Higher altitudes and aib

[Tux18]

I am on vacation in Denver Colorado. I am wondering if any of you have noticed any difference in your afib at higher altitude such as is it worse, better, or the same?

[Paulbounce]

Hi Tux.

Back in the day (when you could fly!) I noticed no difference at all when flying. Both my cardio and GP said it was fine to fly - even long haul.

Enjoy your vacation.

Paul

[Tux18 in reply to Paulbounce]

Thanks for your reply. I flew out here and didn’t have trouble on plane but Denver has a much higher altitude than where I came from and afib is off one on all night and not much strength or stamina since getting here.

[Paulbounce in reply to Tux18]

OK Tux.

Here's my suggestion. It's a pain I know when you are on holiday but I would take it easy for a few day's, rest up, and allow your body to adjust to the higher altitude. Then (hopefully) normal service will be resumed and you can enjoy the rest of your holiday. If it were me I would just stay local for a few day's - you could still have a gentle walk and find a local cafe to have a soft drink in. That's what I did when afib returned when I was abroad. Had a natter with the locals and just took things easy. It passed although I was on edge for a week - pleased to say it sorted itself out. I hope it does for you.

Remember as well (if you are in a different time zone) it might be harder to keep in sync with any med's you are on. This could make a difference too.

Paul

[Tux18 in reply to Paulbounce]

You are so right it’s not been easy to keep meds, etc in sync. Wish my system weren’t so sensitive. All good advice. The trip is rather short so haven’t paused as you suggested, but in the future I’ll try to remember your advice. and not push so . Thank you!

[CDreamer]

Worse for me and it’s a few years since I returned to Denver because I struggled, not so much in the city but as soon as we ventured higher. I always did have headaches though, even prior to AF. But then I’m used to living at sea level.

Flying - no problem as you are in a pressurised tin can & it can actually help.

Anything over 1500m tended to to affect me.

[Tux18 in reply to CDreamer]

Like you i have noticed my stamina and ability to just take off walking a normal pace isn’t working. Appreciate your reply!

[LaceyLady in reply to Tux18]

I remember some years ago, we’d traveled to Tanzania, we’d arrived in Ngorrogoro crater. All of us were a bit breathless and that was before my PAF! It wore off after a day or so. I haven’t traveled abroad for the last couple of years. I should have gone to South America but insurers wouldn’t renew, so had to cancel it, was later a blessing due to covid 🤨

[etheral]

Might be worth bringing a pulse oximeter to check your pO2 at altitude. If it's lower you might have more cause for concern as far as your rythym being affected.

[john-boy-92]

I recall being up in the Rockies. My AF wasn't a problem, but trying to run upstairs quickly showed that the oxygen content was lower.

[DevonHubby1]

Wife suffers from PAF although on a holiday to Teneriffe (pre covid) she experienced no episodes. Flight to and from island was uneventful. HOWEVER when she went up Mount Tieje via cable car she experienced breathless and a slight pain in chest. We came down straight away and she was fine after that.

[Tracyhithere]

I asked specific advise from my cardio before traveling to Addis Ababa . He advised that it is not possible to know which people will feel the effect of altitude and be prepared to quickly go down. He did not advise against altitude with AF

[Bambi65 in reply to Tracyhithere]

In my humble opinion...your doc is an idiot. , Ive had afib for over 6 years, and I traveled all over the world until the virus hit. Unless your scared to fly, There is no issue with afib while flying because the cabin is pressurised. Landing in high altitudes, Denver, Ecuador there will be an adjustment because the 02 is much thinner. IE harder to get enough 02 inside your lungs and it can feel very uncomfortable, for a while. Dont let afib stop you from living your life, Your in control, not that afib monster.

[Tracyhithere in reply to Bambi65]

I must have been unclear. I was referring to being on land at Abbis, which is second highest city and altitude sickness can be a problem. The only remedy is to reduce altitude. This is different to air travel.

[Bambi65 in reply to Tracyhithere]

that makes much better sense. Yes, land altitude is very different due to the thinning of the O2. There are somethings that can be done weeks before in prep but they dont always work. Once I had a difficult time and a local suggested a tea that was available in that country. It did not cure it but it sure did help

[Eastwick]

I found high altitude really affected my a fib. Went to Courcheval in the alps and ended up in hospital with severe paroxysmal af. Never any problem flying .By the time we visited Denver, which was more recent, I had had a pacemaker fitted. Without that I suspect it would have been the same as in France.

[jrd210]

I would think it unlikely that the altitude plays any role in your fib. Having had PAF for over 30 years and having fought with authorities to regain my flying licence and having flown certainly up to 13,000 just checking O2 with a pulse oximeter I can only say personally that altitude up to those levels did no more than mild headache and some fatigue if prolonged. I carried a small O2 dispenser to use when my oximeter plus symptoms indicated the benefit from O2. Occasional ventures to 15,000 included more O2 bit still no effect on increasing fib.

[Tracyhithere in reply to jrd210]

Hadn’t thought of oximeter. Good idea and I will take mine on future trips.

[Glb1948]

It could be your O2 sats are dropping. When I have to wear a mask in public for any length of time i start having irregular heart beats and feeling light headed.

[MarkS]

I went to Colorado before my ablation. I had no problems with Denver but felt it when we went up to 12,000 feet in the Rockies and I could only walk on the flat. The whole of that SW part of the US is great.

[RTA_25]

Just the same,i’ve been travelling long haul from the Philippines to Toronto Csnada for 17 hours straight flight though i’m on my meds. Taking Flecainide 100 mg 2 x daily and metoprolol succinate 25! mg once daily for my Afib.

[djmnet]

I live here and have afib. Yes, you can be sure that the altitude is harder on your body and thus your afib for at least several days until you acclimate to being a mile high. Drink lots of water!

[Bigge]

I live in Colorado and used to teach adults in Denver. My students flew in for my classes from all over the country and I would always caution them to take it easy for a few days to get used to the oxygen levels here. For several people, it is very difficult to get used to. Altitude sickness is real! Biggest culprit: alcohol!

[secondtry]

My view on whether altitude tips you into AF is a matter of how close you are to the threshold. Before I was diagnosed I had several episodes skiing in St Anton (Austria) At 1-2000m, worst was when we decided to exert ourselves walking up a mountain track to a restaurant in the evening. Conclusion to myself: Keep below 1000m, don't exert yourself particularly late in the day.

[Magson]

In Joburg ,which is 5750 ft alt ,the air is 15% lighter. You can notice the difference in your vehicle performance compared with the coast. Obviously this has an effect on you body also . I developed AF there after 10 years and on returning to the UK after 24 years eventually had an ablation. I cannot say for sure that altitude caused my AF.

[AussieHeart]

It may be a coincidence? I live in Oz and used to travel annually to holiday with friends living in Las Vegas which is above sea level (where I suffered badly with irregular heartbeat). I didn’t go there to gamble just enjoy the mountains 10-20 miles from the strip. When it first happened (I said Vegas mountains too exciting for me!) but of course (on reflection) it was the start of my aFIB symptomatic journey. It took 2 more years to dx!

[belindalore]

I agree with some of the other posters. Sounds like the lower oxygen at the higher altitude could be causing you some problems. I am one who doesn't do well in a high altitude. And remember we are all different. What bothers one may not bother the other. Hope you're feeling better.

[Bennera513]

I've luckily not had an AF attack while travelling (yet) but I keep a keen eye on my many ectopics. Higher elevations (such as 4,000 ft in high desert of Oregon, or 6,500 ft at Lake Tahoe) will send my heart rate higher than normal which is a recipe for increased ectopics. I'd have to think AF would kick off more readily in such a situation. I also find that the altitude leaves me in an adjustment phase and if I don't stay on hydration then I have issues the first or second day. Alcohol for me, is certainly out of the question at higher altitudes unfortunately. However, I have to say that after an initial adjustment I seem to get along fine and once I return home, I seem to have a nice respite from premature beats for a couple days. I always thought perhaps I had more red blood cells and was more efficient with oxygen/etc. and therefore somewhat protected from arrhythmia.....All anecdotal in my case I'm afraid. I don't believe the altitude of Denver will give you issues as long as you rest, protect from the increased Sun and increase hydration the moment you land to when you leave. Visits to the high ranges could put you in a challenged state but as long as you slowly warm to it and don't try to exercise in those environments (without adaptation) seems you shouldn't be too concerned. Let us know how you get on.

[Rocky-athlete]

Hi Tux and all,

Here are a few thoughts supporting the idea that altitude is implicated as an AF trigger and that it can be managed as one of many stresses that can trigger AF. Sorry so long!

For context, I'm a retired high altitude mountaineer, former ultra-runner, former EMT (not a doc!), outdoor educator who teaches this info., have paroxysmal AF, and am on meds after two unsuccessful ablations.

- Many mechanisms kick in over varying time frames to help acclimatize to altitude. First, we breathe faster and heart rate increases (perhaps enough to trigger!). We put more red blood cells into circulation (esp. from the spleen), make more red blood cells, biochemistry shifts toward alkaline from blowing off CO2, so we urinate more, get dehydrated, we increase 2.3 DPG, and more minutia.

-Altitude symptoms peak 24-36 hours after arrival. We are 80% acclimatized in 2-3 days, 90% in six weeks, and two years later we are still growing more capillaries!

-Airplanes are designed to be pressurized to 8,000 feet above sea level or lower. Most are closer to 6,000' in practice. Thus, even long haul flights generally do not trigger altitude symptoms, but the clock towards peak symptoms is ticking, especially with the low humidity which kick-starts the dehydration. Still, for some acute conditions, such as a pneumothorax, air travel is prohibited.

-Altitude symptoms are best managed with MILD activity (like moving about the hotel), not inactivity (like lying in bed) or high activity. Increasing fluid intake (not alcohol) helps. Decreasing fat intake could help. Symptoms are often worse in the morning from inactivity and sometimes from periodic breathing.

-A common heuristic is that once you are above 8,000', do not ascend more than 1,000'/day. It's advisable to spend a night or two in Denver (~5,300') before ascending to 8,000'.

-If going above 10,000', ask your physician about a common medication (not sure I can mention this carbonic anhydrase inhibitor here). Also, learn to distinguish Acute Mountain Sickness (mild hangover-like symptoms) from High Altitude Cerebral Edema and High Altitude Pulmonary Edema. AMS is a sign to slow down or not ascend until later. HACE and HAPE, very rare at 8,000-10,000', are killers demanding immediate descent and O2.

-I've plotted five years of my own AF frequency and duration vs. altitude (beware n=1). It's well correlated, making me consider retirement at sea level. My pO2 is a couple points lower at 6,000' than at sea level. Still, managing all other variables, I've been able to sleep often above 11,000' without triggering my paroxysmal AF.

I hope this is helpful for those who like a little more detail.

I agree with most of the other posts and am grateful for this forum. Carpe Diem!

-R

N.B. It is the partial pressure of oxygen in the air at altitude that decreases, not the proportion, which remains 21%. At 10,000, the pressure is about 2/3 that at sea level. At 18,000' it is half. On the summit of Everest it is 1/3.

[dezi]

Flying is fine as you are kept at around 10,000 ft. in the pressurised cabin though actually functioning at high altitude such as skiing at high altitude may be a different matter. I had altitude sickness the last time I went to Winter Park ski resort and stayed there I had to be on oxygen at night as couldn’t breathe - that was years before I was diagnosed with AF. In Denver itself I was Ok as it is lower.

Take things easy and if you need see a Doctor.

[Usta]

Forgot to mention on previous "longwinded" comment....after no go with sotalol and tikosyn last October, I had a cardioversion. I was NSR for maybe 1 month and then out of sinus rhythm again. Addionally- no big deal- but my improving throat is still slightly raspy from-I assume - the preablation TEE and the intubation necessary during full sedation.

Cheers.