Exercise and medications for PAF

I've been on propafenone (150mg three times/day) and diltiazem for about 2 months now, and my PAF is now well controlled on these meds.

I'm on the waiting list for an ablation and have been told it will be 6 months or so before I am likely to get a slot for the procedure.

The big issue for me now is that I have a sense of feeling quite breathless on exercise (even with very slow running). I used to run regularly before starting on these meds, but running is no longer enjoyable, so now I just go walking.

I suspect it is the propafenone that is the main cause, or the combination of the two drugs, because I was on diltiazem alone for a while and I could still run relatively well at that point.

I'm interested to know how other "exercisers" have been affected by meds for PAF, and whether or not tolerance to medication side effects is likely to develop with time or not.

[Padayn01]

I was on metropole when I started exercising and felt pretty good I’ve been off them for four weeks now and get terrible ectopics post recovery

[KMRobbo]

I was on 200mg of diltiazem and 2 x 50mg Flecainide for 10 months. The diltiazem was the one which caused a problem running and several other side effects. Was advised this by dispensing cardiologist. My max hr running on 200mg was 137bpm. Not enough.. i was also slightly breathless climbing stairs ..my beathing sort of did not keep up with the oxygen requirement and suddenly I was panting . I had the dose dropped to 120mg for a while which was better for its side effects and slightly increased my max hr to 143 or so, but owing to an afib attack it was increased back to 200mg against my wishes. The other thing about the diltiazem is that although the max hr hr running was consistent, the side effects seemed to get worse the longer I took it. These were the breathlessnes plus brain fog, tiredness and poor memory. When i eventually stopped it 3 months post ablation it took 6 weeks to get back to feeling good and getting rid of the sude effects, which is strange as it only has a fairly short half life .

[Hidden in reply to KMRobbo]

Thanks, that's useful. I've also noticed an unusual breathless sensation when climbing stairs, or if I try to lift something heavy.

I think the problem is that my heart rate just can't respond properly to the increased demands of any exercise. As well as being an anti-arrhythmic, I read that propafenone has a weak beta-blocking effect so that's probably adding to the diltiazem effect in terms of limiting my heart rate response to exercise.

Interesting that you thought that the side effects increased with time, as I've noticed the same thing but then I was wondering if I was imagining it. I've tried tweaking the propafenone dose down to 2.5 tabs a day, but each time I've done that I've had a short episode of AF so I think I'm pretty well tied to the current dose.

The diltiazem is to prevent some potential side effect of the propafenone - I asked the cardiologist if it was really necessary to take it and he seemed to think it was, so I'm stuck with that too.

Guess I just have to hope for a successful ablation and being able to get off the medications, and accept that I won't be able to exercise like I was used to for the moment.

[beach_bum]

I was started on Metoprolol, and it knocked wind and energy out of me.Switched to Diltiazem and back to normal. My normal being 4km dog hike in the morning, 25km gravel bike 3 times a week, 1 40km and light weights ( no more than 45lbs) alternate days. On Metoprolol, I couldn't walk 500 m without gasping.

Metoprolol is a wonder drug for some, but not my experience.

My Dr. Was puzzled why the ER staff but me on a beta blocker, when a channel blocker was called for.

Everyone is different. Different conditions, different drugs.

[KMRobbo]

I have never taken propafenone, but i under stand that is pimarily anti arrhythmic, but owing to it stucturally being a beta blocker can have some rate control characteristics. ( Google) Diltiazem is a calcium channel blocker which is used to reduce blood pressure but in your case is probably being used as a rate control so if you are in arrhythmia your heart rate is controlled ( limited) .

I dont beleve diltiazem has any rhythm control properties.

I also understand Propafenone can in some instances promote arrhthmias ( just as flecainide can do) so this may be another reason your medic may want you to take diltiazem.

However you are surmizing the combination of the two drugs is perhaps limiting your heart rate too much??

As reducing propafenone lets your heart go to afib, this is a no no, but what about decreasing the diltiazem dose? You did not mention what it is . You could speak to your cardiologist about options to try that. As I said I tried 120mg rather than 200 and it was better overall , with a small increase in max hr when running.

I also mentioned I was put back to 200mg . This was because i had an afib attack when taking the 120mg, and i always had high rate , and i ended up back at A&E eventually. The reason i got the attack was because I forgot to take my evening Flecainide and i went straight into afib on waking. My fault nothing to do with the 120mg dose . A cardiologist ( not my EP nor the one who reduced the dose to 120) decided to put me back to 200mg so if i had another afib attack i would not have a high rate and may not end up back in hospital, which was probably very unlikely to be the case anyway!

I put up with it as i was 2 months away from my ablation, and i had a supply of 120s which i saved and took on the days i planned to go running!

I am not medically trained.

[Cookie24]

I have taken propafenone and diltiazem for a couple of years. No trouble exercising until April when my heart rate had started to decrease into the 50s and I felt sluggish. Diltiazem was reduced from 240 mg extended release to 120 mg extended release and I am fine.