My name is Andy I am 34 years old and I have had paroxysmal AF for about 3 years (known), I am on Flecainide 100mg x 2 per day. I do a lot of high intensity exercise and have noticed that my medication isn't working as well as it used to i.e. heart rate reaching 220bpm, and not going any lower than 150 when recovering. Previously while doing high intensity training it would be caped around 150bpm with a normal recovery. This is probably 3 in 10 training sessions and happens very randomly. Ive tried taking my dosages at different intervals. 0900 and 1700 also 0700 and 1900 but still get very random results.
I've considered upping my dose and also getting a beta blocker, (id talk to cardiologist first of course).
The AF is really holding me back. On a good day I can run easily 5 miles at 7.45min miles with normal heart rate of around 150bpm on a bad day I can barely run 10 min miles and have to stop regularly just to catch my breath as heart rate over 200bpm.
All I’m looking for is some advice really would beta blockers help? Should I get a high dosage of flecainide? I am due to run a 20mile obstacle race, but my training is so sporadic due to AF I am unable to get the miles in my legs. I don’t want AF to ruin my active life.
Thanks for reading
Andy
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I will be really interested to see what others think about your post.
For what it's worth I think that you need to seriously reconsider. Your body is telling you that all this leaping about is not good. You need to refer back to your cardiologist/Electrophysiologist and get some up-to-date guidance.
Footballers and athletes retire at your age. We all have to recognise that age catches up with us, especially when our hearts have electrical problems.
I was exhausted when i started bisoprolol Andy..but i have got used to it. I think you have a great attitude and determined to continue your life. I hope you can continue with the level of sport or find a level you are happy with and can cope with.
Hi Andy, its all about quality of life and giving your young age I would get yourself referred to an electro physiologist and discuss the possibility of an ablation as being in AF is always going to effect your ability to exercise and compete at a serious level. Ablations for paroximal AF have a high success rate.
Thanks elbows! I have considered an ablation but the risk of stroke is quite high and would be destrumental at my age, AF only effects my exercise life. I would only consider an ablation later in life if it was effecting me day to day.
I'm just looking to mix up my fleckainide routine and get tips and tricks .
Hi Andy - I used Flec for several years started as PIP which worked very well for a time - then daily doses when episodes became more frequent and then was on the maximum daily dose when it stopped being effective. I couldn't tolerate Bisoprolol at all but I tried it for a while - started at 2.5 mg and ended up on 10 mg and couldn't even climb the stairs without being breathless.
I have never looked up the stroke risk for ablation but surely it cannot be higher risk than remaining in AF? I had 2 ablations in 2013 & 2014, 2nd was successful thankfully, so stopped all meds 12 weeks after ablation.
I then found out that I have an autoimmune disease which is exacerbated by Flecainide - which by the way - can also act as an immunesuppressant.
For me the fewer toxic chemicals I injest the better, these drugs will only ever relieve the symptoms temporarily not treat the cause and you face a lifetime of being on these drugs and suffer the possible longer term side effects of taking them - and taking them so that you can continue to push your body to that level will have longer term consequences.
I get that exercise is your life - I know AF can be a problem for many athletes - because their heart becomes bigger to cope with the extra exertion - the atria stretches and becomes 'baggy' causing the rogue electrical impulses.
I am completely with Bigleg - you need to change something if you want to stay healthy - diet & nutrition helps but I would also suggest that you have another look at ablation which will treat the cause, to me your mindset is like treating a brain tumour by taking a few paracetamol and believing you will survive.
Hi Andy...I'm 45 with svt..only diagnosed 8 months ago running with an svt off 240 Heart rate...on bisoprolol 5mg...I was told to stop all exercise and quit my business....which I've done for the sake of my health... Having an ablation in 2 weeks..the stroke percentage is 1 in 300 so not that high.. With a 90 -95% recovery and 1% chance of returning....I'd really investigate the ablation route and research it...Basildon CTC department statics....theres always risk to any surgery...I think this option for u sounds good....then you can train till your hearts content...excuse the pun xxx
I think you should make an appointment to see an EP and discuss your condition, thoughts and problems. A high proportion of their patients are athletes of your age and younger. Talk to the experts and listen to their guidance and advice.
I started AF at 37, and did not effect me so badly for many years. (Now 57)
Had a meeting with an EP in October finally,( ablation person) and they have suggested an ablation as I am now having trouble exercising( not at your level! ) and meds not really working well.
He also said to watch strenuous exercise( but again I am not really fit like you!)
I asked about strokes and he said for our type of AF and being fit and healthy other wise, stroke risk is only 1% after ablation and as other person mentioned success rate worth giving it a go I reckon.
He implied to me a bigger risk of stroke is to let heart bump around so much as can remodel its self?
I would think about speaking to an EP as you are young and am sure the heart dept near to you would want to help and advise you to best out come for you re quality of life.
I agree with Elbow. At your age and level of fitness the risk of stroke from the Ablation procedure would be very small. Like you I like HIT and cycle 150 miles a week. AF ruined this for me so I opted for an ablation that was done 4 days ago. Do not be afraid of this procedure which could give you your life back.
Many eminent consultants opt for rate control over rhythm control. Flecainide is rthythm control. Look up medical journals and see what happens to the heart where rates are high for prolonged periods.
Are you aware that a number of althetes and professional footballers have stopped due to heart problems?
Are you aware that SURVIVAL rate is ONLY 5% for those who have a cardiac arrest when they are not in a hospital?
The actual risks during an ablation are in reality small and has been said on here many times the medics have to put them forward to cover themselves in the very unlikely event that something goes wrong.
I take my AF very seriously, I have 1 child and 1 on the way, I'm the only provider of income. I'm also a Paramedic, so have a real understanding of the consequences of prolonged fast AF.
My heart rate at resting is between 45-60bpm, and my AF is regarded as slow when doing normal day to day Activities, it's only when I exercise that my heart rate goes over 200, anything from a simple slow jog to a cycle or swim.
My consultant cardiologist has actually put me off having ablation and has encouraged me to continue exercising as I do. It's only been the last 4 months that I have been having issues.
I'll have a word with my GP and Cardiologist about rate control a beta blocker.
Just worries me that with a resting pulse of 45 would this drug send me even lower!
Obviously none of us knew that you are a paramedic. Many of the comments you have received are because people are so concerned for you and your family and there is a lot of information that suggests that excessive exercise is detrimental to long term health. Particularily at only 34 that is a key consideration.
You would have known about the low survival rate re cardiac arrests - most people don't. Last year as an interest exercise I asked about 15 people what the survival rate was and all bar one thought it was over 75%.
You mention cardiologist. I personally (and many others on here will recommend the same) would definitely get a referral to an EP because they are the real specialists with arithmyia. Yes your cardiologist will know a lot but an EP will see far more patients with arithmyia and, contrary to some people's belief, they do not decide to ablate everyone who crosses their door threshold!!! They are also frequently more up to date with current practices and options. As you will know AF and arithmyia in general is an area of medicine that has changed quite a lot in the last 10 years or so (practices, equipment, knowledge, etc).
Andy, my consultant cardiologist also put me off ablation, then I wasted 5 years of my life on drugs which had consequence before I attended the AFA patients conference & had informed, listened to expert opinion from the best EPs in the UK discuss drugs v ablation issue. I went straight back to my GP and asked for a referral to an EP who I saw within a few weeks - had ablation within 2 weeks of that.
Only regret, like others on this thread, was I didn't question my cardiologist and GP and push more thoroughly sooner and that I didn't do my own research earlier so I could come to an informed opinion. Much later and much wiser, I now discover that sometimes doctors give opinions and advice outside of their competence range so I now question everything - very carefully - and always ask how did you come to that conclusion? What is your evidence base for making that statement? Etc etc.....
You obviously must make your own mind up and take advice from your consultant but may I suggest you also think about a second opinion? As others have already suggested, Electrophysiologists not cardiologists are the experts in arrythmia.
Andy I think that the fact you do not have one person replying to you who is not concerned and horrified at what you ask should indicate to you the dangers of what you ask.
Please let us know how you get on, very best wishes CD.
PS - step-grandson is competing in Rio in August so I really do get how important exercising is in your life but don't allow to end your life.
I have thought that a couple of sayings that my father used to say that are very pertinent.
Life's changed not ended.
You are at where you are at [even though you didn't expect to be at that point]. You can only move forward and can only look back to help you move forward [albeit in a different direction to what you planned or thought].
My gut feeling is that you have a much higher risk of stroke carrying on as you are than if you had an ablation. Flecanide is a mask not a cure. There can be serious and significant long term affects taking it. I was on flecanide for about 6 weeks. Then I had a cardioversion but went back into AF 24 hours later. When I saw my EP ten days after that he stopped the flecainide. Both he and my GP had said that flecainide has health risks taking it on a long term basis (there are a few people who have taken for years with few affects but affects can build up). Search past posts on flecainide and in particular responses and posts responses by Kodaska.
Both he and my GP had said that flecainide has health risks taking it on a long term basis (there are a few people who have taken for years with few affects but affects can build up) - depends how you define time - Flecanaide has been around a long time 20+ years and there have been a number of studies on the long term results.
The other nuisance factor for the medics is us patients!!!! Some could start having problems after a few weeks and the next person go 10 years without any problems!!!!
I agree that if you can get an ablation go for it..... It was not offered to me and I was not really educated about a fib so did not persue it when it might have been an option. Now I am told I have permanent a fib and it is not an option. So honestly that is a real drag. So see if it is an option for you. I fought taking drugs I could be stuck on for life. Now I am 64 and I take Pradaxa for blood thinner and diltiazen..... They seem to work well.... I take low doses and can swim 50 laps and exercise ok. Good luck you will figure it out
Finally a swimmer. Sorry 2 hear about yur permanent afib. I just can't hardly believe u can exert yourself swimming with 1/3 of your heart out of commission. I'm on flec. Not in afib. I can only swim 50 meters and then I have to rest 25 seconds or so. Then 25 meters, rest 25 seconds with an occasional 50 meters. I alternate with pull bouy, board and fins. If I really get motivated, I'll do a 25, then 50, then 75, then 50 and finish with 25 but my breathing is really strained. I usually warm up with 200 meters with a 20 sec rest every 25. I just can't get enuf air. My pulse gets up to about 120 but not much higher. Wonder if there's an issue with O2 processing being on flec. Then again, I can run on a treadmill for 40 minutes straight with no breathing difficulties - but my knees can only handle one run a week. Otherwise 3 days of swimming for about 50 minutes. I've tried all kinds of breathing techniques for swimming, same side, interval every 3 strokes, same side 2X followed by other side 2X, but to no avail. Only been swimming 2 years and at 7,000 ft here in Colorado Springs. Is it the altitude, my inexperience, drugs, or what?? I'm 63 years young, but in real good shape. My wife and I bike and hike a lot around here as well. Your thoughts?????? Bill
Interesting I swim freestyle straight for about 40-50 minutes with no issues. I breathe on just the left side every 2 I guess actually 4 strokes probably through my mouth not sure. I do get out of breathe walking up a hill fast and my friend had me ask the cardiologist why swimming was easier and he said it depends what you train in. I doubt I only have 2/3 of the heart working. As far as I can tell I may have it easier with the kind of afib I have because it is low key and not as startling as what people report with sudden rapid heart beat coming on.
Maybe some of it is altitude or how you swim you may be exerting more..... For example do you put your head out of the water when you breathe ......do you breathe in rhythm with the strokes .... It would be interesting to have a swim coach watch you and give you tips.
Our pool was closed for 2 months so just getting back into it.....
Well I have had a cold and it is kind of cold and rainy so not sure when I will get to the pool hopefully soon to test this but ...I think it has to do with the rhythm how you breath....I am like 1, 2, 3,4, 5th stroke (right arm) then breathing simultaneously in through the nose on left. then breathing out into the water through the mouth? nose? not sure with the face turning down
Hard to know while not in the water but might have to do with the rhythm and getting the full breathe when the face is turned to the left and breathing out into the water
Then you can breathe more deeply. If you tried to breathe in and out while your face was out of the water you would not get enough air for sure
Thanks much. I do the same as what yur describing. I've tried every other stroke (same side), every 3 strokes (alternating sides), 2 cycles of every other stroke (same side), followed by switching sides which adds a third stroke before a breath. I've tried inhaling through my mouth, exhaling in the water and inhaling through my mouth and exhaling through my nose and mouth simultaneously in the water. Neither makes a difference. Tried inhaling just through the corner of my mouth but still no difference. I actually had coaching by an olympic swim team coach and he can't figure it out either. I've had one of those lung capacity tests where you suck in as much air as possible and then exhale until you can't stand it and think yur head is going to explode with normal results, so my lungs are fine. Really at a loss to figure this out. But I do appreciate your suggestions. Feel free to suggest more. My goal is 45 minutes continuous but for now its start, stop, start, stop, start, stop. I've never experienced failure doing anything.....except calculus and chemistry!
Hi Andy. You've had some different replies on here, so as a runner, I'll stick my two ha'pence in for what it's worth. I started running at the age of 51 (9 years ago). I completed countless half marathons and 3 marathons before paroxysmal AF reared it's ugly head. Nearly always exercise induced although latterly it used to come on with mild exertion. My heart rate never went above 100 even in AF, but it was hard and unpleasant to run (for me, my easy 10 minute miling dropped to 12 mm which seemed like hard work). If I'm honest, I could have lived with it if it hadn't have been for my running which I love and missed. I was lucky enough to be seen privately and at my first consultation, as the AF wasn't so bad, my EP words were - 'go out and live your life' and that Included running (and with his blessing my last marathon (New York)). However, by my next appointment a year later, it really was becoming a pain. My EP suggested that none of the drugs would do the job without compromising my life in ways that wouldn't have worked for me, so suggested ablation, which I had nearly two years ago. Thus far, I've had no more AF and I run and train the way I used to. The only caveat is that I've been advised not to run farther than 10 miles because of the link between AF and endurance running.
So my advice would be - don't give up and get yourself on the waiting list for an ablation, then you can return to your active life.
Hi Andy, I am now 62. Up to 51,I was in the gym, played football, twice a week, jogged 3 to 4 times a week(5miles in 35 mins at peak) skiied 3 times a year, a keen walker and cyclist . I developed hip trouble which finished the football and jogging. Then got first(known) AF attack on top of Ingleborough, thought my time was up! Drugs for 5 years including amiodarone, bisoprolol, sotalol, atenolol, flecainide, statin, warfarin, ACE inhibitor and others I can't recall. The only constant was that the AF got steadily worse. I have a resting HR of 55 to 60 when in NSR. My left atrium is enlarged. QoL became totally crap. Went down the PVI cryoablation route. Result is am now totally drug free, still get ectopics but have had 2 short AF attacks in a year as opposed to being I AF for 3 out of every 4 weeks. Total no-brainer. Cardiologists ran me ragged for those 5 years with conflicting advice. Eventually saw an EP who put me straight. The more you get AF, the greater the risk of remodelling and changing PAF to persistent AF. Get more advice. Ablation has transformed my life, two of my ex-colleagies and a former student who had hers at age 19.
Stay away from beta blockers. They are known to ruin the active lifestyle of sportsmen. I know what I am talking about. Get yourself on the list to receive an ablation If you want to continue your sports life one day.
If a doctor really suggest beta blockers on whatever dosage I would change. BB just control the adrenalin and noradrenaline receptors on your heart. It's a treatment to be considered for old, inactive people. From what you describe you are likely to have a reentry tachycardia. Ablate the wrong pathways is gold standard for young people, and safe cure. (I am not a doctor)
I am a triathlete (43) and former Cross country skier myself, got the ablation for AF, (not tachy) and this has been a vast improvement since. I am medication free again, and can achieve in stress tests values again I have seen 10years ago the last time.
Put the BB's in the bin, - at least until you're 50 and have high blood pressure and stopped sports
Ive been wondering what your wife thinks. Being pregnant and with another child to look after and a husband who pushes himself too far with the exercise must make her feel pretty insecure or is she spent woman. I love extensive and hate not doing it but PAF has curbed what I do as staying alive and realising what my body is telling me is more important to me. Very good luck to you. Just be sensible
Andy I don't normally answer questions like yours for reason many here understand but there are a couple of points I must make.
Firstly that you must surely know that is it your lifestyle of over exercise which has probably caused your AF. Other than genetic and alcohol related AF the two classes of people who develop AF in younger ages are endurance athletes and fast jet fighter pilots.
Next, in my opinion if you are taking a drug and it isn't working (Flecainide not preventing AF as it is designed to do) then you are introducing a risk for no gain.
Thirdly , beta blockers will reduce an already low resting heart rate and as you know that could be highly detrimental.
Fourth, The risk of stroke is not increased by ablation. You are five times more likely to have a stroke if you have AF regardless of any other issues. As Peter commented all the possible risks from ablation are explained but most of them are extremely rare and only mentioned for the legal protection of the medical staff.
Fifth point. Get to see an electrophysiologist. Many general cardiologists are not up to date with arrhythmia matters. Would you ask a plumber to re-wire your house?
Life is about balance and I would not dare to tell you how to live yours other than to suggest that you consider what is most important to you. AF is not usually life threatening but it is life changing. Accepting that is the first step to dealing with it.
I agree with Bob. I would also like to add that exercising the extent that you are puts you at risk of heart failure if you are in af at the time of exercising due to the reduction in ejection fraction.
My ep also advised me when we were discussing cardioversion or remain on meds about the flecainide side effects as mentioned above and sudden death with exercise.
I am 43 and had ablation just before Christmas and within 3 weeks was back to the gym 3 times a week and now off meds ( was on digoxin and flecainide and rivaroxiban as get too hypotensive with bisoprolol )
Please chat to an ep as the uncontrolled af with the amount of exercise you do sounds concerning.
Fighter pilots??? Hmmmm.....I was a pilot flying commercially. I do know that 1 out of every hundred pilots at my airline did have Afib, including present company, which I think is little different from the population at large. You can still fly having afib, with a waiver from the feds. Just need to do a 24hr holter each year and a letter from yur cardio doc with normal findings. You can't be going in and out of rythym. You can be in it constantly or be in normal sinus rythym constantly, but not in and out. What's crazy is the government approach to life. Even being required to do a holter, I still was required to have a ECG at the FAA doctor's office as part of my annual exam!
Apparently the heart works very hard when you are pulling 9 G and this can load it to the extent that it can cause enlargement of the left atrium which in turn leads to breakdown of the electrical pathways leading to AF. I doubt you make more than + 2 /-1 g max in a commercial aircraft unless you are in deep doo doo.
I've been in deep doo-doo but not in situations you describe. If you're doing -1 g you're really in trouble. 0 g is weightless. Never experienced that in a big airplane either. 2 gs maybe in a tight turn or in severe turbulence but that's usually instantaneous gs. In fighters, especially late 20th century and beyond, the seat is reclined for better g protection. Also there's g suits or....go fast pants which guys wear which protects them from blood pooling to the lower half of their bodies. Not sure if that prevents what enlargening of the left atrium. But very interesting. Gee, they never told us about that!!! Without a g suit, if you pulled 9 gs you'd be unconscious.
Eurofighter Typhoon pulls 9 g in a tight turn according to the guy I met who flies them. No doubt your F35 is similar. Interestingly the Russians did a lot more testing of pilots and only chose those with a high G tolerance rather than relying on g suits which were then back up rather than essential.
I'll have to look into the Typhoon. Guy would have to have been built of steel to withstand 9gs with no g suit. Those Ruskies, I'll tell ya. Their pilots are expendable, think??
Hi Andy,
I'm 40, have an active job and an active lifestyle with two young children. I was diagnosed with AF three years ago and after a few versions opted for an ablation which I have had two of now. From my experience, drugs are not an option for me there are too many side effects (I'm on Xarelto 20mg daily,
Flecainide 50mg twice a day,
Bisoprolol 2.5 mg daily at the moment after a recent episode). The tiredness and dizziness really impact on my daily life. After recovering from my ablation and been drug free I felt I had my full life back. Been back on them now the difference is huge.
You obviously know your stuff with your career all I can tell you is that if they offer me a third ablation I think I will take it. At my age I don't want to be held back by AF.
I'm 41, with PAF, which has almost always - apart from once - come on after running, and which has always been triggered by exercise. In my case, I wonder if it's related to a sustained high average heart rate, as cycling has only brought on an attack once, after an unusually sustained effort: my average HR while running would usually be 169 or more, while my average HR while cycling doesn't go above 140. I've dropped running completely, and now just cycle - and I do a fair bit of cycling, up and down the hills of the Peak District (e.g. 67 very hilly miles yesterday), often at a fair intensity (although not racing, which would ramp things up a great deal). For what it's worth, I was put on 2.5 mg of Bisoprolol when the AF was properly diagnosed, and I've been fine on it, although I didn't feel great on it for the first few weeks: it's reduced my average HR during exercise, and perhaps lowered my resting HR a bit, but it hasn't dramatically lowered my max HR, and I'm able to tolerate it while exercising without any troubles. I also haven't had a bout of AF for just under a year, having previously been having them every few months for a couple of years. While I have no doubt that the AF will return, I'm very glad of the current stretch of time without it, and the Bisoprolol may well have played a part in that: which is all just to say that the Beta Blockers option may not be wholly incompatible with what you're after - that said, AF seems to be such a complex condition, and people seem to respond so differently to different potential remedies, that it's probably worth being very wary of generalising from any other cases to your own.
When I was first diagnosed with Af I was asked about life style, exercise etc, looking for a trigger,I couldnt find one, but now in heindsight 3 years down the road a surpirsingly number occured after I had vistied the gym,
the British heart foundation recommend 30 minutes of mild exercise a day, Im not in that mild camp and work harded, but ever mindfull of not pushing myself into danger, I had an abalation and thankfully its changed my life, I recommend it
you may have to consider changing what you do, or nothing will change except it may get worse and more frequent, weve all had to find our own way adjust ...good luck
Amazing response everyone! thanks so much for all the replies!
I'm going to make an appointment with a EP via my GP next week. And discuss in great detail an ablation, I was putting it off however it's now clear that this should be done sooner than later.
With regards to exercise I wear a heart rate monitor and generally stop or take a break if heart rate above 180's, all my instructors are aware and people I train with are also.
With regards to BB I'll steer clear as my resting heart rate in NSR is 45-60 anyway (probably why I couldn't tolerate bisoprolol in the beginning) and especially as BB can effect exercise anyway.
With regards to the 20 mile obstacle race I'll prospone my entry. As a few of you said it's not worth it! And to fair
pretty selfish of me.
Talking on here has been the best move I've made with regards to my AF so thank you
Worthwhile noting that disregarding the AF aspect some monitors only claim to be accurate within 10% as standard. Add in AF and probably some SVTs accuracy could be upto +-25%.
Cuff monitors are even worse and I cross checked mine (a well known make) for about three weeks against AliveCor after I bought AliveCor and the variance was up to +- 35% but it was not only inconsistent on the % but also sometimes gave lower reading and sometimes a higher reading than the AliveCor.
Smart decision Andy, Af will always be there in the background, life will never be fully the same unfortunatley,
as youll find out if you need to travel overseas, and get medical insurance its called a pre existing medical condition...sorry I dont mean to be negative but its a fact of life, the good news is your young, healthy and can probably get it fixed and get on with life..
Eleanor, I also have had PAF for years and take 300 mgs of Flecanaide daily. I have considered taking as PIP because I worry about taking max dosage daily for long period of time. Have you always taken Flecanaide as PIP ?
Hi Andy; you will have seen that there's some fairly polarized views on the subject of AF and exercise and, that there isn't a one size fit all answer. I Orienteered and ran an average of 50 miles a week (6 to 7 min/miles) for fifteen years plus cycling during the summer. During that time my heart rate always exceeded the 220 - age. I stopped for many years and when I restarted, I could hit 190 bpm during Spin classes and cycling and it was not a problem, but running at 200 bpm and above was really unpleasant and reduced me to run / jog. I was a gym bunny with PAF until May 2014 when dronedarone (for PAF) came close to finishing me off or damaging my lungs through pulmonary toxicity / COP. Fortunately I was able to start back in the gym in November 2015 and I'm only taking 5mg amlodipine for blood pressure as a hang over from taking high and prolonged doses of prednisolone to offset the pulmonary toxicity. At age 69 I now row 5km in 23 minutes on a Concept 2 followed by 25 minutes on an Ascent (a kind of an elliptical) increasing resistance every two minutes. Some times I get AF (over 180 bpm) that drops my power output by around 20% and other times I don't; but I can keep going.
So, why not try non-weight bearing aerobic exercise as a change from running? It's hard to let go of that endorphin buzz, you just have to find what suits you. A twenty miler sounds too much though. Good luck, take care with your body but don't give up on life and exercising!
After my ablation at age 33 I had a few afib attacks but got back in NSR twice with cardio version. On 100mg aspirin (cardio care) and 2.5mg Bisoprolol now(to keep my heart rate down according to my doctor). I have been on it so long I don't feel any side effects.
Ablation was very good for me even if my EP said he was only 70% successful.
Hi Andy, you have got plenty of advice already – I agree with much of it but some of the comments sound very definite and don't take into account that we're all different. As an EP who is not in favour of the "ablation for everyone" approach, here are my thoughts:
1) The flecainide is probably helping but evidently not completely successful under exercise conditions. This is a common problem and one of the reasons for combining it with a beta blocker. Beta blockers commonly cause side effects but these vary from person to person and depend on the dose used. I have several exercise enthusiast patients who take regular flecainide to avoid random attacks of AF but then add in a short acting beta-blocker such as metoprolol (25-50mg) before undertaking training or competition. This will probably not have any significant adverse affect on your performance, indeed before it was banned it was popular with triathlon competitors because the benefits in the shooting stage outweighed any disadvantage in the others.
2) There is no harm in taking these drugs long-term provided they are working and although your fitness program may be contributing to the AF tendency it is obviously important to you. So if no drug regime is sufficiently effective to allow you to continue, and especially if the problem seems to be getting worse, then I think you should consider AF ablation.
3) AF ablation is a brilliant technical advance but you should be aware that it may take two or more attempts to get a sustained successful result and there is a significant (10-20%) failure rate – and some rare but serious complications, as you will read in other posts on the site. We have very little data about long-term (10 year) outcomes.
Good information Jonathon and your probably one of the most qualified In here!
So what your saying is that I shouldn't completely give up fleckainide? My experience of Flec is very good, I get no side effects and as I said up until a few months ago could exercise with in normal heart ranges.
Adding a beta blocker seemed to be the next logically step, but i was aware of its side effects due to previous use (bisoprolol).
My most recent 7 day tape concluded that I'm in AF 33% of the time which had previously been at 13% at diagnoses. 33% being my normal rate of AF which is 80bpm (no signs and symptoms)
Metoprolol sounds like exactly what I need. I'm still going to get a GP appointment and be referred to some someone like yourself.
what is yor oppinion on long term Flec use and how my heart could potentially mould itself into a damaged heart?
Andy, lots of valuable and pertinent comments. I am 71 years old and did intensive exercise 5 days a week. Swimming a mile 3 times a week and biking 40 plus miles twice a week. Paroxysmal Afib caught up with me. I was put on beta blockers and statins and anti arrhythmic drugs. It seemed to work for awhile then I started to struggle while swimming and biking. Heart rate while biking would shoot up over 200 bpm. I tried all kinds of med combos,taking my meds at different time and supplements to try to get my"stamina" back. The last thing I wanted was an ablation. It was getting worse. My EP suggested I really consider ablation. Scheduled the ablation and since it was later in the day decided one last swim before I go in. Bad move. Went into atrial flutter ad shortly afterwards afib. Dr. couldn't believe I went for a swim prior to the procedure. I'm just starting back into my exercise again but modified . Starting out real slow and working my way up. I've got plenty of time to get back. I wake up in the mornings and feel so much better. I'll modify my exercise routine. I've nothing to prove to anyone. I'm just extremely grateful I can start again ,hopefully, afib free.
I am addressing this mainly yo you as you said you were an EP.
I am 77 years old an was in paroxysmal AF from the age of 62.
I was told then that there was no 'magic cure' and was put on warfRin and Sotolol. After 2 years I was put on Flecainide instead of Sotolol which didn't seem to be working.
I remained on flecainide (100 twice a day) until last September (2015) when my paroxysmal AF became persistent. I saw a cardiologist who specialised in arythmias who mentioned doing a cardioversion. I decided against as I didn't like the sound of the drug amiodarone which I would have to have taken for several months.
I decided with his blessing to stay as I was. He took me off flecainide and am now on bisoprolol. The only problem is that I get very tired but I am 77.
Reading comments on this site tho' has made me worry very much about having been so long (12 years) on flecainide. My echocardiogram did indicate a very enlarged left atria. Did flecainide do this?
I have never seen an EP or even heard of their existence until I joined this group.
If you have been patient enough to read this far, your comments please.
As I am a great worrier please don't give me very bad news.
Sorry I only just saw this. There's no problem with being on flecainide long-term unless you are one of the very few people who have side-effects (mainly pins-and-needles and numbness). The enlarged left atrium is just part of the AF problem and is probably why the felecainide stopped working.
You can minimise the tiredness side-effects of bisoprolol by using the minimum dose and adding in digoxin (which usually doesn't have any side-effects) and/or diltiazem which has some opposite side effects to bisoprolol (gives you WARM feet) and can also be heplful if you have high blood pressure.
It's worthwhile checking how fast your heart is actually going now because often it gradually slows down by itself and you don't need so much rate control meds. A 24 hour heart monitor is helpful for this (you should go for a stiff walk while it is running to check how much it speeds up).
The problem for a lot of statistics re risks relating to AF is that the studies and reports were done many years ago and techniques and equipment have developed significantly in the interim.
On ablation, like all surgery, there is always a risk element. I spoke to my GP about it and he said with regard his patients the worst case scenario he'd experienced was that it simply didn't work. But then I read that Alvin Lee of 60-7os band Ten Years After actually die during a 'routine procedure' to convert his AF, although that was in Spain for what it's worth.
Hi Andy. I am really interested to read your post and feel quite inadequate in my exercise regime! I was diagnosed with AF a few months ago, although I do feel this was undiagnosed for a few years. I am 52 and have run for about 8 years. I enter 10ks every 2 months or so and try to run twice a week, only about 5 miles each time. However, since the diagnosis I am fearful of running and haven't done so for a few months now. The consultant didn't discourage me but I feel tight chested and breathless when I try to run. Anxiety doesn't help! I understand this is a huge part of your life socially as well. I would suggest asking more advice from your cardiologist. I was prescribed 5mg bisoprolol which has helped with AF symptoms. I hope you get some reassurance and feel able to enjoy your exercise.
I would not advise using a higher dose of fleacinide but you could certainly add a beta blocker such as metoprolol as a kind of "pill in your pocket" taken one hour before you go for a run.
Like many of the replies I think you should consider an AF-ablation.
When to start exercise again post catheter ablation?
Hi everyone, just to let you all know that I had a catheter ablation under GA yesterday morning, and according to the consultant was a successful however I was told that I have a unusually large Atrium so AF could return.
So far my heart has been regular, but means nothing I know! Also groin feels fine but lots of bruising appearing! (Normal so I read)
My question is when can I return to exercising? I have been reading lots of different posts. All with differing advice.
I understand that I am not to do any heavy lifting for 2 weeks, and have been told to start back slowly and listen to my body.
Before the procedure I was at a very high level of fitness, training daily when the AF would allow.
To add I am 35 years old on fleckanide 100mg and Rivaroxaban
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