New AFib patient

I recently was diagnosed with AFib. I'm a long distance cyclist and began to experience a rapid heart rate infrequently on some rides. I went through a whole battery of cardio tests and nothing was found and my heart was deemed to be fine. However, I continued to periodically experience rapid heart rates on rides but never at any other time. Unfortunately, I began to have both rapid and irregular heart rates frequently while at rest and on a daily basis (starting two months ago). I ended up in ER a couple of times and obtained a electrical cardio version two times which kept me in NSR dor a bout 24 hours. During that time my cardiologist kept adding meds to try to control-- first Diltiazem calcium channel blocker, followed by Flecanide (anti arrhythmic) followed by Prodaxa (blood thinner). My expectation is that I will go off the blood thinner once the AFIB stabilizes since my score is zero and I was put on it temporarily given the frequent and sustained AFib episodes. I've been on the drugs for two weeks and have yet to experience any relief from AFIB so it is possible my dose will be increased. Since I am in the early stages of AFIB, I suspect that my cardiologist will want to continue with the drug routine to get me stabilized. That being said, and I recognize that I am very early in the process, leading an active lifestyle is very important to me including cycling, skiing and weights. I've done a lot of reading on surgery options. I have read that the catheter ablation seems to be the procedure of choice with varying levels of success and duration. I've been reading about combo procedures that combines the ablation with another procedure known as a Maze. The procedure is known as a hybrid procedure and does not involve open heart surgery with a relatively rapid recovery and an excellent rate of success. The idea is that this hybrid procedure treats the fullness of the heart both on the outside and inside which an ablation cannot achieve by itself.

Again, I recognize that I am early in the process but don't have a desire long term to stay on drugs only and would like to explore this option as an eventual longer term solution. Is anyone familiar with this hybrid procedure and if so, how is it going?

Thanks much


36 Replies

  • Hi Jeff I was in a similar position to you 18 months ago. I went for cryo last November and I'm back cycling, skiing and all the rest of it. I still get palpitations but taking a magnesium supplement almost eliminates these. You are a fit guy, my advice would be go to a private electrophysiolosgit ASAP and access your options with minimal financial commitment. It's unlikely you'll need maze. Check out Prof Richard Schilling at London Bridge Hospital.

  • First of all, I think you should do a little research on the drugs you've been prescribed. Check out for starters. If you look at drug interactions you'll find that there is reason to believe diltiazem and flecainde should not be prescribed together because of one of the drugs' similarity to another drug that's a problem. There is not enough information to indicate whether taking the drugs together is safe.

    Also, diltiazem and flecainide increase each other's effects. So taking them together, you're essentially getting an extra small dose, though I don't know how much.

    The key question is whether the arrhythmias bother you. If your heart rate bounces around a bit but you can still function pretty well, in my view there's no point in trying to control it. If, however, it runs up to something really high (for you, 150 bpm may not be a big issue) and really impairs your functioning, it makes sense to keep it under some control.

    Flecainide is a dangerous drug. It loses its effectiveness over time, and it suppresses the brain's immune system. I was a road cyclist, canoeing instructor, and wilderness camper until I took flecainide after my ablation last spring. I stopped the flecainide in June but now I have almost daily dizziness, fatigue, and a few other disabling symptoms that have totally stopped those activities. I'm glad I'm 66 because I have only 20-25 years of this to look forward to. If I were 40 I might consider stopping the entire program.

    Best of luck.

  • atrial fibrillation is bad enough but the drugs used to treat it can make you feel terrible and in some cases make the condition worse. Some people get great relief from the different medications but none of them worked for me and two of them were very pro-arrhythmic but I just thought the condition was getting worse. I had a cryo ablation with a little bit of radiofrequency ablation as well and 18 months on it has been completely successful so far. By all means try the rhythm control drugs but if they don't work or make it worse there is no point in taking them and rate control drugs are generally more tolerated. My cardiologist told me that they only expect each drug to work on about 50% of patients. Frankly in my case even if the drugs had worked they left me feeling so fuzzy brained that half the time I couldn't do anything. Rate control for me still has some problems especially with some bradycardia at rest when not in AF but at least I could function.

  • I am a cyclist too in long term chronic AF. You may find the whole situation bewildering to start with. Sorting out what is "good " advice for you from respected sources can be extremely difficult. Over the years I have been to several AFA annual meetings. Here I could talk people who had actually had ablations, on different drugs, electro cardiologists at the top of their profession, people in a worse or better condition than me. I decided personally that I did not want an ablation. They seemed intrusive and success rate was very moderate. Some people regretted the intervention others were pleased with the outcome.

    I came away more confident and relaxed about my condition. It always seems to me uncertainty is the worst enemy. At 76 living on my own I recently had a and a new aortic valve fitted and a single bypass four months ago. I elected to have this done before I had heart failure/attack fit enough to stand a very big operation . This was a success and the medics have given the normal life expectancy but AF remains. I am back on my bike at a gentle rate and dancing again. I have lowered my expectations and do yoga and meditation. I am virtually back at peace with myself. I do feel my "spirit" has been handled and must stress I have never been subject to whimsy.

    This forum is very supportive and has helped me a lot. I wish you luck and don't rush into anything too quickly.

    Best wishes


  • Hi JamesP,

    I don't often look at Health Unlocked anymore but, occasionally, something grabs me. I saw your answer, just now, to jhcoop55 and felt compelled to communicate.

    I, like yourself, am 76 and have suffered from AF ever since a severe attack of "community acquired pneumonia" about 7 years ago. I had repeated cardioversions which never lasted for long so, ultimately, I had a pacemaker fitted just over a year ago. I have little doubt that was done in deference to my age, since they are expensive to replace. But I can see the dark humour in that. I am determined to prove them wrong. Anyway, I no longer think about my AF because, whatever is happening underneath, I am not aware of it. I, too, am a cyclist. I have a house in the Auvergne, in central France, and that just demands cycling. I now do it at a slightly gentler pace but the pacemaker hasn't stopped me at all. On the contrary. I haven't had anything as radical as bypass surgery but I think you are so right when you say that uncertainty is a big negative factor. Well, I think that life itself is uncertain so there is no point in further jeopardising one's enjoyment of it by something that may or may not ever happen.

    Can I wish you a happy Christmas.


  • I have probably now had enough of the sites and am now better informed. I am now almost completely fatalistic but desperately try to avoid wasting any opportunities to socialise without getting too tired trying to monitor any changes of personality or behavior. I did ask my friends to tell me but they are understandably reticent to do so. My meditation has also helped and taught me "acceptance" and like you I do not worry about my persistent AF any more.

    Happy Christmas!


  • You are likely to be young and almost for certain a "vagal" afibber.

    Check out yourself how quickly your condition will progress, and what are the best options:

    For vagal, fit Afibbers with no underlying heart condition the ablation is the treatment of choice. Btw even if there are people(or doctors) who tell you to outweight risks and benefits of a surgery, I never met someone who told me they better not have had the ablation! There are pro cyclists who had ablation with excellent outcome (recently, rob gesink, and axel Teichmann, the skier- i think you find more if you search on, read their stories)

    Of course, I respect everyone who prefers to take drugs over surgery.- In my case, I tried over the course of a year with meds. I had 2 e-cardioversions in between and several short runs (up to 3 hours) which where either ended with Pill in a pocket or with up to 30 minutes moderate/strong exercise (running up flights of stairs). It progressed over the course of one year from monthly to bi-weekly episodes, usually at rest 12-24 hrs after long bike rides or runs of 25km or above.

    At the end (after 12 months) I was not able to get on a run/ride without the afib monster in my neck the day after.

    PVI has high first time success rates above 95%.

    Please be careful with any medication- especially rhythm control drugs like flec or beta blockers. Both may be helpful for keep afib at bay for andregenic triggered arrhythmia, but will worsen the condition with pro-arrhythmic effects and cause lethargic, depressed feelings in fit, young endurance athletes.

    I am very happy I did the ablation 9 weeks ago. I am back in the slopes, yesterday I smashed it and I am back to my 2008 levels!

  • Stating a 95% first time success rate is a number way, way higher than any number that I have ever seen or heard of and is not a number on the AFA's Website (unless added very recently).

    This is also way, way higher than that presented by the eminent consultants at the AFA's patient day in Birmingham in October. If I recall correctly the numbers quoted were 30% to 40% if in persistent AF and 60% to 70% if have paroxsymal AF.

    I have done a lot of reading and research.

    Where is your source for this high claim?

  • It's stated by my EP. She claims it depends on the root cause of afib, and whether or not an early intervention (prior to remodelling) was undertaken the chances are higher or lower.

    Of course, this is not backed by studies.- also, the long term effect is unclear.

    I think a more differentiated view on the chances of ablation as a cure is required. - Not just to encourage people to go, but also not to raise the hopes for others who are likely to fail.

    My EP/ surgeon has done/supervised more than 3000 ablations in the past 10 years. I think it's a good amount to make own judgement.- of course, no study to back up. - so I take back the 95%.

  • Tdl, this is of course the major issue. Not only do Cardios and EP's, have differing views regarding guidelines, protocols, call it what you will, but individual hospitals, and trusts appear to have differing views. Add the fact that the condition is so individual specific, the working our way through the maze, can be very difficult, whilst also coping with the symptoms of the condition. My EP, an eminent professor no less, gave me a less than 40% chance of success, and encouraged me to enquirer very carefully as to whom I let do the procedure, if and when, I decided to get it done. That, frankly spoke volumes. He recommended the Bordeaux facility.

  • Thanks for your response. Looking at this again in the light of a Sunday morning and with the extra things in your response I have some thoughts as to how that figure may be arrived at. She said probably just used the term AFib to denote those on paroxsymal AF in which case the level is 60% to 70% first time. Add to that a natural bias / enthusiasm towards success (who would want to admit failure) probably adds another 10% to 20%. Also probably adding further quantifications that apply to you could easily add another 5% to 10% (and age and fitness are possibly two). Also the national accepted figures could be 5% or so low due to natural conservatism and also being slightly out of date. Then taking other things into account I can see that it could get up to the 95% in YOUR case.

    On the flip side I specifically asked my EP to be honest and open as to what the chances of ablation success were in MY case (I was / I am in persistent AF). Told me first time it was 0% (zero %). That was evidenced by the fact that he decided that I would have a review Consultation at 6 weeks rather than 13 weeks in the hope that my heart was still in NSR so he could see the effects on my tricuspid valve (moderate to severe leakage) and mitral valve (minor leakage) - the latter more affected by AF. However I went back into persistent AF less than 72 hours later and I am awaiting my second ablation.

  • It also makes a huge difference where and who performs the ablation as well as how healthy one is to begin with.!!!!!

    The skill of the EP and the facility where it's done can raise the odds in your favor appreciatively!

  • I was quoted 85% for the first ablation and 95% if a second was needed. That was Prof Richard Scilling who is one of the leading electrophysiolosgit in the UK. I don't know if it was based on any studies but certainly good enough to give me the confidence to go ahead; really glad I did!

  • That is due to you personal situation and glad it worked. His website quotes 70% to 80% after multiple procedures.

    I am very pleased I had my first ablation done even though I was back in persistent AF less than 72 hours later - I have had some improvements on some aspects of my health.

  • I too am in a similar situation -- enjoy/need an active lifestyle centered around biking, skiing, and tennis – tho not really in the “endurance” category. My first AFIB episode was ~10 years ago when I was 40 yo. I saw an EP (in SF, CA, USA) who recommended that I live with it until it became unbearable. Recently the AFIB has been happening more often (several times a week), and become more difficult to revert to NSR. I am now thinking of trying ablation. It’s impossible to know the right course of action. While my EP said wait, others suggest it’s best to resolve as quickly as possible before the AFIB establishes the faulty pathways in the heart.

    I was intrigued by your “30 minutes of moderate/strong exercise” comment. I have found this to be a fairly reliable method for reversion to NSR. 10-20 minutes of running stairs or jumping rope does the trick for me most (over half) the time. I thought I'd comment to see if others have found the same trick, and to inform others of the possibility.

  • Hi Jeff, I have had the new Hybrid procedure so please read my posts for the whole story. Have been in NSR ever since. Regards Geoff

  • This could be me writing the OP. I am 58, currently on Digoxin, for rate, Bisoprolol, for BP, and Pradaxa Digibatran, and had a failed CV, and am now diagnosed Permanent AF. I also was/ am very fit, cyclist, gym, mountain climbing, etc. I also am really bothered about long term meds, and bluntly, I am not feeling too good. My NHS EP, told me not to go for ablation, citing the usual failure rates, the intrusiveness, but, if my quality of life warranted it, he would put me on the list. Spoke to a GP yesterday, who said, at my age, definitely ablation. It is a real conundrum, and I had resigned myself to meds until my next Cardio appointment in April. Reading this, I think Iwill book a couple of sessions with Richard Schilling, although this will be my fifth different Cardio, all it seems with a differing perspective on it. I think the real dilemma is what is causing your unwellness. Is it the meds, is it the Afib? All tests show in my case that the heart is strong, no artery problems, and I actually think, that this in itself is an issue with Afib. Stronger the heart, more difficult to control......

  • In my case exercise was making me feel unwell for decades before I developed AF or went on any meds, so it's obviously neither causing my problems. It didn't stop my EP blaming the meds though, he told me AF was harmless, stopped my prescription, and discharged me. Fourteen days later I was back to A&E by ambulance, with the consultant in resus wanting to know why I stopped taking my meds.

    I've had an ablation for flutter and take meds for fibrillation, but a doctor who doesn't understand the difference has written "Failed ablation" in my records.

  • That's what my cardiologist said to me (you have a strong heart and it is hard to control it) I taught he was just saying it for a laugh but he was serious.

  • I'm 59. Ablation is the only choice for me - no drugs. I'm 4 months out on my touch up ablation and all is well.

    Good luck!

  • The medications for it are horrid. Go for the ablation....find the best EP you can find and go for it!

  • Another biker chiming in !!! I have paroxysmal afib. It affects my swimming and biking. The afib rears up only when I stress my body such as long climbs or swimming too fast. So far I have been able to go back into nsr rather quickly. Of course, there have been a few times when I didn't. A cryoablation has been recommended for me. My ep stated that the first time success rate is around 70%. Going for a consult next week with my gp about the procedure. I'm still on the fence with this whole idea.. Oh yeah, i"m 70 years old and not ready to hang anything up just yet.

  • My view is go for it now whilst it is on offer. Success rates very much better in paroxsymal AF as opposed to persistent AF. Also whilst you are fit and healthy you may be less so in future and that may prevent it being done then or the AF may prevent other things being done. There are two operations that I should have but they won't do because of the AF and I am only 61!!!

  • Thanks to everyone for your prompt replies. Lots to think about but great information that will help me navigate this journey. By the way, I turn 60 at the end of this month and based upon a battery of tests, my heart is strong, but the AFIB is something I will need to work on. Also, I didn't realize that this was mostly a UK site (as I live in California) but the info is much appreciated and I look forward to learning more about the condition


    Jeff Cooper

  • Hey Jeff, I am here in the states too, and one other point that I want to make is that endurance athletes are high on the list of those who develop A.F. It is definitely a risk factor. So whatever you choose to do to fix it, I would seriously consider moderating the cycling a bit because even if you get a hybrid procedure done, you don't want to undo the repair by pushing too hard. Not saying you need to hang up the bike, but once we get a 'change of heart' by ablation, or other surgical procedure, success also hangs on how differently we live so as to avoid what caused it in the first place. Good luck! Are you in SoCal? I know there are excellent EP's at UCLA, or if you are in the north, Stanford is where I would go. Be well

  • Thanks for the encouragement. I live in Northern Cal near Auburn foothills. I've come to the realization that once I get my AFIB under control as best I can, my performance cycling days of 140 mile rides and 15,000 feet of climbing are likely over. Perhaps, more moderate 30 to 40 mile idea is a worthwhile goal. I've been reading that endurance athletes can get AFIB. I retired two years ago and have put in about 13,000 miles over that period with a lot of strenuous climbing which I really enjoyed. That may have well contributed to my condition. So the key going forward for me is to continue my fitness but at a much more moderate level. I will be exploring all medical options with my cardiologist and likely consult with an EP whom my wife works with at Kaiser

    Thanks Much

  • Oh, that's great, that your wife already knows an EP. You absolutely want him/ her in on this because the cardiologist just looks at this as a symptom of heart disease, and the EP looks at it as the main problem to correct. I also just read that Kaiser is the first health system to start to recommend an all plant based diet as their first line of health care. My EP has all of us switching to whole food plant based diets to reverse heart disease, and avoid diabetes. Food is medicine! Good luck, and keep us in the loop. I'm sure you'll be back to cycling, just keeping it at a moderate level!

  • Hi in the same boat as you, 58 when diognosed with afib, think ive had it for 10 years, had all the tests strong heart, been cycling weight lifting for 40 years, now on meds still training but not so hard, not sure a ablation would work when in permanent af for so long,

    Not feeling to bad on meds cold feet fingers and ringing in ears.

    Just going out for couple pints, got to have a bit of pleasure in life.

    Happy Christmas all.

  • I live in Florida and didn't realize it was a UK site until I kept reading "Wales, Scotland ,and funny expressions" but the comments are caring and informative for the most part and preferable to any other forums I have seen in USA .....wonder heart is strong too I have been told maybe that's why I had persistent afib. I found great EP in Boston as well as hospital and going into 4th month afib free. Still have some fluttering and palpitations but way way way better after ablation. California has great facilities I'm sure in fact just read some Article about EP in Los Angeles who sounded great but name I cannot remember. He may write a column. Keep in touch!

  • Jeff

    Sorry to hear that you have AF. But, you are not alone. The research shows that people who have engaged in long term endurance exercise are twice as likely to suffer from AF. It is thought the it happens as a result of long term damage and enlargement to the left atrium.

    Keep well and I hope that your AF doesn't deteriorate.

    My only piece of advice is to make sure that you are dealing with an EP cardiologist. From what you say this might already be the case.


  • Ablation! Dump the drugs - they compromise your ability to exercise, and as your AF progresses - oh, yes it will! - they wil lose their efficacy.

    I did cryo a year ago and I was better. At 7 months out I was back to AF about once a week and on beta blockers to try and stay in NSR. In mid August I went in for a tough up - RF ablation - to see if there were any "leaks". There were and they were "patched". I've been AF free since. No drugs either. I just finished a 20 mile road ride and feel great.

    A caution: your AF may be from high heart rates associated with long periods of exercise - riding, etc. This can stretch the left atria and mess up the electrical system of the heart. That's my story. I now plan to lift 2X per week for 90 minutes - and kick my ass in doing so - kind of ike intervals. But for cycing I'm going to back off on the obsessive/excessive mountain bike rides. So far so good!

    Good luck - and get on the list for that abation! Oh, your EP will chime in, but my guy said PVI only - maze and things like that are for down the road when other things have not worked.

  • My guy said same thing.....start with ablation.........

  • Sadly Jeff, those of us who have been evolved in endurance sports do seem to be rather prone to AF. Like you my AF was triggered during a cycling event whilst I was pushing rather harder than I should have been when suffering from a viral infection. It seems to me to that AF is The Couch Potato's Revenge, "you see, I told you that excercise was'nt good for you....."

    There is life with AF however. I still cycle and cross-country ski, just frustratingly slowly!

  • Thanks. I definitely pushed it too hard following retirement two years ago. I just wished that this had been diagnosed ayear ago when I first started to bonk out occasionally on challenging rides, but my heart was deemed strong following a battery of tests and EKGs and related stress tests at the time showed normal SR. Nevertheless, I kept at it for another year before AFIB started to rear its ugly head when I was merely resting. It was fun while it lasted but agree that I'll just need to smell the roses, albeit at a slower pace.

  • Yup, retirement seems to play it's part. They say that AF is age related, could it be that retirement gives us the chance to go for it and invite AF into our lives?

    Don't worry about when it was diagnosed, that wouldn't have changed the outcome. My job required me to have an ECG every year. Within 18 months of my retirement I was in to AF. You cannot understand just how frustrating that is. Because my job relied on my health I had a loss of licence insurance, if I had been diagnosed with AF before retirement I could have claimed on that insurance and retired early with a lovely fat lump sum.

    The only advice that I can give, based on my own experience, is don't look back with regret. Be proud of what you have achieved. You now have AF and must aspire to achieving different goals. Having AF diagnosed earlier would not have changed where you are now.

  • You probably have seen me quote before from my father you are at when you are at and you can only move forward but you can only learn from looking back (ie to help you to move forward).

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