Strategies for avoiding episodes after exercise?

[BigArnie]

Hello,

Has anyone figured out anything that works? I lived with PAF for over a year without this happening, but it started a few months ago and seems to happen or very nearly happen almost every time after a run now. I have tried very easy running, different durations of cool down or gaps to having a shower, but no sooner do I sit down then it gets me in short order. (I have considered not sitting down, but this becomes impractical!) I understand this is classic ‘Vagal’ Afib, but not exactly sure of the mechanism. Is it because the vagus nerve has been triggered during exercise to keep the heart rate down and doesn’t switch off after, even when the heart rate is down and dropping anyway?

Any insights appreciated. Thanks.

[PlanetaryKim]

I think you are right in your analysis. This does sound like classic vagal afib. I think what is happening is vagus nerve is increasing its tone/activity once you come to rest after exertion. I have had same happen - but usually 2 hours after big exertion when I am in recliner with feet up and a meal in me, then BAM. In my opinion, they best strategy would be to not get too relaxed physically or mentally. Stay on your feet or sit up straight if you are sitting, don't recline or lie down, don't eat for a while (full belly can also be vagal trigger. That's what I would try at any rate - to stay on my feet somehow - doing dishes, laundry, vacuuming, whatever. I'll see if I can find a link to an article I found helpful on this.

[BigArnie in reply to PlanetaryKim]

Thanks Kim, perhaps I have overlooked the classic answer here - just don’t do what makes it happen! I certainly try to sit up. Perhaps I need to look at a standing desk, although no doubt Afib will find a way to get me even then And it would also be great if you could find the article.

[PlanetaryKim in reply to BigArnie]

I looked and could not find it. Will look again. It was basically saying though that sympathetic nervous system (adrenergic) is for fight or flight... and so will be engaged/dominant when exercising, jogging, etc. Whereas parasympathetic nervous system, which involves vagus nerve, is activated/dominant during "feed & breed" (also know as "rest and digest").

The strategy I try on myself - and it has worked more often than not - is to actually stimulate the sympathetic/adrenergic nervous system with strong coffee and/or exercise (a walk usually) and/or cold. These things will engage the part of your nervous system that is NOT causing your afib. Basically any strategy that would make the vagus nerve become less dominant, less active, may convert you back to NSR.

I had an afib episode going all day and evening and woke up with it next morning. It was not responding to any of my usual gambits. Then I got outside early to work with contractor on gutter repair. It was cold and wet and strenuous work... And an hour later the afib was gone. I think entirely because I stimulated the sympathetic/adrenergic nervous system, elevating its activity above the vagal system.

Remember, caffeine is an afib trigger for adrenergic afibbers. But it can be a conversion strategy for vagal afibbers by stimulating the adrenergic nervous system. Some afibbers say a strong cup of coffee converts them back to NSR. Those would be vagal afibbers. Not that it will work on everyone. And of course some people are mixed vagal and adrenergic.

[BigArnie in reply to PlanetaryKim]

Thanks that is a very useful explanation. So.. I am wondering if I should try stimulating the sympathetic nervous system after exercise (coffee and/or cold shower for example) to head off the episode before it triggers... might not work as I suspect that I am mainly Vagal, but a bit mixed, but you never know until you try these things. I will say that I am generally very tolerant of coffee, but I have a bit of a suspicion that it might have extended an episode actually in progress once or twice rather than terminate it. We shall see..

[PlanetaryKim in reply to BigArnie]

I would be more inclined to try the strong coffee as soon as the afib commences... But it is all one grand experiment, for sure. And if you feel that coffee may have contributed to an episode, or extended it, then it might not be such a good idea after all.

[BigArnie in reply to PlanetaryKim]

Yup, not a good idea for me. Tried it on an episode today and definitely pumped up the volume and I'm pretty sure made it last longer than it might have done. Worth a try though!

[PlanetaryKim in reply to BigArnie]

Oh! Sorry to hear that! So much of this is trial and error (hopefully guided by logic!) trying to dial in the thing that WILL work. I probably should not have suggested it. Because, although I do do minor experimenting like that on myself to try to figure out best strategy ... that is not a road I should lead someone else down!

I had developed a rescue remedy for myself that seemed to be working at converting me (small can low-sodium v8 + 400 mg magnesium + 2-3 cups water). And one day it didn't do much, and I thought "maybe i need MORE potassium." Because the low-sodium V8 has 500 mg potassium in 5 oz can. so i mixed up a glass of warm water using No Salt, which is straight potassium chloride. I measured it in so I had 325 mg potassium in the glass (1/8 tsp). And before I was more than a few sips in, I went into tachycardia - 160 bpm. But afib gone! The rhythm was regular, just extremely fast. That was scary because tachycardia does not usually happen to me. I was very glad to have some metoprolol on hand (which I do not normally use). It was quite effective at bringing my heart rate down to acceptable level. But live and learn on that one. Will NOT be using potassium chloride again! (Although will continue to do the small can of LS-V8 because that seems to help more often than not.)

[BigArnie in reply to PlanetaryKim]

Don’t worry about it for one second - I take 100% responsibility for my actions!

[PlanetaryKim in reply to BigArnie]

ok! good to know. i am same.

[secondtry]

Without going into speculation on the vagaries of the Vagus Nerve, I believe the issue is you have to reduce the contrast between activities e.g. stop running and do a brisk walk, if that doesn't work just a normal walk. Also, at night have a 'quiet hour' before retiring. I was very much a brake and accelerator person and loved challenging sports but exchanged all that for much improved QOL.

[BigArnie in reply to secondtry]

Hi secondtry, yes I've kind of tried this, but perhaps it does warrant more effort. Since I have curtailed the running I am less fit anyway, so there is time scope for a short run and a proper walk afterwards, rather than (only) a slightly elongated cool down. (Flipping love running and don't love walking though!)

[secondtry in reply to BigArnie]

I was not a walker either BA, maybe seek out a walk where you can do something at the same time. I am lucky because we live close to a long well maintained army track with lakes (so part-time twitcher) and I use Nordic Poles which is a poor substitute to when I skied but it works for me! It also helps with the walking basketball I played pre-Covid. What do they say it is not the strongest that survive but the ones that can adapt the most! Good luck.

[BigArnie in reply to secondtry]

Thank you and hope your strategy keeps on working well!

[AFCyclist]

Yep often used to start with me when I was relaxed or even overnight after a strenuous bike ride. Keeping active can fend it off but your have to relax at sometime.I found that the next day if I got back on my bike and cycled up a hill I would always kick back into NSR.

Now I avoid the tough stuff and have found my electric bike keeps the pressure off.

[BigArnie in reply to AFCyclist]

Yup, relaxing sometime is indeed the thing. However I am going to try keeping up the activity for longer after the run one way or another to see it works. Thanks.

[Ianc2 in reply to AFCyclist]

Keep getting tempted by an electric bike having met a few e-riders out and about who swear it does their knees good. Any recommendations ?

[AFCyclist in reply to Ianc2]

Lots of choice about now. The heavier ones are powered from the crank. lighter ones have a motor on one of the wheel hubs. I have a Ribble electric road bike which is only 11kg and I can lift into the back of the car. You can also get an extension battery.

[KMRobbo]

For 20 months and 11 episodes I used to go for a run to STOP my afib. Just shows what a mongrel AFIB is.

[BigArnie in reply to KMRobbo]

Indeed it is! For about a year I used a run occasionally to very successfully terminate episodes. Now they don't terminate, but just get worse if I try that. AND I have the post run issue as well. Many many swear words come to mind!

[KMRobbo in reply to BigArnie]

yep, my magic trick stopped on the 12th episode and I was in AFIB 130-195 resting for 8 days before beingconverted by flecainide infusion. I never knew what kicked of my AFib. no triggers at all.

[BigArnie in reply to KMRobbo]

Ouch, very nasty! My warning shot was similarly vigorous, but thankfully only lasted a few hours. Definitely one of the scariest ones ever and played a big part in going back to my cardiologist to try daily Flecainide instead of PIP. Early days with that, so still hopeful...