Persistent/ permanent AF episode and exerc... - AF Association

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Persistent/ permanent AF episode and exercise


Hello to all again , I have been reading your postings as usual with interest.

I would be grateful if you share your thoughts and experience with me.

You may remember that I was diagnosed with PAF a year and a half ago . My AF episodes were every four month or so which lasts about 48hour , were my resting heart rate increased to about 80-85bpm (normal resting heart rate 50-55 as I am on metoprolol and NOAC ). Last Monday I began an AF episode , and it has not gone away ,now nearly 7 days . I do not have any symptoms or discomfort , only notice it by taking my pulse and the monitors on the machines in the gym . Could this be the progression of the PAF to persistent / permanent AF ?

Now that I am not in NSR should I stop exercising or continue my normal gym activity ? My exercises normally increase my heart rate by about 50bpm i.e.~ 110bpm when in NSR and now that I am in AF episode to 130-135bpm . During the latter period I do not feel very much different to when I am in NSR (normal heart rhythm ) while exercising . Thank you for reading my post .

23 Replies

I think the critical thing is to listen to your body. If you feel the exercise too much then slow down. Otherwise if it makes you happy then do it.

As far as progression of AF is concerned you may be persistent but you are not permanent until cardioversion is unable to return you to NSR. Since you are only on rate control drug and anticoagulant yet do not notice your AF I think you would be considered very lucky by most members here,


Hi, it seems strange to me that some people don't get any symptoms with AF, 7 days is a long time and if you were having symptoms you'd feel dreadful, and you'd have to see a doctor or take yourself down to A & E, which might not be a bad idea, as an ECG would tell them and you what's happening, and they would give you advice on the exercising.

Ppiman in reply to Hidden

I read posts like the one above in confusion since the idea of being able to exercise at all just isn’t a possibility for me.

I have permanent atrial flutter - and how different that seems to be from Afib. Since it began over five weeks back, my life has changed completely. There’s no chance of exercising at all and every chance of overdoing things, feeling faint and deeply ill, and being forced to sit or lie down to recover. The fear and feelings are intense and difficult to bear. Normal life isn’t possible. I’m looking forward to my ablation in early June as a way out for me.

I'm in persistent AF and exercise as much as I feel able to do. I'm on Bisoprolol for rate control and and that slows me down a bit. I would suggest a visit to your GP/cardiologist to discuss a cardioversion if you don't revert.

Emsysy in reply to Stucoo

My condition is same as yours, Stucoo and I agree entirely.

The key thing is NOT to do your normal gym activity but to do the amount that feels right given your changed circumstances. How much is that? The guideline I was given was to exercise at a level at which you can still speak - perhaps with a bit of breathlessness but still capable of speech. Alternatively, keep an eye on your maximum heart rate. There are several equations for that - the most common being 220 - age. An alternative is 207 - 0.7*age (Gellish, 2007). Whatever you use, accept the readings, don't fixate on the energy output required to reach that level because it will vary day-by-day and especially if you are in NSR or AF.

So, in summary, exercise is still good but modify it to how you feel - don't push too hard and, as BobD says, listen to your body.

I was in AF for 7 days on two occasions but then my heart reverted back by itself. However my heart kind of puts in a few fast beats during my AF rather than racing. I don't have any symptoms and only know by checking my pulse too. If it happens whilst exercising, for example running, then I do lose efficiency. They say 20% less efficient when in AF.

It sounds to me like you are not pushing yourself too much but then your heart rate will be limited by your medication. The advice about knowing your limits and being able to hold a conversation whilst in exercise is sensible. The weights shouldn't be too heavy either just a good resistance level.

I'm only 48 and hope to be as active as you at 60.

This week I've seen my cardio and have been prescribed propafenone and an anticoag to be used only during episodes of AF.

I'll report on its efficacy when I use it next.

Is your heart back in AF? I was told that 2 weeks is a maximum before going to A&E and asking for cardioversion. The longer the bouts of AF the more effect it has on your atrium, making it larger which is not what you want.

Whether your AF becomes permanent is difficult to predict. Again a recent study put it at 20% I think? Dr Sanjay Gupta video in this.

Take care.

cuore in reply to Physmeister

Physmeister, I am most interested in your statement that two weeks is the maximum before asking for a cardioversion when in persistent. Was it the doctors that told you that? Is that how things are done in the U.K.? In fact, it will be June before a triumvirate sees me and July before the electrophysiologist, all the while in persistent.

I did have one cardioversion April 13) at day 91 persistent since it had to be the pre-requisite before I would even be considered for an ablation. When I talked to some "nurse" in the AF department of what the next step was since I was back in persistent with the cardioversion working on and off for only two days, her comment was that my rate was being controlled and she did not give a "darn" about the persistent. (my word about the darn) That is the system in Vancouver, B.C. Canada. They let you progress to long-standing AF with a clear conscience.

Physmeister in reply to cuore


I was told by my cardiologist last week that if I was in AF for 2 weeks to go to hospital A&E and make a fuss/insist about wanting a cardioversion. Of course there would be no guarantee I guess. I'm not sure of the process here. Perhaps others in the U.K. have experience of this? He said that it's not good for the heart's anatomy to be in AF for long periods. Makes the left atrium larger I think he said. Never been this far yet however I wouldn't want to be in AF any longer.


cuore in reply to Physmeister

You have a great cardiologist to give you such advice. He is certainly up to date on the current literature that focuses on duration of AF and what it is doing to the heart whereas the "old" focus on symptoms, symptoms, symptoms. As a result I am in day 109 persistent just waiting and waiting in the system. I already had an enlarged atrium before I went into persistent. I can imagine what it is now. I am writing a letter to my cardiologist about this waiting time, and you have just given me fodder to point out how much more advanced some cardiologists are in the U.K. compared to Canada. Thank you so much.

Thank you all for your caring thoughts , they are so much appreciated . It lifts my heart to see so many lovely members on this forum .

Bob thank you ! I can imagine that it must be very hard for those who have symptomatic AF when they go into an episode . I have booked to see my GP tomorrow and will try to see my EP if I can get an appointment.

As I am symptom free with no adverse reaction , I feel cardioversion may be a step too far at the moment .

I have taken note to maintain my exercise routine to a limit of my comfort and will try to listen to my body ,if it talks to me !! HA HA.

My heart seems to behave like yours Phymeister. As when I am in AF the rates are not too high and I notice that few fast beats rather than racing. But still ends up at 70-80 bpm. However I am 72 and not 60. Today I am still in AF being exactly a week in episode . I shall try to find DR Sanjay 's Video that you recommended .

pablojack in reply to Bahman

Jimmy mac. I could have been in persistent atrial flutter for many months. Now after cv I have a similar response to exercise as yourself. I also had no symptoms and like you only knew from the machines in the gym that I was in flutter. I exercised as normal before and after cv. An additional benefit of cv was that all me ectopics have disappeared. So far so good. Cv was simple with no downtime. I cannot think of any reason not to go for cv as a first step

You sound similar to me.......2 years after being diagnosed and an increase in episodes, I went into what I thought was an AF episode, but my heart never went back into sinus rhythm......

I now have a permanently irregular heartbeat (I say permanent, because I although i have never had a cardioversion, it was suggested that it wouldn't be a success if i did anyway!).

I don't have symptoms as such - a few "whumps" and quivers sometimes at night, and i get breathless walking up hills (my main exercise is walking....mostly on the flat!).

I am on rate control (this makes me very fatigued I think) and warfarin.......

I am wondering if you ARE still in an episode or if things have changed?

Vivante in reply to Wightbaby

I have been taking Warfarin for many years, plus other meds. I find some exercise does affect me, like walking up hills. I also have Osteopenia, it may have gone on to osteoporosis now. Whatever form of exercise you do, please take care and avoid going over the top, you can bruise too easily. There have been many occasions I have overdone the balances and knocked myself, too many bruises. Avoid some exercises where the head is lower than the heart, you may become dizzy.

Hi Wightbaby , I am still in AF episode with the heart rate of 70-80 bpm resulting from irregular beats after a week . My resting heart rate is 50-55 bpm and this is why I am concerned . As mentioned in my notes I have very little symptoms and exercise regularly , and play tennis .

BevCynfelyn in reply to Bahman

Hi Bahman, hope you get back into Sinus Rhythm soon, please don't write off the idea of a cardioversion if you are offered one, its surely better to be in the correct rhythm than in AF. You're lucky in that you don't have symptoms, most of us aren't so fortunate - I've had two episodes of AF since I started with it back in March 2016, that episode lasted until June 2016 and the second started in August 2016 and ended in March 2017. Both times only went back into SR after DC cardioversion, my heart rate achieved over 180 for several days, then months around the 130 mark, now with flecainide, bisoprolol, and candesartan, plus apixaban and furosemide its holding steady at 60 and in SR. This second episode I've managed to continue to work all the way through, the first episode landed me in a cardiac unit for several days and off work for months - I'm determined it won't again!

There are different ways of viewing and/or classifying AF.

There are different ways of viewing and/or classifying AF;

1. adrenergic versus vagal

2. asymptomatic versus symptomatic

3.duration classification (paroxysmal, persistent, long-standing, permanent)

4. extent of AF causing symptoms( EHRA score I-IV, or CCS -SAF score 0-IV)

You are in persistent AF if your AF lasts longer than a week. I remember reading that younger patients tend to be symptomatic and older ones asymptomatic.

The current focus of the medical system is basically only the extent of the Af causing symptoms matters at the expense of the duration. In the last few years there has been a shift in highlighting the duration of the AF for treatment.

You are taking metoprolol which is a beta blocker rate control drug to prevent the ventricles from beating too rapidly to try and catch up to the beating of the atria when you are in AF. I would suggest you read the interaction between Vegal AF and beta blockers.

Before, you rule out cardioversion to bring you back to sinus rhythm, you might want to consider that the longer you are in persistent the longer you will stay in persistent until the one year mark when it is considered long-lasting persistent. I am not suggesting you have a cardioversion; I am merely trying to emphasise that you know exactly what is going on. But, because you are 72, the progression may be much faster , at least that is what I experienced, at about your age -- a little older.

Now, I will leave you with a quote from Healthline network:

"According to the American Heart Association (AHA), if your episodes of paroxysmal AFib last longer than two days, you're more likely to develop chronic AFib."

You are on target as you say your episodes lasted about 48 hours. Plus, you may not have symptoms now, but what happens when you remain in persistent -- to your heart, I mean!

Bahman in reply to cuore

Thank you Cuore , for you detail explanation . I will follow it up and speak to my EP about your comments.

Just been to my GP and she did not think I should worry too much about the fact that I am in AF episode as my heart rate was about 70 . She said that if I went to A & E they would do nothing as I am on the necessary medication and heart rate is not too high , they will only react if the resting rate is about 130-150 bpm and above . She did organise an ECG which I have done now , and it shows that I am in AF as one would expect . I am mind full of the fact that AF is a specialised subject and not all the GP's are fully gend up on it !!

cuore in reply to Bahman

Your GP is following the "old literature" emphasising only symptoms and rate. I suggest you be vilegent about duration -- that is, progression towards persistent AF, which may happen quickly when one is older. I got the same garbage from my GP who was not even concerned when I landed in the hospital with severe symptoms. The result was that I became persistent in a matter of six months without ever being referred to a GP. And since the referral it will be 6 months to see an EP and 6 months to an ablation by which time I will be in long-standing persistent. I am really suggesting that you be on top of things because I have lost faith.

Jholl in reply to cuore

I’ve lost faith somewhat as well. Have been in persistent AF for six years now but this hasn’t been helped by the fact that I’ve had to wait for a whole year for each of the two ablations I’ve had. That’s two extra years I’ve had AF just cos I’ve been stuck on a waiting list. When I’ve read research that says the longer you have AF the lower the success rate with ablation. What the heck?!

cuore in reply to Jholl

On May 27, 2019 I had my third ablation in Bordeaux, France. I did pay all three myself but they were worth it because now, only a month later, I am in sinus rhythm. But, the waiting time caused me to have a remodelled heart. In B.C., Canada where I live, private clinics are forbidden. So, we either have to leave the country or be condemned to have remodelled hearts due to the waiting time.

It looks as if I am back in NSR today after 10 days with pulse about 55-60 bpm. I now have an appointment with my EP whom I had seen before on 23rd of June .

I need to find more information about the regulation regarding CV with NHS , and at what point I should be referred for treatment , so that I can pass it on to my GP. Any guidance would be welcomed .

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