Hi All. Been reading for some time but I'm not getting anywhere really and would appreciate some thoughts from you experienced folk.
I was diagnosed with Paroxysmal(sp?) AFib last year after some diagnostics. I have private health which is a nice perk so get to see good cardiologists relatively easily.
So I only get attacks when doing exercise (running normally when also talking with friends). I can feel palpitations when walking up stairs etc too, but compared to what I gather some people have its not bad. It does stop me running, which as a runner is frustrating, leaving me breathless and dizzy, but on stopping it quickly resolves. Other than that no real impact to my life.
So I was offered a few options. 1 stop exercising, 2 medication, 3 ablation. 1 doesn't really sit well with me. I am someone who regularly does a couple of endurance events every year. Low intensity stuff, things like 2 marathons in two days. Its a wonderful part of my life and I'd like to continue. I am also overweight and it is one of the things that helps me motivate myself to trim up every so often.
So 3 is an option, but the suggestion is try 2 first, so at the moment I am on bisoprolol, lowest dose (1.25?) for 3 months to see how we go. That makes me sleepy, cold hands etc and I am not sure it helps the symptoms, though I am trying to get back into runs to find out (I had stopped running for a while, so now when I run I get tired fast, could be lack of training, could be the bisoprolol limiting my ability to exercise). I am not optimistic though I will keep trying for the next couple of months.
The question is when I have done that, where next? I am intruiged by the link to obesity. I am heavy build which doesn't help, but my bmi is about 32, and I read much about getting that down. That is proving doubly hard whilst on betablockers, but I just wonder if my mild symptoms could go away if I get down to bmi 25 (I have not been that low for 25 years). The best way to do that would be to stop the bisoprolol, so that diverges from where I am now.
OR - do I got for ablation. I worry that's a bit of a sledgehammer in my case and I am worried by all the risks associated with it. I have also read that it can be a case of "good to catch it early" and that I should grasp the ablation option to sort it before I do more damage?
Just very confused as to where to go next. Cardiologist seems a knowledgeable guy, and appreciate him encouraging me to not leap into the ablation, and also he directed me here, but he's never discussed bmi/diet etc.
My diet by the way is ok. not great but ok (cant be that great as I am carrying at least 3 stone more than I should!), I eat most things in variety, a bit too much red meat and sugar, probably a bit too much alcohol but nothing silly.
Many thanks all
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AfRunner
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In your position- lifestyle first - lose the 3 stone - stop all sugar & alcohol & moderate your running ie listen to your body - rule of thumb - be able to run & talk. Once you have achieved that, if it hasn’t worked to eliminate the AF - then consider drugs & ablation. If nothing else you will be giving yourself a much better chance of ablation working.
I agree CDreamer, in fact I would go further and stop the running completely until fixed and then build it back slowly but not to the same level. I appreciate Afrunner will find it hard but in my view if you take the Lifestyle prevention route it has to be 'belt & braces' at the start.
Lose the weight first. That may be all you need per studies. Exercise in moderation and read John Mandrola's book, "Haywire Heart". He is a doctor, endurance athlete and afib sufferer. Get a Kardia Mobile so you can identify, document and share any events with your doctor. Personally I'd get off the bisoprolol but talk to your cardiologist. Look into the FODMAP diet. It's helped some people with their arrhythmias.
I agree with CD but would add that whatever you do the over exercise may bring on AF EVEN if you have ablation. Remember that all treatment for AF is not about cure it is only about improving quality of life (QOL). For many people medication has worse side effects than what it is supposed to be helping in that respect so life style first.
Thanks guys, a few of these replies do hone in on some of my thoughts. Its just that having heard nothing from the medical team about diet/bmi etc that you start thinking you are barking up the wrong tree, or "believing what you read on the internet!"
This is completely about QOL for me as you say Bob. That's where the medication doesn't seem a good fit for me, It may not help much with the symptoms, and if it prevents me from running then there really is little point unless its doing me some other good elsewhere (like stopping incidents where I am doing damage) The few comments I had heard about getting it fixed before it gets worse haven't been echoed by any of the responses above, so I am taking from that, that it is probably nonsense. Its just that I am still relatively young, 43, so want to be able to exercise regularly (if a little more moderately, although to CD suggestion above the run and talk has always been my measure!), but not cause myself long term damage.
Have ordered the book as step one. That's easy! Losing the glasses of red is going to be a wrench!
Last July I was at the gym and the SVT kicked in, wouldn't stop and was in A&E being Cardioverted a few hours later. Doc told me that 130bpm at the gym was now my limit and I was on 2.5mg bisoprolol even then.
Subconsciously I stopped going to the gym more and more, walked the dog for miles but put on 2 stone over 9 months.
The Bisoprolol made me tired and my get up and go, got up and went.
I was scared to fly anywhere in case an attack happened mid-flight, SVT ruled my life.
10 months and 3 cardioversions from first being diagnosed I booked in the ablation which I had yesterday. They have taken me off the Bisoprolol and are 95% sure I am fixed.
Personal choice, can you live with it and the drugs, will it get worse as time goes on (mine did). Can or cant will dictate your decision to ablate, but having just had it done it wasn't as bad as you think it will be.
So what are you going to do when the first ablation fails, then you have another which leaves you worse, so you have a third which leaves you better, but you still have AF and are told you wont be offered any more ablations? That was me and looking back now I really wish I'd paid more attention to my diet. Moving to a more plant based one and cutting out all artificial additives, alcohol, caffeine etc, has helped me more than any ablation.
Very interesting. I just switched to this diet. I have not scene anything in the literature that found this would make a difference so I am excited by your experience!
My suggestions to the OP might not help - I`ll throw them in the pot anyway.
Bisoprolol affects some people more than others. For me - I tend to take it quite well without any really bad side effects. I`m on 2.5 mg a day - if my heart really starts to race later in the day, I take another half and feel OK. That`s not recommended of course - certainly without consulting with your doctor. For me though it seems to work.
Life style choices are very important. We all have different triggers. It`s worth keeping a diary, or writing things down, to find out what the triggers bring on your a-fib. Maybe the food you eat or how much sleep you have had. Not drinking enough water for example. All these things can start an a-fib attack.
Having a high BMI is not good for your a-fib or any other heart condition. I guess the key is to build up slowly with exercise (as you are a runner this is likely not to apply to you as much). Just doing a 20 minute walk everyday will help the heart - could you just do half of the distance you already run or walk the same distance ? I fully understand your point though - it`s a catch 22. The blockers can put on weight = not good = more strain on your heart when you exercise.
I know I have mentioned it before but I`ll throw it in again. For me an ablation will only be an option using the AcQmap. An ablation (IMO) are far to hit and miss - some work, some don`t. You mentioned you have health insurance - are you from the USA ? If so they have moved forward, more than the UK, using this method. Google it and also ask your doctor about it.
There are 4 main ways to help a-fib.
1. Cardioversion (effective for many but often shorted lived).
2. Drugs ie flecaincide etc.
3. Life style changes.
4. Ablation
Or a mix of all of them ! In order I`ll put life style first, followed by CV and drugs, then ablation last.
I truly believe, in another 5 - 10 years, ablation will be a thing of the past - medicine moves forward so quickly. You only have to look at the advances for cancer patient in the last 10 years, to understand how things can quickly move forward - certainly with some types of cancer.
Good luck anyway. One thing I know is this - a-fib isn`t going to beat me - I`ll beat it. That`s a promise
The consultant who is the medical director of our af support group once said that AF will come back after ablation if people are overweight= studies in the US have shown lifestyle changes are better than ablation. You will have to lessen the exercise whichever route you choose- the training makes your heart muscle larger which then allows the errant electrical signals
Hi there AfRunner, I understand where you're coming from (before my AF-induced stroke, I was a serious quarter-miler, now some days I struggle to walk 100 metres). Your dilemma is definitely not an uncommon one. What everyone is saying here is really sound advice. I haven't had an ablation but probably will in the next few months. And the drugs generally make you feel lousy - especially if you were healthy before the AF kicked in (like me). The only thing I would add is that Dr John Mandrola has a blog that is probably even more up-to-date than his book. Just google him and you will easily find it. It is absolutely worth reading. He emphasises lifestyle change as the first-order response to AF. He is an ablationist but is clear-minded about its risks and benefits. Cheers.
What's your blood pressure like ? BP can cause AF and weight will increase BP ! I think if you hit 25 BMI you will notice a big difference
I was a PAF suffer and decided on my first ablation when my EP made it clear that "AF begets AF" and as time goes on attacks become more regular.
I moderated my lifestyle but he was right as I still had PAF with no discernible triggers having previously been able to identify that it was heavy meals late at night.
If you have been offered the ablation take it as it will improve your quality of life but do moderate your lifestyle as others have said.
Ablations are normally successful first time in 80% of cases. That said I have just been booked into Papworth for my second ablation on April 9th to sort out a rogue Atrial Flutter issue and all things being equal should resolve my problems for many years ahead.
Forget the word ‘diet’ and start thinking about nutrition - what does your body need? Keeping balanced electrolytes is important for us AF’ers. Gold standard - see a Nutritionist for individual advice, have all the tests and get individual advice - that is what the elite atheletes do. (Grandson is a double Olympian).
I have a very similar story. Have been on flecanide regularly for 2 years now but recommended I take a blood thinner which I am NOT happy about. I keep my exercise in the moderate range ( use a polar heart rate monitor) rather than my usual high intensity workout. Struggling with the same decision!
Wow. Lots of good advice here. To answer the questions raised I am in London so UK based. BP normal range, had fairly extensive medical through work and everything in normal range, with respect cholesterol, BP, all the other good stuff they do. As I said earlier although bmi is 32 my % body fat isn't as bad due to heavy build. Was advised in those terms to lose 7kg of fat to get into normal range. Obviously that wouldn't get me to 25 on bmi.
All other investigations show normal anatomy and funtionetc, that included an echo, coronary ct, treadmill test where I eventually got into af on recovery, and a couple of weeks of halter ecg thing whilst running confirming PAF.
I am taking away lifestyle first, and not to rush into any alternatives until that fails, although if I do end up looking at ablation it's good to hear a few good stories. I just worry when they state the possible complications etc. I am firmly of the view that heart surgery is not to be taken lightly!
I was a runner doing marathons etc but about 15 years ago changed to a bike due to dodgy knees. 20 years ago they diagnosed left bundle branch block and said that I should detrain to see if it went away. I was in training for the Chicago Marathon for my 50th birthday and I ignored them and ran one of my best ever times! AF developed about 5 years later when I was moving over to biking. Progressively I changed my lifestyle. Kept fit and healthy and not overweight. Progressively reduced the alcohol so that now I have been teetotal for the last 5 years. Minimise stress and anxiety (no getting to the airport late etc). Medication, taking losartan, bisoprol and warfarin. Have had 4 cardioversions but have found I can also stop my AF by getting on my bike and cycling up a hill. Had a cryoablation which might have helped but was not the total answer. Having removed a lot of the triggers I find that hard cycling can trigger AF the next day so I have bought one of the new light carbon electric bikes. Mandrola book is good. I still cycle regularly doing about 120 miles a week. It is like a journey and we are all different and have to find our own path. Hope this helps.
AF BEGETS AF the more you have it, the more you will have it.
I tried the drugs , bisoprolol was very bad for me even at 1.25mg. Dreadful symptoms max HR below 120, a fast shuffle not really unning at this rate. I was on verapamil a calcium channel blocker after this and that was non Intrusive with no bad side effects. However rate control drugs do not stop afib, they just reduce your heart rate when in it. I always have done exercise but not marathons, just 4 or 6 miles running twice a week and a Saturday morning 25 to 55 mile bike ride. I also did an hours circuit training once a week. I actually found that if I went I to afib , going runing got me into NSR after 7 or 10 mins. Unfortunately after 20 months and a dozen attacks this method stopped working. The afib had progressed. Afib begets afib! Then I was in high rate afib 130 to 195 resting, for 8 days. I spent 3 days in hospital and was only eventually cardioverted by flecainide infusion in the CCU of my local hospital. I was then put on flecainide rhythm control and diltiazem (another ccb) rate control pills. I did not get on with the 200mg diltiazem, several side effect including exercise Intolerance 137bpm max. But 137 was agony like the last 100 yard sprint on a 10K race. Felt like that after 2 to 300 yards of the start of a run. Result: stopped bothering and put on weight and got an increase in Blood pressure , both counter productive to afib. It was only after this step change for the worse that I considered an ablation. I had one 8 months later which stopped the afib, and then 9 days later I developed atrial flutter in the right atria , very possibly promoted by the flecainide ( in the absence of the afib??). Drugs have side effects. (flecainide nevertheless kept me in nsrc when I had afib so I think it's a good drug).
A flutter was very symptomatic for me hr continually at 137 to 140 (ie flat out if I was running) walking to the kitchen for a brew made me breathless. I spent the next 3 weeks mostly on my back before a second ablation stopped the flutter. I was in very poor physical shape after this as I had not done any movement and you quickly degrade when you are 57 as I was then. However I have been off all drugs since May 15th 2018 and have not been in afib or flutter since the ablations. I am back cycling and running as before. I am well over a stone lighter than I was at my worst and am now the lightest I have been since I stopped playing 5 a side football in 2004.
With hindsight I could have avoided a crap 10 months of my life by going for the ablation earlier. I did not know this until I lived it . If I had managed to get an earlier ablation, I may not have had so much afib, so I may never have got so bad. Afib begets afib - atrial remodelling.
Disclaimers:
I am not medically trained, this is my experience of me, who has got I to aFib possibly by a different route than you.
Everyone is different: some people get on with bisoprolol and diltiazem
Other people get afib by a vast range of triggers - I never found my triggers unless it was stress, which I very difficult to prove as it can be so many things.
Main point I think I understand is to not get into afib episodes if you can avoid it.
Adittionally you are quite young at 43.
You don't want to be taking daily drugs for the next 40 years. They are all poisons. Also you dont want to be "developing" your afib for 40 years, so you need to make some adjustments to stop this. It's up to you but there are no magic cures I am aware of.
Lastly there was a study posted yesterday or the day before that seemed to Indicate that having an ablation whilst still paroxysmal was likely to result in success. If you wait till it's permanent afib then ablations are not so successful. Have a look through the last 2 days posts and read it.
Sorry missed a main point: get a good EP, which for me is one who is competent but with empathy who understands what you want out of life and suggests things to improve on them. Not just one who just throws drugs at you and says this will keep you at a low rate and you have to put up with the side effects as all they reakly want is to keep you out of hospital and away from them except for the 15 minute appointment twice a year.
You will gather from all the posts in this forum that no one really knows. The one person that knows your condition best is your doctor and he/she has the experiance to best judge your treatment. Doctors may not be right all the time but they are the best you have to get the best QOL.
I agree with ectopic1. I am very active and on diltiazem. It was much easier for me to exercise on that, than beta blockers. I never had any issues with swollen feet or ankles. Exercise for stress relief and to keep my weight down were very important to me and according to my EP, very important to my heart health.
I’ve had 2 RF ablations the first made everything a lot worse & the second 12 weeks later, left me without AF for 3+ years but exacerbated other conditions. 5 years ago I would have said exactly what you said - in fact I did if you read back on my posts.
Older & wiser - I would be a lot more circumspect - as are a lot more Cardiologist’s these days & I think Dr Mandrola’s blog summed up my thoughts very well - it’s an option - but not always should be the first one & I wouldn’t have said that 5 years ago.
It’s very individual- If you are under 45, fit & healthy with no other health issues then - yes - it is definitely a good first treatment option.
Ablation is not without risks as I have found out. I had cryo ablation 6 months ago for PAF. Worked great for my PAF but have suffered from gasteroparesis since then. I will have the PAF swapped back gladly but can't reverse time.
Of course most people do well after ablation so if you end up having it done then it is considered a safe procedure and a treatment option for AF/PAF.
I was on Flecainide and the dose was increasing to control the breakthrough episodes. I didn't want to be on tablets for the rest of my life and also did not want the A/F to become permanent.
Whatever option you take, don't regret it as sometimes there are no right or wrong decisions.
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Do I need to seek cardiology advice
Anyone out there with really positive post-ablation stories?
PVCs, PAF and ablation 
Needing encouragement to cut back on Flecainide, post ablation!
