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Skiing after cardioversion

Hi folks - 1st post here so be gentle...;-).

I suffered a minor strike last November which was caused by a previous undiagnosed AF. I should have recognized the AF symptoms as during 2017 I was running and cycling like a sack of spuds compared to previous years (I'm a triathlete since 2003, previous rugby/climbing/mountain biking/running etc) and was putting this down to age, lack of mojo etc, and not down to a problem. Hey ho - at least the stroke was minor and I have fully recovered and been discharged by the stroke team in my local NHS Trust. I am back exercising - running mostly up to 5 miles, albeit slowly - and feeling better for so doing.

After discussing the AF with a cardiologist we have agreed on cardioversion as the 1st step to try to restore NSR - this is taking place on 3rd March I heard this morning.

I am waiting for my cardiologist to get back to me with some answers but thought I'd throw this out there - a week after the cardioversion I am off for 2 weeks skiing so wondered whether I should be OK for this. I am a 30+ year skier so pretty competent - expert maybe - with a love of off-piste, steeps etc but it's rarely high intensity/high risk these days unless I'm in icy moguls! The other question is the effect of altitude as I could be going up to 3000m.

So - what are people's views on a) should I be OK skiing even if I keep things "gentle" (*cough*), and b) will I be OK at altitude? I am not flying btw but taking our motorhome to the Alps and sharing driving with my wife.

Oh yeh - I'll be 65 later in March. Drugs - apixaban 5mg twice daily, bisoprolol 2.5mg once daily, atorvastatin 40mg once daily.

Thoughts and comments much appreciated.

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Gosh I admire your get up and go.

I've had lots of cardioversions, my last one being almost two years ago. The day after having that one I went to a team picnic in the beautiful gardens of the property where I volunteer. One of the head gardeners came and said would we like him to lead a tour. Well I was off like a shot, gave no thought to how steep the gardens are, and climbing up a hill my heart went back into AF. I bitterly regretted being so foolish as all my other cardioversions had lasted for quite a while.

I think you are going to go on your skiing trip, regardless of what anyone says here. It sounds as though your AF isn't too disabling especially if you are still able to run 5 miles.

Go and enjoy your holiday.

Best wishes

Jean

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The DCCV itself should not stop you going skiing but maybe the AF will return and slow you down as will the bisoprolol of course. You will know that it is undoubtedly your past activities which have caused your AF so maybe time to stop and consider your future options. That said I am jealous as it is now many years since I last went skiing (Les Arcs) but it was my knees which stopped me then not my heart. Still dream about it sometimes.

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thanks Bob. not sure if my past activities led to my AF or whether just consuming too much booze over the years did - I suspect the latter as I have no other risk factors for it. I'm not sold on stopping my "activities" as they are part of what makes me tick, even if I have to slow down on some of them. I'll be talking to a cardioversion nurse tomorrow to get some more insight. PS - we're off to Les Arcs just to make you jealous!

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There is ample evidence to show that over exercise causes AF so probably not the booze. Give my love to the Aigille Rouge.

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I too am very jealous. Very sensible Bob. I would dearly like to go skiing again because it is the 'thing I do best' or rather was. I have been told that high altitude is not a good idea with a heart problem. The body requires oxygen and demands that the heart delivers so the heart has to work harder to do so and voila.............Is 2 weeks of fun and glorious mountains with the challenge of all that hopefully new snow on black runs and off piste really worth jeopardizing all your future activities, and I mean all of them? Take up something which puts less strain on the body like golf. That is a real challenge and is something one can do into old age. What is more the younger you start the better chance you have of becoming good. There is a learning curve to start with before the satisfaction sets in but well worth trying. Good luck and commiserations. It is so difficult to accept that certain things are no long sensibly possible.

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"Take up something which puts less strain on the body like golf. That is a real challenge and is something one can do into old age. What is more the younger you start the better chance you have of becoming good. " sorry - I'm in the Jonathan Swift camp when it comes to golf - it's a good walk ruined. and even if I wasn't in that camp, there is no way at 64 that I am going to take up (yet another) expensive sport where you have to spend time and money to progress. I already do enough other expensive sports so to add another now is a no goer. yes - I love adrenaline rushes; I love competition; I like aerobic exercise so mountain fun is key to me and my well being. my cardiologist knows what I want as an outcome and he's happy to help me get there - we have discussed this. yes, there are risks I won't get the outcome I want but I'm going to give it a go. if I don't get to the end point at least I will have tried. as the quote says - better to have spent a day as a lion than a 100 years as a sheep.

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Good luck to you. I wish you well - literally. Say hello to the peaks for me. May you have brilliant snow and sparkling sunshine during the day. As I said I would love to go again. We took our children skiing to les arc 40 odd years ago when our youngest was 3 ( her second year skiing) She was too light to hold the ski lift dinner plates down so had to have her between my knees. Have fun.

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You may be welsh, but I bet you ain’t fat!

I’m not so jealous about the skiing, but I’m really envious about the motorhome trip....mine’s stuck in storage waiting for fairer weather due to ‘er indoors!!

The CV in itself shouldn’t be a problem, just listen to your body and do not do any more than YOUR WIFE wants you to. Certainly avoid booze, but enjoy yourself. Try to remember that the longer the CV works, the more likely you are to have a successful outcome from any future procedures which should be an incentive to be a bit careful.....have a great time, John

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my wife will want me to do as much as I can/want as she’s as athletic as I am. and I may not look atypically fat but I’m knocking 105kg/17 stone as I used to play rugby at prop.

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My feeling is that skiing at high altitude will put you back in to AF. Dehydration and relative hypoxia will make you more symptomatic. The combination will diminish your enjoyment.

You had a stroke 3 months ago, I don't know the figures for protection against second stroke with the anticoagulant. I think you could be playing with fire.

I expect you know about the link between the unhealthy exercise of the type you enjoy , and who doesn't enjoy it, but all we need to do for cardio health is a brisk 20 minute walk 5 times a week. But none of us endurance exercise AF folk listen to advice until we have had our first ablation. 🙂

I hope your wife is there when you get the definitive answers from the cardiologist. What's her take on all this?

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according to the stroke consultant and cardiologist while I’m taking the drugs I’m safe from another stroke. and it was a pretty minor stroke with a quick recovery of 2 weeks.

as for my wife, she’s as mad and as fit (fitter at the mo) than me and is my partner in crime in skiing, running and cycling - although she’s a better swimmer! 😜 she’ll be there with me talking to the cardiologist and will keep me in check if needs be. my cardiologist know what my target is - back to a NSR and a high activity level and thinks it’s feasible

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It sounds like you have had your trans oesophageal echocardiogram (TOE). If not, it will be done before your DCCV, which will not go ahead in the unlikely event you have any residual LA clot.

In those circumstances, you might decide to defer your trip.

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I believe in some trusts you have to sign a declaration confirming that you have not missed single dose of your anticoagulant for a period of 4 weeks prior to the procedure. Obviously not a good idea to sign if there is any doubt. Recently, a member missed one dose of Apixaban 2 weeks before an ablation and it was cancelled. The risk of ignoring this is clear.....

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Well, I too am a keen skier having worked 2 seasons in the Austrian Alps in my youth and numerous holidays since. However, since climbing up to a mountain restaurant one evening and doing langlauf (also great but strenuous) - not sure whether it was the altitude or the exercise, I have not been back. The difficult thing is we are all different and it may not affect you or indeed me if I went back (my son just got back yesterday and was egging me on with an invitation to stay with his girlfriends parents who live in an Austrian resort!). The bottom line is do you like skiing or NSR best? Sorry, I'm sure that's not the answer you wanted but we are here to provide our honest personal experiences.

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I went into AF in Jan 2017 and was cardioverted shortly afterwards. NSR came back after one shock and has been there ever since. We had a skiing trip programmed for this period and ended up arriving a couple of weeks late due to the AF incident. I found skiing quite hard work with all the new drugs in my system (bisoprolol , cordarone, apixaban) and had to abandon most of my outings. My wife's baleful stares every time I mentioned the slopes didn't help either. After a year spent reducing the meds with the approval of my cardiologist (now 1.25mg bisoprolol and cordarone 3x week) I tried skiing again this year. All went fine and my energy levels seemed fine. Unfortunately, some douche came tearing the the slopes and crashed into my daughter and a friend. Daughter ended up with a bruised lung and the friend was evacuated by helico with his jaw broken in 3 places. So that was the end of the skiing adventure this year...If you do decide to go, take it easy and make sure your accident insurance is up-to-date !

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thanks Chesson - very useful. I'm not expecting the skiing to be easy and am prepared to have to become a piste cruiser, and let my wife head off for the more exciting stuff. I haven't booked the insurance yet (I normally take out an annual policy that covers me for all the daft stuff we do) as I know I'll need to declare various conditions but wanted to leave it closer to the travel date once I know all details - if the cardioversion hadn't taken place before we go, I wouldn't need to declare that. out of interest - did you have any issues getting insurance in place?? having had a helico rescue myself in the past (broken jaw/unconscious after hitting a rock face first) I know the value of great insurance and normally use BMC, Snowcard or Dogtag.

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It is usually the idiot who does not know what they are doing who gets out of control and causes the horrible accidents. You can be minding your own business on the slopes coming down neatly and tidily making neat little twiddles and bang you are crashed into (often by a snowboarder) and you are the one who gets hurt. If you are on Apixaban my doc tells me all they can do is make you comfortable while you bleed. Nice.

I think you have to declare that you are awaiting a procedure to any insurance company otherwise they are out of obligo. In my experience they take the last 6months medical records into account when they give you a quote.

I am quite sure you, fatwelshbuddha will not be a piste cruiser. Too dull and too exposed to the dangers of all those rotten skiers/boarders. There is something to be said for going off piste carefully with someone else because it is not so crowded. You can go at your own pace and stop whenever you need to do so. I do not recommend going on any runs which entail climbing because that is really strenuous on the heart. Downhill only and that rules out some of the more interesting runs.

Let us know what you decide and tell us what it was like when you come back.

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yes - I know the risks in skiing and they are many. but there are as many risks around the home that can cause similar problems - slipping down the stairs, kitchen knives, power tools etc - and unless I wrap myself in cotton wool and go nowhere, I'm fine, but I'm not going to live like that - I'll take the risks.

as an example, I had my cardioversion today - back into NSR on first shock which was good - but one of the other patients hadn't been out of the house for 2 months as she was shit scared of doing something that would cause a major problem. no way would I want to live like that.

I'm a very experienced mountaineer/skier so know what the risks are on the hills so I should be able to manage OK - risks or not. now the CV has been done and NSR has been restored, I will speak to insurance companies to get appropriate cover - I've only held back in case there were any complications of the CV but so far all good.

I will be cautious on the trip - I know it would be stupid to do my usual balls out approach and get way off-piste, or into dodgy icy mogul fields, or race some bloody kid who goes screaming past. and if I'm not comfy, I can come off the hills. we're taking our motorhome so ultimately have control on where we are and if I'm not happy at all, we can move on. our ski pass is flexible (Skialacarte) so it's not like I'm tied to skiing because I've shelled out a load of £ and don't have to ski as a result like a one week holiday trip skier.

will feed back when back at the end of March - we're driving over next weekend.

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Some good advice here,one thing i would fret about,not tbe AF returning,but a head bang and bleed while on APixaban...see what your cardio person says.Enjoynif you go,and let us know!

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it was pointed out to me after the stroke and when they prescribed apixaban that skiing was not recommended. but then power tools and kitchen knives are also dangerous and I'm more likely to damage myself with them than if skiing as I very rarely fall (and wear protection). I also wear a medical alert dogtag in case of a bleed in an accident to alert anyone.

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Insurance can be a bit of a pain in the butt. You may have to declare that you are on a waiting list for the cardioversion. I had to for my ablation. Not needed travel insurance while on cardioversion waiting list

With insurance i'm always wary of not telling them the whole story and then them not paying out if something undeclared crops up, if you had to make a claim.

Be careful of overdoing the booze too. My AF returned after a couple of heavy days & nights at the Munich Oktoberfest. May have been a coincidence but my best guess it was excess alcohol....or excess dehydration that triggered it

Enjoy your holiday

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The best approach for insurance is probably to take it when you buy the ski pass. It costs only a few quid per day and is adapted to skiing. They ask no questions, so you tell no lies! I actually have a yearly insurance through a French company since I live there half the year. They don't ask for medical history either. As regards Apixaban, I had a nose bleed whilst in the mountains last year and it was hard to stop due to the AC. I now take one of those meshes to stuff in my nose if it happens again. The mesh contains a clotting agent and does help speed up the sealing process. Again, mine was purchased in France but i'm sure you can find a similar product in the UK. Enjoy the ski and take it easy...

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I'm aware of the Carre Neige insurance and although it's good for covering incidents on the hills, it doesn't cover items such as repatriation (if needed) so we'll still need full medical cover and it's easier to take out a complete insurance package from the UK.

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I have changed to simvastatin as I was experiencing muscle pain and stomach ache seem to be ok on this

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hi all - just an update on how the skiing trip went.

I had my cardioversion about 10 days before I started skiing and was instantly back into NSR - and remain so after the ski trip! YAY!!

it took me a little while to get my head around the skiing as I guess I was still concerned about either going back into AF or having a fall which would cause bleeding (I'm on apixiban) and conditions didn't help much as we had snow and poor visibility etc for the first few days which always creates some tenseness so I wasn't skiing to my full ability and this just played with my head. Anyway, the weather brightened as did my mood so I got the hang of just "letting go" and skiing normally - and after a few comfy days of skiing just went back to what we've always done - skiing off-piste in powder (what we could find) and into the steeps and moguls. It was great!

my legs suffered as my fitness isn't there just yet (did too little exercise last year before my stroke) and otherwise had no ill effects and my heart is still pounding away nicely in NSR - long may it do so!

so in summary, no ill effects from the exercise or altitude so next is to do some running and biking to see what happens - all gentle to start with of course.

I don't have a date for a follow up appointment on my cardioversion so keeping fingers crossed that I can maintain the NSR. at the moment my HR is stable and hovering around 50 which I'm happy with.

onwards and sideways!!

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