AF after exercise

My AF sometimes occurs after exercise. Tonight for example I take part in an orienteering event. I run for about 60mins; no AF. 50 minutes after exercise I eat my dinner (curry/rice) and whilst doing so I go into AF. Quite bizarre as on Saturday I ran for over 1& half hours on quite a hilly route and have no AF after? It can take about a week for NSR to return. When in AF my heart doesn't beat excessively fast just irregularly. 80-90 BPM. My resting heart is about 50BPM. Anyone else have anything similar. I'm going back to cardiologist later this month. Went to A&E last time and they put me on bisoporol which makes me feel tired and really suppresses my exercise performance. 2.5mg but I've halved the dose daily. Any thoughts comments or words of wisdom appreciated. Going to ask to see an electrophysiologist.

Thanks

33 Replies

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  • Could it be the food which was the trigger, not the exercise? Some people find they cannot eat large meals because it sets off their AF.

    Bisoprolol has that affect, I couldn't take it and was much better without it and other drug treatments are available and ask about ablation, the sooner the better if you stay in AF for more than a few hours.

    Good you are seeing an EP soon in the meantime research, research and more research - check out the AFA website for questions to ask you ur EP.

  • I don't think so. It wasn't a huge amount and the AF started whilst eating. I'm desperate to nail down the triggers though. I'll add large meals to the check list in case though. Thanks for your reply.

  • The vagus nerve runs very close to the heart and through the stomach so food and drink can often be triggers, as well as exercise or rest and alcohol etc, etc. No matter what the triggers may be, you will still have AF and it is the underlying condition that requires treatment. Bob told me that chasing triggers will send you mad - well I think I am still relatively sane - but every time I thought I had correlated a trigger either a 'new' one popped up - and then not.

  • Interesting about the vagus nervre, thanks. Trigger chasing will probably drive me crazy! I'm just looking forward to eventually seeing a specialist but as always it takes time.

  • I also often have very frequent atrial ectopics as soon as my heart starts slowing down after (or during) exercise. If I sit down or eat, the ectopics get worse and sometimes I go into short bouts of AF. Sometimes it can be triggered by the first or second swallow during eating. This is clearly a vagal effect.

  • I totally agree about chasing triggers - that way madness lies! I came to the relatively simple conclusion some time ago that I've got dodgy electrics - 2 ablations in 2 years and still on drugs - but things have settled these past 6 months which would be great if they'd not been replaced by other unrelated issues! Sometimes it may just pay to accept you have the condition and adjust your lifestyle and hobbies etc accordingly. Not a lot of fun especially if you are one of the younger sufferers - but acceptance of the condition and making the best of it is a battle we all face to varying degrees.

    Good luck especially if you go down the ablation route, which I would grab at if the EP thinks you are a suitable candidate.

  • Ah yes. Triggers! Human nature at it's best. I too could exercise and then go into AF within about 30 minutes of stopping. Sometimes I went into AF during a mountain bike ride - that makes for a fun time getting back to the trailhead! Notice I use the past tense here? I took no drugs and asked for an ablation. My first one was 26 months ago. I made it 8 months and did it again. since then I've been able to do pretty much whatever I want - especially ride my bike again! You are obviously fit so you may have AF with no other lifestyle problems - smoking, BP issues, diabetes, etc. If so you may get lucky like I did. If you are in poor health an ablation without cleaning up your act may not be so good. Good luck! Get an ablation!!

  • My AF commenced following exercise some 5 years ago. I am a triathlete and have since undergone 2 x Ablation. It always started about 1/2 hours after exercise. I looked at other triggers but at the end of the day I don't believe you can pin anything down to a particular food type -? Some believe you can and cut these out of their diet but at the end of the day AF finds away round it. I was initially put on bisoprolol and on it I could barely walk fast. Both my Ablations temporarily appeared to work but after a few months AF returned - ablations are not an exact science I'm afraid. The good news is I am now on a low dose of Flecainide 50mg twice a day and I am stable. I am exercising fully again and appear very stable. I have undertaken several ironman distance and half ironman tris so it's possible to stay healthy and fit even with AF in the background. I don't drink because alcohol can be a certain trigger for me. I would ask about Ablations as your symptoms go on for a relatively long time. My AF periods lasted hours only. Good luck!

  • How long how you been on flecanide? i was put on it in Dec and so far no Afib, been 4 months... tried numerous other drugs and they did not work.

  • I'm 55 years old and have had AF since 2012/3. I have been taking Flecainide for 8 months now. It works for me and allows me to swim/bike/ run fairly hard. Beta blockers are no good for me!

  • Yes, I think the exercise would have lowered your threshold for AF, and then as people say the eating would have pushed it over the edge. That doesn't mean you'll go into AF every time you exercise, it just means when you exert yourself there is a higher probability than normal so you just need to be a bit careful.

    But keep exercising in a controlled way. The better your fitness, the lower your stroke risk.

    The trick is to exercise enough to keep yourself fit, without over-exerting yourself and lowering your threshold for AF to the point where any other trigger (e.g., digestion) will trip you into AF.

    As for the "50 minutes later" - people with vagal AF often go into AF after they recover from exertion - not during - so your experience of the timing of AF is not surprising to me. Something to consider is how slowly you warm down - never just stop exercising on a dime - slowly reduce your heart rate, and avoid eating within a couple of hours of exertion.

  • You might enjoy reading 'The Haywire Heart' by Christopher J Case and Dr John Mandrola, about exercise and the heart.

  • Thanks for the replies. I'm 48 years' old and it's comforting to read about people with similar experiences. I tried flecainide as a pill in the pocket but that never worked. I'll definitely try the not eating for several hours after exercise method too. I had a CHADVASC score of 1 so am currently not on any anticoagulants. Again something else to discuss with the cardio.

    Thanks again for the replies.

  • Not really an answer (sorry!), but seeing similarities here and there, thought I throw a bit of my story down.

    History: 50 yrs now, have been very sporty in swimming, triathlons, bike riding, kayaking, etc. I suspect I over did things with the triathlons and at age 42 things came to a head and AF began. Long story short - Ablation in August 2015 (good for 3 months) and a 2nd in March 2016. Had one AF morning in April 2016, but got cardioverted straight back.

    Since feeling much better after Ab 2, I`ve been exercising a lot more regularly, but trying not to overdo it. Built up my stamina on my surfski kayak and regularly go for a 90min paddle at around 130bpm with bursts up to 160bpm. 2 months ago I got the bit between my teeth and pushded in training with a mate. Basically, 30 mins at 164bpm and the last 40 at 150ish. I knew I`d overcooked myself, and sure enough, once I got back to the beach and checked my pulse, I was back into an irregular AF (at around 80/90 bpm). (previously my training had brought down my post Ab resting HR from 90 to 67ish).

    I decided to "see how it goes" before rushing to cardioversion again. By evening I could feeling it starting to settle and 24 hours later it was back to normal. So, it was a relief and perhaps I`d managed to find that line - the one you can`t see until you go over it!

    I mentioned this to my doctor and he laughed (I think it appealed to his Japanese sense of humour). He`s given me pilsicainide tablets to take either before I raise my HR to those levels again (I`m trying not to!) or if I go into AF after exercise again.

    So, no answer from me, but I do echo what others have said, ie, experiment, but ultimately change parts of your lifestyle and just accept it.

    Good luck!

    Owen

    ps so glad I did have my ablations.

  • Thanks Owen. That again gives more food for thought. I try not to push myself too much but you know what is sports people are like!

    Alex

  • Forgot to ask Owen are you on anticoagulants?

    A.

  • Hi Alex,

    It`s all in Japanese, but I don`t think so! I was on Warfarin, loads of the stuff, for years, but thankfully no more since the ablations. My present drugs include:

    Irbetan for blood pressure

    Aprinol for gout

    Tanbocar for anti-arrythmia

    and Bepricol to keep regular heartbeat.

    Got to do the school run now - all the best!

    Owen

  • Hi Physmeister,

    I've had similar to this. Up until last June, I was a regular squash player, 3-4 times per week for about 25 years. Then I went into AF on the court and got taken to hospital, I came back into NSR naturally, but stayed in overnight. They also did an angiogram on me and told me I had mild coronary heart disease (a bit of a shock to me as I have always lead an active life and tried to keep myself fit etc).

    Anyway, since then, I've only played a handful of games, I got a bit scared of doing hard exercise in case I kicked the AF off again. What I found when I played was that I was Ok during the game, heart rate going up to about 160bpm, but when laying in bed, some 5-6 hours later, I would suddenly go into AF, sometimes a combination of atrial flutter and fibrillation. I had usually eaten something after the game (couldn't eat before for obvious reasons) and I'd had a couple of pints with my opponent in the bar after. That combination (which had been normal for me, for years) seems a "no no" now. I've certainly cut down on alcohol, probably only a couple of pints on a Friday and a Saturday now.

    Quite often since, I've found if I eat late (9.30-10pm) it's not good.

    I'm frustrated because I really want to get back to playing squash regularly but I'm always worried by what might happen after. So far, all my episodes, which can last anything from 3 hours to about 21 hours have resolved on their own (my heart rate during this time is typically around 130-140bpm). But I worry about the time it might not resolve on its own.

    I'm taking Sotalol as a pill-in-the-pocket now. I was taking it everyday, but if I'm not pushing myself, I don't tend to get the AF at the higher heart rate, so didn't want to take it for the sake of it (I really dislike taking tablets anyway).

    My GP has got me an appointment at the local arrhythmia clinic (at the JR in Oxford) for end of May, so I'm hoping they might be able to assess me in terms of a possible ablation or at least advise me about exercise.

    I've been told that the "stop/start" nature of squash and sudden jumps in heart rate is not the best for someone in my position. Just running on the treadmill might be better, although certainly more boring!

    Take care,

    Andy (P.S. I'm almost 57 years old by the way)

  • Thanks for that Andy. I agree with the stop start nature. This has triggered mine occasionally. Lots to discuss at my next visit to cardio. Thanks again

    Alex

  • I used to do competitive cycling, and would sometimes go into AF at the end of the ride---never during. Over the years, the episodes went from an hour or so each to persistent---an unfortunately common trajectory. Ablation has helped---like others, I'd jump at the chance. I also couldn't tolerate beta blockers. Now use a calcium channel blocker (diltiazem) when needed---much more gentle effect on HR.

  • Thanks for that. Are you still taking regular exercise?

  • Yes . I still do weight training and HIIT, but not competitive cycling anymore. Mainly to stay fit for windsurfing and snowboarding, which is how I got sucked into cycling in the first place. I think the sustained high HR of competitive cycling was a bit much for this 70 yr old body. Also, I lost my competitive edge with the AF meds.

  • At 70 that's enough I'm sure. If you're anything like me I still think I'm 20!

    Take it easy.

    Alex

  • Chasing triggers:

  • So just over 36 hours in AF and played badminton for 2 hours whilst in AF. About 10 minutes after back in NSR. Don't you love AF!

  • I get the same response to exercise and have read that distance runners are about 10 times more likely to have AF. The food works against it too. I think our type AF is called VAGAL and is somehow tied to our digestive system and that VAGUS nerve that is connected to the heart.

  • Hi

    Do you take any meds? I was on bisoporol but have taken myself off it after 3 months as it was draining me of energy.

    Alex

  • No just high cholesterol have had an Ablation and was good for a year but it is back just now

  • Sorry to hear it's back. I've just started taking a magnesium supplement to see if that helps.

    Regards

    Alex

  • I have magnesium gonna take it now just forget about it

  • Good to read all your experiences above. Had Paroxysmal AF for about 10yrs (Im 52) and episodes are fairly few with large gaps of 12-18months of no AF. I have had several hypothesis on triggers but probably need to give them up. I run, Crossfit and cycle but neither of these things seem to send me into AF. I was put on Betablockers and Warfarin about 5yrs ago but thankfully got referred to a Cardiologist in BRI that knew his stuff and wouldn't ablate me and got me to use Flecainide also took me off dreaded Warfarin and Bisopropol. I had an episode Easter Monday and after two doses back in NSR.

  • I tried Flecainide as a pill in the pocket but didn't seem to work though it was only as small dose. Perhaps I should consider it again at my next consultation? I shall ask. I've just started taking magnesium to see if this has a positive benefit.

    Thanks for your reply.

    Alex

  • I only take 2-3 doses of 100mg and it is back in NSR after 24-36hrs. I think I was lucky to have been referred to AF specialist (Electrophysiologist) who took me off zombie making beta blockers and Warfarin which I didn't need. Maybe you should insist on seeing a specialist and ask for range of options? Good luck Fizz 👍🏻

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