I’ve seen a few posts touching on this and thought I might share my experiences in case anyone is interested, in particular those with an ‘exercise dependency’ like me. Whenever I am faced with any sort of life disruption one of my first thoughts is what impact it will have on my exercise routine. I workout 6 days a week with crossfit and maybe 2-3 x 5km runs on top of that plus a few other things if I have time.
I have suffered from PAF for 20+ years (I’m now 43). Was diagnosed 10 years ago and managed to get by on PIP since then. That is until this year when frequency of episodes increased to around monthly and they also became less predictable - avoiding my usual triggers didn’t always work. I’d had enough and spoke to my EP, 2 weeks later had RF ablation (PVI and flutter), this was almost 3 months ago.
In discussing the ablation one of my first questions to the EP was how soon I could get back to exercise. I’d read all the literature but still needed to hear the answer directly. As expected I was told to take it very easy for 1 week, could go for walks in week 2 and then gradual return to exercise from week 3.
The ablation went very smoothly, I had no pain/discomfort/groin bruising at all afterwards apart from a sore throat with a bit of bloody mucus for a few days. On day 3 I walked around the supermarket and could barely make it back to the car, felt extremely tired like my legs were about to give out. Fortunately I had a trolley to lean on and my wife was driving. Day 4 I felt a bit better and walked the dog, about 2km. Tired at the end but not wobbling like the day before. Steady improvement with the same dog walk each day.
At the start of week 2 I began more exercise focused walking, building from 5 to 10km per day over the course of the week. I was very careful to listen to my body and always wore a heart rate monitor. I tried to keep my rate below 120. I never had any chest pain or discomfort nor any other issues.
Start of week 3 (2 weeks post op) I began to build things up again. Definitely got carried away and overdid it on the first day (again no pain but just very fatigued) but learned from that and whilst I always listened to my body, I did also push as much as I could within these limits. The limits to me were pretty obvious, I would just hit a wall and it was clear I could physically go no further. From about week 5 I have been pushing as hard as possible.
My EP told me that ablation is like open heart surgery just without opening the chest, it’s a significant intervention. Like any surgery, but especially involving the heart, sufficient rest and recovery is crucial. He did however say that overdoing things would not affect the success or otherwise of the procedure itself, it’s just clearly not a good idea to strain a system that’s had such a shock.
I have now been exercising without any restriction for about 7 weeks (minus a week with man flu). In fact my volume is now higher than pre-ablation because exercise was always a trigger and I found if I did a hard workout in the morning I had to take it easy for the rest of the day. Now I have no issue doing a couple of hard sessions per day. I also had to hold back on certain HIIT workouts in the past as they were triggers but have no such limitation now. This being said it’s clear that my fitness has not yet recovered to where it was pre-ablation and I reckon that might take another 3 months or more.
This is obviously not meant as any advice on how to manage your own situations, everyone will have different experiences. I am fortunate to have an EP who understood my goals and was supportive of me getting back to being active. He trusted me not to overdo things and for the most part I hope I have lived up to this. I did however find that it is absolutely possible to get back to high intensity exercise within a month.
I’m very happy with the ablation and just wish I’d done it a few years ago.
Sorry for the long post.
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Olben
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I’m not medically trained therefore can only express a view based on what I have heard from those who are. Very often we hear that AF can develop in people engaged in extreme sporting activity. When AF does occur, one can only assume that the heart has found it difficult to tolerate the pressures it has been put under over time. Whilst an ablation may successfully stop the symptoms associated with AF, we are told it is not a cure therefore logic suggests that AF is likely to return if the patient returns to the activity levels that may have caused it in the first place.
Clearly you have taken on board the need to progress with caution but it’s possible that you run the risk of AF returning if your goal is to eventually return to your original exercise regime. I appreciate this is hard to accept for anyone who is passionate about their sport, but from what I have heard, it’s not just about dealing sensibly with recovery, it more about what caused AF in the first place and how best can that be avoided.....
Thanks Flapjack. My AF started when I was not doing any exercise, I was overweight and had a poor lifestyle. This was one of the reasons I started getting fit & healthy, shortly after being diagnosed, and this seemed to keep things at bay and perhaps delayed the progression of the condition. Whilst I do exercise frequently I would not say to extreme levels or for long periods such as a triathlete or ultra marathon runner may do for example. My current EP is happy with my exercise regime as have the 4 or 5 different EPs I have consulted on my travels with work over the last 10 years. Current EP also commented that fitter individuals tend to have better ablation outcomes.
I have returned to my pre-ablation exercise levels and so far so good. I am in discussion with my EP throughout and have his support & encouragement, I have been very open with him about what I do and what I am continuing to do.
Obviously it’s difficult to individualise things in a forum such as this and everyone is different. I only wished to observe that with proper guidance and endorsement, ablation does not necessarily need to mean an end to an exercise focused life if that is what’s important to someone with AF.
Yes they does add a different dimension but as I’m sure will appreciate, we can only respond to what what we read. Could not agree more about maintaining a fit an healthy life style so all bodes well for a successful outcome. We use a term often on this forum “listen to your body” which works well for most of us. Good luck and best wishes for a healthy future.....John
Great to read your post Olben! Inspiring to hear the positive comments on exercise and AF and to hear how well you're doing.
Would you feel comfortable to share the name of your EP? I only ask as I had my first ablation in August and due to the long waits on the NHS, I won't find out the results of the post ablation 24 Holter monitor until January 16th!! Which feels like a long time to me to know if the symptoms that I've experienced since the ablation are still AF or some other version! I'd love some second opinions. Your EP sounds very good! If you're happy to share his name and whereabouts in the uk, that'd be fantastic. I'm also 43! I used to be fit but life took over and I'm on the way to attempting to get fit again now!
Wishing you well on your journey and thanks again for your post!
Hi James, I’m actually based in Australia (Perth) - sorry it might have been useful if I’d mentioned that at some point... I was lucky enough to be able to select my EP based on advice from my GP and research online as to who was the ‘best’ in Perth. The EP trained at Bordeaux and ablations are pretty much all he does. It does pay to find an EP who fits your mindset and goals. I did switch from another doc who was not even recommending ablation but just to continue with medication. When I found the right EP everything seemed to click and resonate with my way of thinking. That was very useful.
It must be very frustrating to wait 5 months post ablation to know the outcome. I didn’t have a holter after my procedure but like most sufferers I am very sensitive to my heart beat and know immediately if I’m in AF. I do still get ectopics from time to time but know this is normal. Have you also tried a Kardia device? This should give you some
idea of if you’re in rythmn if you have any doubts or unusual beats.
Watch DR Gupta’s video about the Norwegian study into HiiT training to prevent Afib over a 12 week period. I tried it out and it knackered me and my heart was all over the shop afterwards. I panicked thought what the hell have I done but still despite the weird pattern on the Kardia it was saying normal and the Polar monitor hadn’t shown any of the 135 bpm when I was in Flutter and knew nothing about it and assumed the Polar was broken. However my Cardiologist took one look at the ECG off the Kardia and said that’s fine. WTF said I! My heart was fine its the adrenaline from the exercise that changes the pattern and indeed by bed time back to normal.
So I am going to try it again, three times a week, and start doing the stuff my wife says us old people should do like Yoga as well. Suggestion is do the first six weeks at two minutes instead of four minutes for the 85 to 90% max heart rate. You can also find the paper on line type in Dr Malmo study on exercise and Atrial Fibrillation. And when I said 135 bpm when the flutter was not diagnosed I mean 135 at rest and 30 minutes later at the end of a workout on the rowing machine. Think thats when I began to think oh it must be the Polar. Strangely I couldn’t even get up to 133 for the high intensity portion post ablation and Cardioversion. May be easier (ha ha) when doing the four minute high intensity.
One thing my Cardiologist said right at the start of this journey is carry on cycling, running, rowing etc just don’t push it. It won’t do any harm but your heart will simply say Enough! Thats what happened the day before I first went to the walk in centre. Cross country running, blatting up a steep slope I have run hundreds of times. Three quarters of the way up suddenly couldn’t breath. Moment I stopped all fine, few yards of walking then good again. That’s when I thought something isn’t right here despite having climbed Cadair Idris the week before at high speed with my 22 year old daughter and a guide.
And read “The Haywire Heart” available on Amazon and recommended by my Cardiologist...that should give any of these wannabee elite athletes a major moment to pause...
Interesting stuff. HIIT definitely didn’t agree with me in the past, it was a trigger for flutter especially rowing for some reason. The flutter would then convert to AF after a minute or so. I would still frequently do HIIT but had to be careful especially with rowing. Since the ablation however HIIT has become my friend again...
I did find post ablation, when I started to build up work rate again, that I couldn’t get my heart rate up into maximum effort range, I would fatigue out well before then and didn’t push it. Now however it’s not a problem and I feel great afterwards. Pre ablation when I would push hard, I frequently had a lot of ectopics as my HR came down. I had discussed with a previous EP and this is not unusual apparently. Since ablation, whilst I do get the odd ectopic, this variety has stopped completely.
I will have a look at the videos & articles you mention, thanks.
Strangely if it hadn’t been for Flutter and Fibrillation I would have been in Perth next April staying with friends but discovered it the week before we booked the flights so everything went on hold until December when hopefully I get the all clear to do the journey to Auckland where my younger daughter is going to be based for nine weeks...and how is this for happenstance? The Cardiologist who saw me here in Norfolk UK back in 2004 with an ectopic beat moved to the small hospital in Hamilton NZ where she will be doing dermatology and is friends with my current Cardiologist. The AF angel is clearly looking on!
"My EP told me that ablation is like open heart surgery just without opening the chest, it’s a significant intervention. Like any surgery, but especially involving the heart, sufficient rest and recovery is crucial. He did however say that overdoing things would not affect the success or otherwise of the procedure itself, it’s just clearly not a good idea to strain a system that’s had such a shock."
^ Thank you for this, it's a great analogy and explains to people not "in the know" what it's like. Usually I say to people - they stab you in the crotch and burn your heart a few times and that feels like you're being stabbed in the heart as well, then you ache like you've been bull running in Spain for a week or so and all of that is if everything goes to plan!
I've been guilty of pushing too far too soon on a couple of my ablations, BobD gave some great advice which I've followed (and felt better for)... along the lines of "Do nothing for the first week, slightly more than nothing the next week and then a bit more the week after..." and it's always stuck with me.
Other half has a week of holiday kept back to facilitate this for my upcoming 5th ablation..... !
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