as it is less than a week that I have been on them. Thank you and I hope that your ablation turns out to be very successful for you. yan

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Hi yan , it was very scarey when I started to go back to the woods for my usual 7 mile run , I walked it for a few weeks getting faster and faster till it was easier to jog , I'm now jogging this with the dogs and do enjoy it , I'm no endurance athlete neither only ran two 7 milers a week unless I was training for a half marathon of which I only did 4 total but usually ran 14 mile on a Sunday then , i really struggled to motivate when I was first put on flec and bisoprolol , I had to half the bisoprolol dose it stopped me totally , I'm a bit older than you I'm 47 I think it's a lot about conquering the mind which I can most of the time but still have the days when I worry myself silly , be well mate Paul

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14 miles a week is a good effort! Well done you, and you've only got a few years on me, I am 42 this month! :) I only take flec. I was given bisoprolol in A&E but only to get my BP under control on that occasion. Generally, BP is ok. I agree though, it all is very worrying...! Take care yourself, yan

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Hi yan , I started exactly the same I was only given flec as pill in the pocket until things progressed and was getting more episodes of af , they put me on bisoprolol to control the rate and flecainide to sort the rhythm ,anyway I went down the ablation route which isn't always successfull the first time round so we will see cheers Paul

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Cheers Paul. It makes me think if I will be offered a pill in the pocket or if I am now past that stage...we'll see. Fingers crossed for you that your ablation was successful!! ☺

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I also have exercise induced AF (diagnosed at 50) and have mainly stopped high intensity, competitive sports. I stopped all high intensity sports for a few years, while taking high dose magnesium, vitamin B, and fish oil daily - sensing my heart needed time to recover. After about 5 years of a few episodes per year, I decided to go on 50 mg flecenaide per day and re-initiate competitive sports in a milder form than before, starting slowly and gradually increasing the degree of exertion. I have not had an episode since (but it's only been 2 years so far). When I play something intense like squash, I take a quarter beta blocker to ensure I don't get fast beats. It probably slows me down a bit, but since I no longer play in league competition, I don't notice. Not sure if - with an ablation - you can resume exactly as before given the diagnosis. As someone else said, AF means you've pushed your body beyond its limits so need to make adjustments. Keep us informed and good luck!

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Thank you. Well it's great to hear that you have not had any episodes for 2 years! That sounds wonderful. Long may it continue! Again, I find it very interesting how many people with AF take Magnesium (and Fish Oil). I have started taking fish oil myself and my Magnesium is on order! :) Take care, yan


Hi Yan.

There are quite a few runners, cyclists and general exercise junkies on this forum. I'm now 44, but my AF started when I was 41. From the age of 6 my life has been sport and exercise, Football, weights and running mainly, but from my early 30's I started boxing and mixed martial arts. These are my experiences, but would like to share them with you just in case they are of any benefit.

When I first got AF I noticed it during sparring sessions, not a racing heart, but dizziness. I tried to ignore it, but when I finally went to the Doc's I was diagnosed. I didn't want medication, I didn't want to be told to calm things down and stubbornly I ignored most advice (Most of it given on this forum). I started taking meds and things improved, so life pretty much went on as normal. However my episodes got worse and to cut a very long story short I opted for an ablation.

I still take Flecainide at the moment (2 x 100MG a day), but don't train until about 4 hours after taking it. I find I tend to struggle a little if I exercise too soon after taking it, but other than that no issues.

My pastimes all involve exercise of some sort or another, however I have had to cut back ever so slightly, I say cut back more of adjusted my regime. I don't max out my heart rate on every session now, as I'm wary of pushing it too far, plus I'm getting older and I know trying to keep up with twenty odd year olds is not going to happen anymore.

Listen to your body, you know it best. If you have not seen an EP, please do so and discuss your exercise with him. I was given the option of an ablation so I could be symptom free. I felt a bit of a fraud as I didn't really suffer many symptoms, but my EP stated if my quality of life was being affected (I struggled in the gym, so I guess it was), then an ablation could address this. The last thing, which took me over 2 years to achieve is ease up a little whilst being treated.

Good luck



Thanks Jason. It is good to hear the experience of someone who is extremely active like yourself. Have I understood correctly that you had an ablation but still take 2 x 100mg of Flecainide? Is that usual? I have been led to believe that medication is not necessary after a successful ablation or have I misunderstood? Or, is it necessary for 'a period' after an ablation? Perhaps you have had it recently? I understand what you say about not trying to keep up with the 20 year olds!! haha


You're right with your thinking yan. The ultimate goal is to be free of medication post ablation. However, it may take more than one procedure. My ablation was over 7 months a go, but I have had a few small episodes in that time. My EP suggested I stay on the meds until our next meeting and we would discuss. If I'm honest I suspect another procedure will be required, but I have no issue with this. However, compared to what my episodes were prior to the ablation I would probably take my current situation as the meds don't cause me a problem and the handful of episodes I've had have only been minutes.

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Well that's really positive. I am starting to learn quickly though that I think I am in this for the long haul and there is not an easy quick fix solution...Thanks again


OK I got the same problem of you I use to be on flecainide 100mg x 2 and Bisoprolol..... I felt my heart upset after being diagnosed with AF my heart went to 216 heart bit at A&E they cardioverted me with flecainide then I was well for a while.... I start to training again and I went on steady high heart ritm 120 HB just walking they gived me Bisoprolol and Flec for 6 months I was fine till I started to play tennis than a strange feeling on my heart like I bruising it and then again pain in the heart and light palpitations.

Now I'm fine and no more on Flecainide just Bisoprolol Why ? .....

High intensity training is not good for your heart WALKING is the CUURE.... if you want get better and have one chance to avoid Ablation try this !!!!

For a period of at list 6 months walk ONLY about 8000 to 10000 step at day

Completely clean your diet from any sort of junk food no Alcohol ' no coffee not smock not Indian food not Mechy nothing.... Just stemmed vegetable a bit of sauce like tomato or some garlic deep a bit of meat a bit of cheese , mozzarella , avocado , garlic is a Must !!!!! Drink water and home made juice especially from carrots blueberry exetera friend you heart need rest and high quality food can eat dark chocolate with stevia if you like but stay fare from sugar and Carbs they are agitating your heart.

You can be proud of your Maraton but I think you have to change activity forever as they discover that those kind of activity can damage your heart creating dangerous scares in your heart and all sort of Aritmias.

After 6 months of Walking probably you can Lights !!!!!! ciclyng 1 hours 3 times a weak.

I warning you that if you'll put more stress in your heart it can become

a GAME extremely dangerous.

Please follow my advise and give up the Marathon have look at this article if do not believe me and good luck.

Sorry for my English !!!!!


Hey your English is absolutely fine! Thank you for your reply. I have read the article, very interesting. Amazing how can they can get so much information from Rats too!! Your diet sounds spot on. If only we all had your will power and determination. I love walking myself, however, I find that with a full time job and a young family it is hard to fit in the time to walk far and regular. With running, I can be out and back within 30-40mins and absolutely shattered, hence having limited impact on my life. Although, that impact is clearly more than I thought it was on my heart! Thanks again for your reply. Best wishes, yan

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I agree with Maxicono on walking. I would add it does not have to be for hours to be effective, I walk with Nordic poles for 1 mile x2 per day - roughly 30 mins per session - and believe that steady discipline on the heart has been beneficial in helping to keep me AF free for 18 months.

Clean food and your gastro condition is another biggie!

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Thank you... I believe that walk exercise the heart gently helping the heart and the nervous system to recovery from a previously past of heavy workouts plus a diet empty of chemicals, preservative and steroids that today are in almost all food will help the heart to keep calm and RELAXED !!!!!!

People's das not realize how much the food is compromised underestimate the importance of removing stress from different internal organs like kidneys , liver Exetera.

I warning that this is not a process that can be done in a month can take years but after 6 months your blood should be mutch more clean the sugar level improved and the blood pressure should be lower that is so important to preserve the right size of the heart ATRIUM !!!!!!.

That will make more powerful tablets like Bisoprolol and will be able not only to make us feel better but delay the Caterer Ablation

Procedure that at the moment is more like a good PROTOTYPE !!!!!!

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Totally agree Maxicono with all those points. Since my AF diagnosis in 2008, I have been determined to turn it into something positive.

So far hard work but a better diet, lifestyle, dental health, stronger christian beliefs and personal relationship.

I may not have stopped AF yet but I am confident I have stopped a lot of other bad stuff, which is some compensation.

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One day Catheter Ablation will be a piece of cake not more a question-mark technology fly since on Bisoprolol 2.5 mg lucky me I had not symptoms apart discomfort in my heart and light palpitation more rising heart-bit now and then my GP told me keep your blood pressure down and the sugar try loose weight no alcohol ....for me this stuff is RELIGION !!!!!

I'm so proud of you and your effort that demonstrate that keep your body in good health PAY YOU OFF !!!!!!

keep doing and carry on to spread this concept to people that believe that medicine can do it all..HELP YOURSELF THAT GOOD WILL HELP YOU ..take care


Look at the last post from elbows ,15 months post abblation and see how he is living life , cheers Brian


Thanks Brian. Sorry where can I find this post from elbows?


Go to latest posts ,scroll up until you come to newest / find a member , tap on find a member and key in elbows and it will give you all his posts (hope it helps you ) Brian.

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Thanks Brian


Yann , look up tyramine and fast heart beat , and look at the list of food that its in . Some of these foods can give you fast heart beat, I think you will have to find a cardiologist to read you e.c g.😁 PS did you manage to read elbows post.

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Thank you Brian. I will. I did read Elbows post, in fact I read most of them back to 2 years ago, pre-ablation and 3/6 months after etc. Very, very interesting. I messaged him to ask how old he is and what meds, if any, he now takes. Waiting to hear back from him. Thanks again, yan


I've just dropped my Flecainide down to 2x50mg / day and am starting to build up my exercise having previously dropped upper abs and lifting heavy (for me) weights. At the AF Patients' Day, the advice was not to start doing adrenaline-filled sports such as parachute jumping and bungee jumping (but no reason to stop if you already do them and enjoy them without landing up in AF). Ultra marathons also not a great idea.

For myself, I'm in the gym most mornings (before I take my Flecainide), doing Body Balance (yoga / pilates with more movement), interval training in the form of walking and jogging and strength training (squats, lunges, chest presses, rowing...), plank and variations, lower abs work and am about to start increasing the effort. The main consideration with the strength training has been to keep my movements symmetrical so I don't put one side of my body under any more strain than the other. The EP's advice was not to lift heavy weights e.g. lifting your body weight

One thing to bear in mind is that you shouldn't target your heart rate to go as high as you used to. Talking to Dr Faye at the Patients' Day, the concern over exercising is pushing the heart rate up too far - hence why I can do interval training at a lower rate but not sprint continuously for a long period of time. If I know I've pushed my heart rate up (usually through lunges using the TRX band, strangely!), I'll wait to see that it comes back down again before going onto the next exercise. It's also really important to warm up gradually to increase your hear rate, particularly if you end up on rate control drugs (Flecainide is rhythm control).

As someone else has said, you know your body. If it doesn't feel right on a particular day, don't push it, but enjoy the days that you do feel good.

Re food and drink, I know a lot of people on here have found that giving up various food and drink items has prevented episodes occurring. Personally, I was determined I wasn't going to give up anything I liked and I haven't. For me, it's more about keeping my posture right and making sure that I'm fit and healthy.



Thanks Caroline. Very interesting. I find it especially interesting that you exercise 'prior' to taking your morning pill. I didn't think that for example, exercise could perhaps best be restricted to early morning, and evening before tablet time! I also think it's great that you have not had to cut out certain foods/drinks. It sounds very positive and I am glad your plan is working for you. Thank you, yan


Wish I was s fraction as fit as you Caroline !


Not all on the same day, I hasten to add!!



Hi Yan,

I have a similar story although I am much older...60, to be exact. I have been an endurance athlete all my life and as proud of my very low resting heart rate! I developed atrial runs and ectopic beats that were non stop (but apparently not actual a fib) that were really distressing. All tests were normal...healthy heart (but no MRI). I went on propafenone (similar to Flec) and felt like I was doing everything in slow motion. It is better after 6 weeks on it. I am scheduled for an ablation a week from today. I know that I am going to need to modify the intensity of my sport (mountain biking) and just walk up the big hills in the future. I am having a REALLY HARD time accepting a different identity and realize I am not only exercise addicted, but hang a lot of my ego on being really fit. I sense you are concerned about many of the same issues. However, I am trying to remember there are many different kinds of strength, courage, and endurance and draw from those same things that made me a good athlete my whole life to now negotiate what the future "me" will look like. Keep in touch and please share your journey...


Hi. I do feel your pain. I feel bad moaning on this forum too much about exercise as there are so many stories of people seemingly much worse than me, however, for the past few years running had become more than just exercise for me, it had become a hobby, a passion, an anxiety release and a way of life. I recently started cycling (on a mountain bike) and realised how much I loved it very quickly. I was mixing cycling with running and was even going to start swimming with a Triathlon at the back of my mind for next year. However, this last episode of AF I had (the worst one yet) on the back of a hard, hilly cycle has scared me into stopping for now, and taking Flecainide. At the moment I am down, but like you, have to draw on the positives. I would also be very interested to hear how you get on so please keep me informed of your ablation next week. I wish you the very best of luck and good health, yan


I think mountain biking is unique in that it is really hard to "just slow down" going up a steep hill, because then you are off the bike and pushing it. It's so tempting to do those 10 extra pedal strokes to make it to the top! But adapting is the name of the game, and I'll wear a HR monitor and stop and walk when I need to. At least we can still enjoy the down hills! Even after a successful ablation, you sure don't want to just go back to the same habits that got you there in the first place, and after 2 months of denial, I realize that I had pushed too hard, too often.

I'll post about the ablation...thanks for the conversation!

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Wise words. Good luck with everything. Stay positive. I'll keep everything crossed for you. Thank you too. Yan ☺


Your symptom progression sounds exactly like what I had experienced before my ablation a year ago, when it put a complete halt to full time AF. While not a marathoner, I've been involved in aerobic exercise regularly since my twenties. No meds nor cardioversion were helpful before ablation, but I am now able to do everything I did before with only a few "flutters" at the start of an uphill walk or climbing on the elliptical. However, there is just enough increased "pressure" since ablation, even if I had previously been used to the sustained punishment of a marathon before, I don't think I could do so now. My resting heartbeat had been 60 before full time AF set in and is now consistently 70 to 80. My only medication is Lisinopril for blood pressure. I highly recommend the ablation sooner than later, cause it ain't going away on its own! Hope this helps.

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Thank you. Yes, it is very helpful. It is so reassuring and helpful to hear from others that suffer with AF as with all due respect, people who haven't experienced it, do not understand. Thank you and best wishes. yan


Hi Yan. The trouble with us 'boys' is that we think that we are indestructible,and we 'love' the exercise. I am on Flecainide and Bisoprolol. I first got AF at 62 and I am now 73.I try and 'read' my body but can get carried away with the moment! Here are two examples. I am on a 6 mile walk, a little hilly, but I am feeling good. I average 4 miles an hour and I am pleased (I am 73 and it was hilly in parts!). The next day I am in AF. On another sunny day I am in my back garden which is flat with a brick wall border either end - a great football pitch. My grandson (8 years) and I are playing against his father (my son). We are having a fantastic game and play for a long time. The next day I have heat stroke, a bad back and AF. The message for me is that exercise beyond that which my body can absorb triggers AF. Another limitation is that I have no speed! Even fast movement over 2 or 3 yards can leave me breathless whether in AF or not. This could be caused by Bisoprolol.

I will not relate what my wife thinks!

It is difficult to accept the consequences of AF and the associated drugs. The only impact of Flecainide on me has been dizziness on the top dose.

I read somewhere that athletes are more at risk of getting AF.

Maybe the only answer is to adapt or ablate.

...but keep exercising (in moderation)!


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haha wise words Terry! So true that 'us boys' never learn. My wife is always saying 'listen to your body' and I am afraid to say, she is right, well they always are aren't they! Thank you very much for your response. Take care, yan


Believe me, it isn't limited to "the boys"! I'm a case in point!


I am 74 and have had consistent AF since 9 years ago. Treated with meds (Toprol succ 50mg daily) and then a PIP of Rhymol 150x2 when have episode and could take another 150 eight hours later if needed. Then, in last 6 weeks, have been on flecainide 50mg 2x daily. About 10 days ago, had an AF episode and they jumped me up to 100mg flec 2x daily. Feel good and walk dogs without any problems. Not working out on my elliptical bike yet. Also, on warfarin and monitor it myself. It is consistently between 2.0 and 2.9.

About 25 years ago, I was exercising with weights at a gym and was exerting so much, that I lost my eyesight for 20 minutes or so. Doctor said that is was a blood clot. Then, at age 65, they discovered a secundum atrial septal defect, which accounts for the clot 25 years earlier. I had it repaired via Amplatzer and started warfarin. I am hoping that flec, 100mg twice day will prevent AF for long time between episodes. Doctor said I could take up to 300 mg total per 24 hours. So, if I have an episode, I can take up to 100mg to stop it.

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Hi, it sounds as if you have been through it! Sounds positive though that things have settled down somewhat now. Interesting that you can take up to 300mg in a 24 hour period! When I was offered Flecainide I was hoping I would be advised to take a pill in the pocket when I had AF but I have been put on a constant daily dose. This is something I will be asking about as I don't fully understand the reasoning behind this. Best wishes, yan


As a follow up to my previous post, since I had the hole repaired in my heart with Amplatzer, which contains metal, I am NOT a good candidate for ablation. I believe that is the current thinking, anyway. If anyone has a different take on this, let me know. Thanks. I am in Texas.


Google SVT and look at the Wikipedia results. At the bottom it lists famous people who have suffered from SVTs and what they have gone on to achieve. It lists olympic swimmers, cyclists and rowers. If theres no underlying disease this condition can be corrected. I will note they have all had ablations though to correct the problem.

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Thanks Jimmy. I did what you said. Interesting! Though I am not sure if SVT is the same as AF? It was hard to distinguish which athlete suffered from what. However, when I have time, I might look up each person and try and find out a bit more about them. Thank you, yan


Yanbart, I've been pretty active over the last few years . Went from swimming a mile three days a week to swimming and biking on the in between days. Then Afib . I am currently on dofetilide plus anti coags for the afib. Also had stents put in. What I have found is, either due to the PAF or the meds or a combo of both, my stamina is not there anymore. Where I used to be able to do 40,50, or 60K plus on my bike and swim a mile the next day,they are no more. Where I used to be able to sprint up the hills,I now hope to just make it to the top in my granny gear. I'm learning to live within what I've got. If I have to stop on the hill and rest so be it. I've cut my swims down to about 3/4 of a mile. If I have to stop ,I stop. I am grateful just to be able to do these things. After the diagnosis of Afib,the doom and gloom set in. But I realized I could still do the things I was doing before but differently. Yeah, the triathlon is out for the time being but I still do what I can. I keep a journal of what happens when I exercise noting episodes,shortness of breath,tiredness, type of exercise,time and distance,etc. Don't give up!!! Modify and adapt. By the way I'm over 70 and still going.


Hi Paul, it sounds as if you have been very sensible and humble too. I think you are amazing to still be able to swim 3/4 mile, however I can imagine how you feel if you used to do more, and more easily too. You were obviously a superfit person, and still are with AF, only with less stamina. It is difficult to know what these drugs do to us. After a week of Flecainide, I am still unsure exactly how it makes me feel. Thirsty, nauseas, funny taste in my mouth, funny sensation in my chest, or is that the AF? That's the issue for me at the moment, my HR has gone down and I am now finding it difficult to know if I am still in AF, in and out of it daily, it is certainly much better now I am on the drugs but I would ideally like another ECG now to tell me if it is working, or just making me feel better due to lower HR. Thank you for sharing your story anyway and keep training and enjoying it. Best wishes, yan


Lots of good advice and comments. I will give you a few thoughts.

You are now at a junction I your life and your body has given you a warning (you, probably like me, had others but you either weren't aware of them at the time or you ignored them). Going forward from this road junction you either change path(s) or carry on regardless. The choice is a no brainer to me.

My father had a saying "life's changed not ended" (and particularly when he was diagnosed with bowel cancer and told he had max 1 year to live - he didn't tell us that at the time). He also told me that when I had a bad car crash in my 30s and had to give up squash and hockey. I believe this is very true for AFers.

AF will almost certainly get worse (more frequent and more severe). At some point many will have an ablation. If your consultant suggests an ablation that then very seriously think about it. Some consultants are now claiming it can cure and others do not!!

I was only diagnosed with AF when I was just 60 (13 months ago) and at that point I was in persistent AF with loads of sources and this makes it much harder to sort out. I was largely asymptomatic but there were warning signs.

One thing that my GP said when discussing my AF was that if having an ablation was the option to prevent a lifetime on drugs (and you are many years younger than me) then the ablation option certainly had advantages.

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Thanks for that Peter. Very wise words and your Dad was obviously a very wise man too. Yes, looking back I did have warnings. I was just telling someone else that I was undiagnosed for around 3 years I think. My palpatations used to come and go quickly and gone before I ever had an ECG. Now, there is so mistaking them. They stay for longer each time and the periods inbetween are getting shorter. It's almost like they are trying to take over your body. I sense that I am at the beginning of a long journey so we shall see how things pan out. Thank you for the advice. I will take heed. Best wishes, yan


I didn't fully appreciate his saying at the time but I do now (and some others!!!).

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Yan, I've been reading on the association between AF and chronic endurance training for years, I have a very long list of references you're welcome to if you want it.

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Yes I would be very interested in reading about the association if you would be so kind to share. Thank you very much, yan


I've been through the list and deleted most of the irrelevant stuff, apologies if there's anything I've left in.

2015 Gebel, Ding, Chey, Stamatakis, Brown, Bauman:

Effect of Moderate to Vigorous Physical Activity on All-Cause Mortality in Middle-aged and Older Australians.

JAMA Intern Med. 2015 Apr 6. doi: 10.1001/jamainternmed.2015.0541.

2015 Arem, Moore, Patel, Hartge, Berrington de Gonzalez, Visvanathan, Campbell, Freedman, Weiderpass, Adami, Linet, Lee, Matthews:

Leisure Time Physical Activity and Mortality: A Detailed Pooled Analysis of the Dose-Response Relationship.

JAMA Intern Med. 2015 Apr 6. doi: 10.1001/jamainternmed.2015.0533.

2014 Kwok, Anderson, Myint, Mamas, Loke:

Physical activity and incidence of atrial fibrillation: A systematic review and meta-analysis

International Journal of Cardiology December 15, 2014 Vol.177, Iss 2, pp 467–476

2014 Jacobs, Woller, Stevens, May, Bair, Anderson, Crandall, Day, Johanning, Long, Mallender, Olson, Osborn, Weiss, Bunch:

Time outside of therapeutic range in atrial fibrillation patients is associated with long-term risk of dementia.

Heart Rhythm Volume 11, Issue 12, December 2014, Pages 2206–2213

2014 Goudis, Ntalas, Ketikoglou:

Atrial Fibrillation in Athletes.

Cardiology in Review: December 4, 2014

2014 Drca, Wolk, Jensen-Urstad, Larsson:

Atrial fibrillation is associated with different levels of physical activity levels at different ages in men.

Heart. 2014 Jul, 100(13):1037-42.

2013 Schnohr, Marott, Lange, Jensen:

Longevity in Male and Female Joggers: The Copenhagen City Heart Study.

American Journal of Epidemiology Vol. 177, No. 7

2013 Ruiz, Joyner, Lucia:

Crosstalk: Rebuttal from Jonatan R. Ruiz, Michael Joyner and Alejandro Lucia

The Journal of Physiology 591.20 (2013) p 4949

2013 Ruiz, Joyner, Lucia:

Crosstalk: opposing view: Prolonged intense exercise does not lead to cardiac damage.

The Journal of Physiology, 591, 4943-4945

2013 Ofman, Khawaja, Rahilly-Tierney, Peralta, Hoffmeister, Reynolds, Gaziano, Djousse:

Regular Physical Activity and Risk of Atrial Fibrillation: A Systematic Review and Meta-analysis.

Circulation: Arrhythmia and Electrophysiology 2013; 6: 252-256

2013 La Gerche, Schmied:

Atrial fibrillation in athletes and the interplay between exercise and health

European Heart Journal (2013) 34, 3599–3602

2013 Hausswirth, Louis, Aubry, Bonnet, Duffield, Le Meur:

Evidence of Disturbed Sleep and Increased Illness in Overreached Endurance Athletes

MSSE/ACSM 24.9.13

2013 Guasch, Nattel:

Rebuttal from Eduard Guasch and Stanley Nattel

The Journal of Physiology 591.20 (2013) p 4947

2013 Guasch, Nattel:

CrossTalk proposal: Prolonged intense exercise training does lead to myocardial damage.

The Journal of Physiology 591.20 (2013) pp 4939–4941

2013 Guasch, Benito, Qi, Cifelli, Naud, Shi, Mighiu, Tardif, Tadevosyan, Chen, Gillis, Iwasaki, Dobrev, Mont, Heximer, Nattel:

Atrial Fibrillation Promotion by Endurance Exercise: Demonstration and Mechanistic Exploration in an Animal Model

Journal of the American College of Cardiology

2013 Grundvold, Torger Skretteberg, Liestøl, Erikssen, Engeseth, Gjesdal, Kjeldsen, Arnesen, Erikssen, Bodegard:

Low Heart Rates Predict Incident Atrial Fibrillation in Healthy Middle-Aged Men

Circ Arrhythm Electrophysiol. online 21.7.13

2013 Fragakis, Pagourelias, Koskinas, Vassilikos:

Arrhythmias in Athletes: Evidence-Based Strategies and Challenges for Diagnosis, Management, and Sports Eligibility

Cardiology in Review: September/October 2013 vol. 21 Iss 5 229-238

2013 Andersen, Farahmand, Ahlbom, Held, Ljunghall, Michaelsson, Sundstrom:

Risk of arrhythmias in 52,755 long-distance cross-country skiers: a cohort study.

European Heart Journal (2013) 34, 3624–3631 doi:10.1093/eurheartj/eht188

2013 ACSM

Guidelines for Exercise Testing and Prescription, 9th Ed.

ACSM 2013 ISBN 978-1-60913-605-5

2012 Wilson, Whyte:

Is lifelong exercise damaging to the heart?

BJSM (2012) 46, 9: 623-624

2012 Turagam, Velagapudi, Kocheril:

Atrial Fibrillation in Athletes.

American Journal of Cardiology Volume 109, Issue 2 , Pages 296-302, 15 January 2012.

2012 Sharma, Zaidi:

Exercise induced arrhythmogenic right ventricular cardiomyopathy: fact or fallacy?

European Heart Journal (2012) 33 938-940

2012 Schnohr, Marott, Jensen, Jensen:

Intensity versus duration of cycling, impact on all-cause and coronary heart disease mortality: the Copenhagen City Heart Study

European Journal of Preventive Cardiology February 2012 vol. 19 no. 1 73-80

2012 Lowres, Neubeck, Freedman, Briffa, Bauman, Redfern:

Lifestyle risk reduction interventions in atrial fibrillation: a systematic review.

European Journal of Preventive Cardiology October 2012 v 19 no5 1091-1100

2012 Kirchhof et al (56 authors)

Comprehensive risk reduction in patients with atrial fibrillation: emerging diagnostic and therapeutic options- a report from the 3rd Atrial fibrillation Competence NETwork/ European Heart Rhythm Association consensus conference.

Europace (2012) 14 8-27

2012 Delise, Sitta, Berton:

Does long-lasting sports practice increase the risk of atrial fibrillation in healthy middle-aged men? Weak suggestions, no objective evidence

Journal of Cardiovascular Medicine: June 2012 - Vol 13 - Iss 6 - p 381–385

doi: 10.2459/JCM.0b013e3283522485

2012 Camm, Lip, DeCaterina, Savelieva, Atar, Hohnloser, Hindricks, Kirchhof:

2012 Focused update of the ESC Guidelines for the management of atrial fibrillation.

European heart Journal (2012) 33, 27119-2747

2012 Calvo, Brugada, Sitges, Mont:

Atrial fibrillation and atrial flutter in athletes.

Br J Sports Med 2012

2012 Calkin et al (50 authors)

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design.


2011 Wilhelm, Roten, Tanner, Wilhelm, Schmid, Saner:

Atrial Remodeling, Autonomic Tone, and Lifetime Training Hours in Nonelite Athletes

Am J Cardiol 2011;108:580 –585

2011 Sorokin, Araujo, Zweibel, Thompson:

Atrial fibrillation in endurance-trained athletes.

Br J Sports Med 2011;45:185-188

2011 Rowland:

Is the athletes heart arrhythmogenic?: Implications for sudden cardiac death.

Sports Medicine 2011, 41(5) 401-411

2011 LaGerche, Prior, Heidbuchel:

Strenuous endurance exercise: is more better for everyone? Our genes won’t tell us.

BJSM mar 2011 v45 no3

2011 Garber, Blissmer, Deschenes, Franklin, Lamonte, Lee, Nieman, Swain:

American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise.

Med Sci Sports Exerc, 2011 Jul; 43(7): 1334-59

2011 Evangelos, Antonio, Montse:

Electrocardiographic abnormalities and diagnostic criteria

British Journal of Sports Medicine 2011; 45:e1

2011 Claessen, Colyn, LaGerche, Koopman, Alzand, Garweg, Willems, Nuyens, Heidbuchel:

Long –term endurance sport is a risk factor for development of lone atrial flutter.

Heart 2011; 97:918-922

2011 Chomistek, Chiuve, Jensen, Cook, Rimm :

Vigorous physical activity, mediating biomarkers, and risk of myocardial infarction.

Med Sci Sports Exerc. 2011 October ; 43(10): 1884–1890

2011 Baggish, Wood:

Athletes heart and cardiovascular care of the athlete: Scientific and clinical update.

Circulation 2011, 123, 2723-2735

2010 Link, Estes:

Athletes and Arrhythmias.

Journal of Cardiovascular Electrophysiology 21(10):1184-1189, October 2010

2010 Grimsmo, Grundvold, Maehlum, Arnesen:

High prevalence of atrial fibrillation in long-term endurance cross-country skiers: echocardiographic findings and possible predictors — a 28-30 years follow-up study.

European Journal of Preventive Cardiology February 2010 vol. 17 no. 1 100-105

2010 Calvo, Mont, Tamborero, Berruezo, Viola, Guasch, Nadal, Andreu, Vidal, Sitges, Brugada:

Efficacy of circumferential pulmonary vein ablation of atrial fibrillation in endurance athletes

Europace (2010) 12, 30–36

2009 Mont, Elosua, Brugada:

Endurance sport practice as a risk factor for atrial fibrillation and atrial flutter

Europace (2009) 11, 11–17

2009 Lakkireddy, Pillarisetti, Patel, Boc, Bommana, Sawers, Vanga, Sayana, Chen, Nath, Vacek:

Evolution of Paroxysmal Atrial Fibrillation to Persistent or Permanent Atrial Fibrillation: Predictors of Progression

Journal of Atrial Fibrillation (2009) Volume: 1, Issue: 7 ISSN: 1941-6911

DOI: 10.4022/jafib.v1i7.536

2009 Doherty:

AF and Exercise.

Presentation, Heart Rhythm Congress 2009

2009 Aizer, Gaziano, Cook, Manson, Buring, Albert:

Relation of Vigorous Exercise to Risk of Atrial Fibrillation

Am J Cardiol 2009;103:1572–1577

2009 Abdulla, Nielsen:

Is the risk of atrial fibrillation higher in athletes than the general population? A systematic review and meta-analysis.

Europace (2009) 11, 1156-1159

2008 Schoonderwoerd, Smit, Pen, van Gelder:

New risk factors for atrial fibrillation: causes of ‘not so lone atrial fibrillation’.

Europace (2008) 10, 668-673

2008 Pelliccia, Zipes, Maron:

Bethesda Conference #36 and the European Society of Cardiology Consensus Recommendations Revisited A Comparison of U.S. and European Criteria for Eligibility and Disqualification of Competitive Athletes With Cardiovascular Abnormalities.

Journal of the American College of Cardiology Vol. 52, No. 24, 2008

2008 Mozaffarian,. Furberg, Psaty, Siscovick:

Physical Activity and Incidence of Atrial Fibrillation in Older Adults: The Cardiovascular Health Study.

Circulation 2008;118:800-807

2008 Mont, Tamborero, Elosua, Molina, Coll-Vinent, Sitges, Vidal, Scalise, Tejeira, Berruezo, Brugada:

Physical activity, height, and left atrial size are independent risk factors for lone atrial fibrillation in middle-aged healthy individuals.

Europace (2008) 10 (1): 15-20.

2008 Molina, Mont, Marrugat, Berruezo, Brugada, Bruguera, Rebato, Elosua:

Long-term endurance sport practice increases the incidence of lone atrial fibrillation in men: a follow-up study

Europace (2008) 10 (5): 618-623.

2008 Mattioli, Bonatti, Zennaro, Melotti, Mattioli:

Effect of coffee consumption, lifestyle and acute life stress in the development of acute lone atrial fibrillation

Journal of Cardiovascular Medicine: August 2008 - Volume 9 - Issue 8 - p 794–798

2008 Furlanello, Lupo, Pittalis, Foresti, Vitali-Serdoz, Francia, De Ambroggi, Ferrero, Nardi, Inama, De Ambroggi, Cappato:

Radiofrequency Catheter Ablation of Atrial Fibrillation in Athletes Referred for Disabling Symptoms Preventing Usual Training Schedule and Sport Competition

Journal of Cardiovascular Electrophysiology Volume 19, Issue 5, pp 457–462, May 2008

2008 Baldesberger, Bauersfeld, Candinas, Seifert, Zuber, Ritter, Jenni, Oechslin, Luthi, Scharf, Marti, Attenhofer Jost:

Sinus node disease and arrhythmias in the long-term follow-up of former professional cyclists

Eur Heart J (2008) 29 (1): 71-78.

2007 Schnohr Scharling Jensen:

Intensity versus duration of walking, impact on mortality: the Copenhagen City Heart Study

European Journal of Preventive Cardiology February 2007 vol. 14 no. 1 72-78

2007 Jahangir, Lee, Friedman, Trusty, Hodge, Kopecky, Packer, Hammill, Shen, Gersh:

Long-Term Progression and Outcomes With Aging in Patients With Lone Atrial Fibrillation: A 30-Year Follow-Up Study

Circulation. 2007;115:3050-3056

2006 Warburton, Nicol, Bredin:

Review: Health benefits of physical activity: the evidence.

CMAJ March 14, 2006 vol. 174 no. 6

2006 Swanson:

Atrial fibrillation in athletes: Implicit literature-based connections suggest that overtraining and subsequent inflammation may be a contributory mechanism.

Medical Hypotheses (2006) 66, 1085-1092

2006 Heidbüchel, Panhuyzen-Goedkoop, Corrado, Hoffmann, Biffi, Delise, Blomstrom-Lundqvist, Vanhees, IvarHoff, Dorwarth, Pelliccia:

Recommendations for participation in leisure-time physical activity and competitive sports in patients with arrhythmias and potentially arrhythmogenic conditions Part I:

Supraventricular arrhythmias and pacemakers.

European Journal of Cardiovascular Prevention & Rehabilitation 2006 13: 475

2006 Heidbuchel, Anne, Willems, Adrianssens, van der Werf, Ector:

Endurance sports is a risk factor for atrial fibrillation after ablation for atrial flutter.

Int J Cardiol. 2006 Feb 8;107(1):67-72

2006 Elosua, Arquera, Mont, Molina, Garcia-Moran, Brugada, Marrugat:

Sport practice and the risk of lone atrial fibrillation: A case-control study

International Journal of Cardiology V108, Iss 3, 14 Apr 2006, Pages 332-337

2005 Zipes, Ackerman, Estes, Grant, Myerburg, Van Hare:

Task Force 7: Arrhythmias

36th Bethesda Conference

Eligibility Recommendations for Competitive Athletes With Cardiovascular Abnormalities

JACC Vol. 45, No. 8, 2005 April 19, 2005:1354–63

2005 Mitchell, Haskell, Snell, Van Camp:

Task Force 8: Classification of Sports

36th Bethesda Conference

JACC Vol. 45, No. 8, 2005 April 19, 2005:1364–7

2005 Dernellis, Panaretou:

Effect of C-reactive protein reduction on paroxysmal atrial fibrillation.

American Heart Journal Volume 150, Issue 5, November 2005, Pages 1064.e7–1064

2004 Lombardi, Tarricone, Tundo, Colombo, Belletti, Fiorentini:

Autonomic nervous system and paroxysmal atrial fibrillation: a study based on the analysis of RR interval changes before, during and after paroxysmal atrial fibrillation.

European Heart Journal (2004) 25, 1242-1248

2004 Hoogsteen, Schep, van Hemel, van der Wall:

Paroxysmal atrial fibrillation in male endurance athletes. A 9 year follow up.

Europace (2004) 6 222-228

2004 Hoogsteen, Bennekers, van der Wall, van Hemel, Wilde, Crijns, Gorgels, Smeets, Hauer, Jordaens, Schalij:

Recommendations and cardiological evaluation of athletes with arrhythmias Part 2

Netherlands Heart Joumal, Volume 12, Number 5, May 2004

2003 Franklin, Swain, Shephard:

New Insights in the Prescription of Exercise for Coronary Patients

J Cardiovasc Nursing Vol. 18, No. 2, pp. 116–123, 2003

2002 Mont, Sambola, Brugada, Vacca, Marrugat, Elosua, Paré, Azqueta, Sanz:

Long-lasting sport practice and lone atrial fibrillation

Eur Heart J (2002) 23 (6): 477-482.

2001 Chung, Martin, Sprecher, Wazni, Kanderian, Carnes, Bauer, Tchou, Niebauer, Natale, Van Wagoner:

C-Reactive Protein Elevation in Patients With Atrial Arrhythmias: Inflammatory Mechanisms and Persistence of Atrial Fibrillation.

Circulation. 2001; 104: 2886-2891 Published online before print November 19, 2001

2000 Hedelin, Wiklund, Bjerle, Henriksson-Larsen:

Cardiac autonomic imbalance in an overtrained athlete.

Med Sci Sports Exerc., v32, no9,1531-1533

1999 Hood, Northcote:

Cardiac assessment of veteran endurance athletes: a 12 year follow up study.

Br J Sports Med 1999 33: 239-243

1998 Karjalainen, Kujala, Kaprio, Sarna, Viitasalo:

Lone atrial fibrillation in vigorously exercising middle aged men: case-control study

BMJ1998 June13; 316(7147):1784-1785

1998 Kannel, Wolf, Benjamin, Levy:

Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: population-based estimates.

American Journal of Cardiology Volume 82, Issue 7, Supplement 1 , Pages 2N-9N, 16 October 1998.

1998 Furlanello, Bertoldi, Dallago, Galassi, Fernando, Biffi, Mazzone, Pappone, Chierchia:

Atrial fibrillation in elite athletes.

Journal of Cardiovascular Electrophysiology [1998, 9(8 Suppl):S63-8]

1998 Benjamin, Wolf, D’Agostino, Silbershatz, Kannel, Levy:

Impact of atrial fibrillation on the risk of death: the Framingham Heart study.

Circulation 1998 Sept 8;98 (10):946-52

1996 Marrugat, Elosua, Covas, Molina, Rubies-Prat:

Amount and Intensity of Physical Activity, Physical Fitness, and Serum Lipids in Men

American Journal of Epidemiology 1996 Vol. 143, No. 6

1994 Coumel:

Paroxysmal atrial fibrillation: a disorder of autonomic tone?

Eur Heart J. 1994 Apr, 15 Suppl A:9-16

1990 van Saase, Noteboom, Vandenbroucke:

Longevity of men capable of prolonged vigorous physical exercise: a 32 year follow up of 2259 participants in the Dutch eleven cities ice skating tour.

BMJ 1990;301:1409-11

1983 Beaglehole, Stewart:

The longevity of international rugby players.

N Z Med J. 1983 Jul 13;96(735):513-5.

1971 Schnohr

Longevity and causes of death in male athletic champions

The Lancet Volume 298, Issue 7738, 18 December 1971, 1364–1366

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Wow!! That's some list! Thank you so much for sharing this. I will start going through them. Many thanks, yan


37-yr old active military male here. Diagnosed with PAF about 6 months ago. 50mg x 2/day far, so good...had some really short runs early on like you described. Also, had times where med seemed to wear off before next dose. However, PACs/PVCs way down and PAF all but 100% controlled. Doc wanted to up me to 100 x 2, or do ablation. I've had 1x ablation for Aflutter about 2 years ago.

As for exercise, I used to run miles at 6:45-7 min pace at 180-190 BPM. Now, Flec plus Lopressor keeps max rate at 150 BPM. I still feel fine running, but can't crack 7:50 mile pace for more than 1/4-1/2 mile...heart just won't beat fast enough.

Ablation for Aflutter is much easier--in and out of right atrium. AFib has to cross over to left atrium through Septum and there is increased (albeit minor) risk of damaging pulmonary vein. Right now, since 50mg x 2 is pretty much doing the trick, I am going to ride it for a while to see what happens. Hang in there. AFib isn't fun, but once you learn more about it and dealing with it, it shouldn't stress you out. I really don't even think about it now, and I mentally and physically feel 100x better. Don't be scared of's a great drug. People say is "dangerous"...not if you are young and otherwise healthy--it has VERY HIGH success rate!


Hi Miami. I LOVE your post. This is exactly what I 'wanted' to hear!! I have a few years on you but it has really reassured me to know that there is someone else out there that takes Flecainide and continues to exercise (albeit not as fast as you used to run). However, you used to run FAST! I am very happy if I can make an 8min mile! Could it be the Lopressor that is stopping your HR from going above 150? At the moment I am only only Flec. Thanks very much for posting this and I really like your positivity. Nice one. Am I correct in thinking that you are not even going to think about having an AF ablation at the moment as you are (in the main) happy with the control the drugs are giving you? yan


I was just recently diagnosed with paroxysmal AF (July this year; I am a female and was 38 when diagnosed). Like you, I did the London Marathon (PB!!) and went on to do a 43 mile Ultra at the end of May. With hindsight, I've had AF symptoms for over 5 years. I noticed no worsening during my training (I had no symptoms at all while running) but once I'd done the April/May races I relaxed for 6 weeks and ate far too much! In July, having put on well over a stone in weight (eating like a marathon runner, training like a couch potato!), I had my worst case of AF yet and ended up in A&E. After 29 hours with AF a beta blocker (bisoprolol) put me back in NSR so I haven't had any flecainide yet. Since then, however, I've had some small AF episodes and lots of palpitations etc so my cardiologist put me onto 1.25 mg bisoprolol daily. I am now back running but having no luck with hills (HR won't go above 150 bpm). My 5K time is 4 mins down on my best and it's hard work. But I am now 2 stone over my marathon weight so I'm hoping things will get better when some weight has gone. It's not easy - I was a 24 min 5 K runner and a 4:19 marathon runner (not anywhere near elite but not bad for a girl!) before but I'm struggling to break 28 mins for 5 K now and the longest 'long slow run' I've managed (with lots of walking) is 10 miles. I'm feeling the effects from the beta blockers (sluggish legs, like someone's turned gravity up!) but I'm hoping these will ease once I'm 'fit' and I weigh less. I feel your pain - people keep telling me to "ease off" the running, and trying to tell me my training "caused" this (it runs in my family and my uncle has never once broken into a jog...). My cardiologist, however, says to listen to my body and see what it will do. I'm going with that advice. The thought of not being able to run devastates me - it's my life and my social life and my time out from the world so to lose it is just not an option I will consider at all. I used to play elite-level netball until injury forced my retirement and running was (is) my solace. I have had tears after attempted runs where I've not been able to run more than 2 miles, but I'm getting back to having some "good" runs too. Hang on in there! I feel like we're in the same boat, so keep me updated with your progress!

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Hi JacqsRobs. Thank you for your reply. It seems that we have a LOT in common, even down to the 4.19 time for a marathon which was my time in London last April! As you say, “not a bad time for a girl” !! haha. I was on for 4hours as it happens but cramp saw an end to that! Yes, like you, I find this forum very useful as my parents worry sick about me. If it was down to them, they would stop me running full stop. However, they are always the first to tell me if I have put on a few pounds!! Like you, I have experienced ‘odd episodes’ of palpitations over the last few years however after going to see my GP and having tests, it never came to anything as I was not presenting any further symptoms at the time. From last October until after London, all through my training I did not experience any ‘noticeable’ episodes and it was only after the marathon that all this really started with me. After London I had lots of niggly injuries and decided to have a break and enjoy myself, yes, I put on weight too. My episodes were initially every month, almost to the day, and lasted a day or so. Then they started to last longer, then became more frequent. I too went to A&E as this was the only way I thought I would ever get a diagnosis, and it worked, I did. After seeing the hospital cardiologist I was prescribed a beta-blocker but didn’t take it until I saw my GP. He explained that this drug would interfere with my running considerably. Anyway, to cut a long story short, I didn’t take them. The cardiologist told me to ‘decondition’ myself as he suspected that the training had caused my condition (the echo showed enlargement of my left ventricle, but only slight I was told). Anyway, again to cut a long story short, I ended up in A&E again a month or so ago after my worst episode yet lasting 4 days solid. It was then that I gave in and decided to start taking what was then prescribed for me, Flecainide. I am not on anything else at the moment, just 2 x 50mg tablets of this every day. The tablets gave me headaches and nauseas feelings and I stopped exercising completely, getting very down very quickly. That is when I joined this site! Anyway, after seeing my GP again, he told me that I should not quit exercise as I would become very old, very quickly (he knows me very well). The last week has seen me start running once again (side effects from Flecainide seem to have passed now in the main). My first run was a mile, I struggled! However, I think this was as much mentally (worry) and because I have put on weight and lost fitness. I have since completed 2 x 5mile runs at steady pace. Very hard, but again, difficult to say if it is the drug or just my fitness/weight. I plan to continue as I am doing, slowly and steadily for now. I really don’t want to give in to this and want to get back fit as soon as I possibly can. At the moment I could not put my hand on my heart and say that the Flecainide is doing its job completely for 2 reasons. The first being that I am not exercising (and drinking any alcohol as much as before) and that I am still having odd sensations and beats, but just not the typical AF episodes that I had experienced. Time will tell I am sure. I now have a busy week as I have my long awaited appointments (Friday with an EP to discuss the possibility of Ablation) and (Monday to see my Cardiologist for a routine review). These appts follow an MRI that I had recently. I will keep you informed if you would like to hear and I too would be interested in hearing how you get on. Maybe you should discuss whether Flecainide would work for you? I am not sure if it affects HR like Bisoprolol? I would be interested to know that. I have only taken Bisoprolol once when in A&E. It is certainly a powerful little drug as it reduced by BP and HR massively within 30mins of taking it in hospital. There is a chap called Miami that posted here before you that seems to get on well with it and exercise. Have a read of his post. Nice talking to you anyway, take care, yan

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I am on the max dose of Flec, it has not cut out my PAF altogether but has reduced the breakthroughs to around once a month. Prior to being diagnosed I was a middle distance runner and have trained pretty hard since I was 15, im 60 next year. Flec combined with beta blockers reduced me to a slug. I had the Sotalol changed for Bisoprolol and Im only half a slug now. I tend to take the beta blockers only when I get breakthroughs as I hate that "not quite with it" feeling that they give you. It took me months to get back into running whilst on this combination and at first I felt like a 90 year old chain smoker. It took me many months to get to the stage where I could get a 7km run under my belt without hailing a taxi at the half way point. Running on these meds is not easy and my days of pushing myself are gone and I had to face up to that. Its still possible to keep reasonably fit by other means though and circuit training is good enough for me now. I still skydive every weekend and swim when I can so life is good. Best of luck, you will find your own way.


Hi Starboard. Well let me first say that heart condition aside, I am very impressed that you skydive every weekend! It is interesting the different mixes of medication that we all seem to be on. I am only on Flec, no betablockers at the moment, and I am told that Flec should not really affect my HR when I run. I am slowly getting back into short runs and am struggling but it might just be my de-conditioned state. So you still get breakthroughs of AF? How long do they last for when you get them? Also, when you say the max dose of Flec, what is that if you don't mind me asking? Thanks ever so much for the reply and I hope that the weather this weekend is favourable for your skydive!! yan


Just to pick up on the bits about Bisoprolol in some of those recent posts... I'm another 41 year old male with PAF, which has almost always (one exception) been associated with running. I've stopped running completely in favour of road cycling, and I'm on 2.5mg Bisoprolol with Flecainide as a 'pill in the pocket'. I've found that the Bisoprolol hasn't made a dramatic difference to my exercising; road cycling doesn't hammer the heart rate in the way that running does, I find, and although I do a lot of cycling up hills - I live in Sheffield, and cycle in the Peak District most of the time - I'm still relatively quick going up them, even though my maximum heart rate has been lowered. I was getting attacks of AF every few months, sometimes lasting for a day or two, but I haven't had one now for 8 months, so I'm assuming that the Bisoprolol is doing its job; long may it continue! Best of luck to everyone - just thought that I'd chime in with a fairly positive tale about Bisoprolol and exercising - I suspect that things will get worse again at some point, but it's nice that things are a bit steadier at the moment.

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I agree!

I'm 44, on 2.5mg Bisoprolol (and aspirin -for the blood), mostly do MTB (mountain biking), not on Flec, and I try and use all my gears when I spin uphill !! But it is true for me, that going uphill (mtb) matches running uphill to an extent.


Hi dommydops. That's really interesting what you said about cycling. I started to get out on my bike for similar reasons and really enjoyed it (though I have a big heavy mountain bike which I was using on the road) but with the dark nights, that has really put the brakes on for me (excuse the pun!) haha. I found though that going up hills on the bike was very similar (aerobically) for me to running up them!! I guess everyone is different. As I said in an earlier post, I find it interesting that different people are on different meds. I do wonder why for example you have been put on Bisoprolol with Flec as a pill in the pocket yet I have been put on Flec twice a day and not Bisoprolol. Do you mind me asking how much Flec you are supposed to take in one go should you get an attack? It's really good though that Bisoprolol has not affected you exercising too much as I have read so many people saying the opposite about the drug. It's really good though that you are on 8months no AF and counting, long may it continue!! yan

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If I go into AF I'm meant to take a Bisoprolol dose and then, 30 - 60 mins later, a whopping 300mg dose of Flecainide; I've just had to do it the once, back in February, and I went back into NSR a few hours after popping the pills.


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Wow. That is a big dose. How did you feel after that? At least it worked that's the main thing. Best of luck with everything. Take care and thanks for the reply :)

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I felt largely OK, although I felt a bit rough the next day, as I recall; I also had a couple of odd visual effects (e.g. a sudden flash!) Best of luck to you too!

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I was diagnosed after using a heart monitor for 30 days. I started taking flecainide about a month ago 2x50mg flecainide has maintained regular heartbeat for me. I still exercise regularly. My exercise consists of walking rapid for 3 miles or bicycling six or 7 miles. I am 72 years old . I don't really feel as strong as I did before but I am able to get in comparable exercise to what I was doing before.


Hi Jdunk. Thank you for your reply. It is good to hear that what I understand to be a relatively low dose is working for you. That's great. Best wishes, yan



I take 150mg twice daily and weaned myself off of the Bisoprolol and only use it if I have a breakthrough to slow the rate down.

I get breakthroughs roughly once a month (from every other day on diagnosis) often only lasting a few hours but can go on for over a day on occasion. I was diagnosed at 50, and spent around a year studying PAF and getting the meds right for me and have never been near a cardiologist since. I have a yearly work medical (intense) conducted by my family doctor and he just asks me how I am getting on with the AF. I was symptom free when this condition was picked up by chance and only suffered symptoms when put on the meds which I believe exaggerate the AF when it appears. This bizarre condition changes all of our lives but at the same time life must go on. I still skydive weekly when I am home, and im typing this from an oil rig in the middle of the Sahara where I work.


It's really good to hear from someone that has basically sorted themselves out with minimum intervention. Good for you. When you say 'from every other day on diagnosis' do you mean you get AF a lot more than you think you do? Thanks for your reply. Don't think I have ever spoken to someone in the Sahara before!! :)


No, not at all.

I was getting AF every other day for probably well over a year but as I was extremely fit it had no inpact on me other than a strange but mild sensation and irregular pulse lasting around 20 mins at a time. I am now and have been since Flec, AF free inbetween bouts that happen around a month apart. Like many of us here I am super sensitive to changes in my heartbeat and can tell immediately if AF has kicked in. Ive had my bad days too, so its not all been a bed of roses but upwards and onwards. Best of luck.


Thanks for answering me again. I understand what you are saying now. In a way you are lucky that you had few symptoms but there again, you can look at that another way and say that you were very lucky it got picked up! Thanks again and take care, yan


I received a donation from someone this morning but there was no name given so please let me know who you are so I can thank you!! Thanks yan


I am 44 now and have had 7 ,or more, ablations since the age of 23.

Used many different drugs, but finally got my ablation in 2003.

On aspirin and bisoprolol now.

My ablation was 70% successful, but after that, I only had 2 atrial fibrillation attacks and got my rhythm back with cardio version. Ablation has worked excellent for me! I would recommend it, I think it has more to do with the EP doing it than the procedure it self, it's about the man/woman holding the tools.

Ablation is not the SUPER cure, and some people may have to go for more than one.

After my ablation I have done 6 Cape Argus cycle races (109KM), half marathon (not a real runner) some 10k's, My longest MTB was 5:35H.

I have also read about ultra athlete - AF connection, but I think you must not overtrain, listen to your body -don't push too hard (train smart not hard), stay hydrated.

I say go for it!!

Hope to hear how the "London" was.

I have started a blog about my heart story

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Hi Janco. Gosh you've been through so much yet achieved so much too. Total Respect. Thank you for your wise words and I shall have a look at your blog. Thank you and take care. Yan


I've just been reading your blog Janco, it is very good!! You should share it on this forum!! :)


Janco, do you mean you have had seven ablations or cardioversions?

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Sorry! it was 7 or more cardio versions, and only 1 ablation.


Thanx Yan!

I only found this forum last night, and will update my profile, thank you for the kind words! I do feel I have a lot to share.

With reference to training: The doctors that I have seen all say exercise is very good for your heart, It's up to u and me to find that right balance of staying fit, but not overdoing it.

When playing squash (racket ball -don't know about the spelling) opposed to cycling my heartbeat goes up very fast with squash (195bpm) compared to cycling were I struggle to get it above 175bpm, the same goes for running if I keep a steady pace all the way - my heartbeat does not spike to high.

According to me the higher your heartbeat goes, the easier it goes into Afib.

My doctor showed me a guideline of what sports are more suited to people with AF, mainly its swimming and cycling.

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Very interesting. Yes you have got a lot to offer, I agree. I'm sure you could help many people on here 😊


Have Afib over 10 years I am 64, take Flecainide 100mg twice daily, ( 50 mg didn't work) for last 8 months. My bouts where almost every nigh, 2am in morning usually started, and lasting sometimes 8-12 hours, Hot weather, and strenuous work triggered it and also eating to much. On aspirin 81. and Cartia too, do not like blood thinners. So Flecainide is working, but! It is effecting my lungs with Flem and coughing and I am starting to feel like I am losing breath sometime. Side effect of drug water droplets on air sacks causing scarring which can lead to Pulmonary Sclerosis, on some people. I exercise 3x's a week with resistance workouts not as a teenager but I do use weights. I do it when felling good and it keeps my heart and muscles in great condition otherwise, took ekg, nuclear stress test two months ago and passed with flying colors no valve or heart disease. I'm weighing in on Ablasion, but then again may have to take meds anyway if needed. Taking Meds that do fix's problem but cause is scarier, since if it cause Pulmonary sclerosis, which once diagnosed is a 5 year death warrant, I will be talking to a specialist on Ablasion and hope for the best. Wish you all well and a cure soon.

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Hi Rhythm. Gosh, I hope you get the all clear and the breathing issues are nothing to worry about, as otherwise you sound fighting fit. Let us know how you get on and what you decide to do about ablation. All the very best to you. Take care


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