Hi – I originally posted the following (or at least a similar version) through the BHF link but didn’t get many replies. I would really like to hear from anyone who is a keen cyclist and/or runner who has developed persistent atrial fibrillation (AF) and either decided to live with it rather than try (risk?) one or more ablation procedures; or has been unable to have an ablation (or take effective drugs) for whatever reason and remains in AF. The question is how are you getting on with continuing to exercise whilst in AF (assuming you have been given the medical OK to do so)?
My situation/background is that I was diagnosed with Paroxysmal AF 17 years ago, which until recently has been controlled with Flecanide, initially as a ‘pill in the pocket’ option and then taking a modest dose daily. It has generally not been a problem for me with very few apparent episodes over that period.
However, even as a reasonably fit and very active person in my early sixties, I unfortunately had a heart attack in April this year (NSTEMI) which luckily has not left me with any significant damage, but not so luckily a week later (presumably related) I went into AF which has now become persistent, including after a cardioversion procedure. I am no longer able to take Flecanide which I understand is contraindicated after my NSTEMI and the Cardiologist is not recommending any other drug that may get me back into sinus rhythm.
After an ECG exercise stress test the Cardiologist (who is a heart rhythm specialist) is happy that my AF is well controlled with the medication I am on, and has suggested I can exercise as I wish, providing I do not feel unwell.
I have also been told that provided my AF symptoms are manageable/not too troublesome for me, then I should not necessarily ‘chase sinus rhythm’, primarily because I believe the balance of evidence is that my overall stroke risk with diagnosed AF is similar regardless of whether I remain in persistent/permanent AF compared with achieving sinus rhythm following a successful ablation. As a lay person I find that counterintuitive but apparently that is presently the case (although that may of course change with new/ongoing research studies).
This then becomes a difficult decision (whether to have an ablation or not) for me – a lifestyle consideration perhaps but much more because exercise is important to my mental health and wellbeing. As things are presently, I am still able to exercise - albeit at a significantly lower level and with less enjoyment than I would like (this may hopefully improve) - with some (relatively mild) intermittent/occasional symptoms (palpitations, as well as some shortness of breath with modest effort and feeling a little lightheaded occasionally). But these are things that I could potentially live with, when balanced against the small but not insignificant life changing disabling risks associated with ablation, which may or may not be successful in any case. I am also told I should not wait too long to decide because otherwise the chances of a successful ablation become significantly reduced for persistent AF.
I am also mindful that even if I get back into Sinus Rhythm after any successful ablation(s), my exercise performance is still likely to be significantly affected by the medication I am on, particularly the Beta Blocker (Bisoprolol) so I may not feel much benefit!
So, in summary, my opening question is the primary reason for this post (although any relevant observations on the background situation would also be most welcome) which is how is anyone out there in a similar situation, perhaps now with permanent AF, getting on with exercising? I would also be interested in your views on ablation and whether you did or didn’t go down that route to where you are now. Thanks for taking the time to read this post and in anticipation of some helpful responses.
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We have quite a few cyclists on this forum and hopefully they will see your post. If you could add Cyclist to your post heading they'll be even more likely to read it. Go to the box at the bottom right of your post where it says More and scroll down to Edit, them make your change and save.
As a former runner not at your level I emphasize. I have changed to walking but I am 75.
Cardiologist (who is a heart rhythm specialist) is happy that my AF is well controlled with the medication I am on, and has suggested I can exercise as I wish, providing I do not feel unwell.
Have you discussed an ablation with your cadiologist ? He knows your history and chance of success. Also, research the maze procedure. A consideration for success would be the fact you had a heart attack (from what I have read).
What is your average heart rate and your current medications ? How high is your heart during exercise and does it properly recede ?
Not a doctor , persistent AFib and always research the subject. But I would encourage you to research and seek opinions from other medical professionals.
I have been in persistent/permanent AFib for 1.5 years and have chosen the "control with medication" route at this time. My quality of life is affected some, but not that bad. But I am in a different age group.
Thank you for your reply - first of all I would stress that I was never a particularly good runner! - but I enjoy pushing myself and discovered fell running fairly late in life (55 - I am 62 now) so pretty strenuous
I have discussed an ablation with my Cardiologist, but as I mentioned he is not pushing it and believes I may be better not 'chasing sinus rhythm'. I understand this is based on my symptoms being manageable and the results of my ECG Exercise Stress test showing that my heart rate is well controlled with the medication that I am on (the main element being I believe the beta blocker - 1.25 mg of Bisoprolol). The stress test started with a heartrate of 64 bpm, rising to 130 bpm with a peak at 151 bpm (Stage 5 of the BRUCE Protocol if that means anything to you) which then came back fairly quickly in recovery. My resting heartrate is very low (typically 40 to 50) but this is I believe largely genetic and the Cardiologist is not considering a pacemaker.
The Cardiologist stressed that the primary reason to consider an ablation (which as a specialist he does himself) was to treat symptoms as there is no conclusive evidence that having a successful ablation reduces overall stroke risk or prolongs life. I have been given ablation success rates, which as I have now been in Persistent/Continuous AFib for 4 months will dwindle over time. I did however agree that I would take a couple of months (expires relatively soon!) to consider things before making a decision. I know the serious risks of the ablation procedure are relatively small, but I must admit it is a factor playing on my mind because my quality of life is still relatively OK as things stand.
I have also spoken to a general Cardiologist who with my age and circumstances would definitely refer me to another specialist for an ablation if that is what I wish, but this would delay things further, although it would be good to get a further specialist opinion, and I may do so in parallel. My GP is neutral on the matter!
I am glad to hear you are managing relatively OK with your own AFib.
I'd been running and cycling for over 20 years when I developed persistent AF in 2017. I enjoyed the challenge of training for half and full marathons and riding long distance events which took me to the remote and scenic parts of the UK and abroad. The AF stopped me doing anything other than walking or easy, flat cycles as I quickly became breathless with high HR. There was no point in pushing myself and I felt it was detrimental to my long term health. It was difficult to adapt to this as I got so much physically and mentally from my sports. A cardioversion after 2 months returned me to sinus rhythm and I was able to resume easy training and slowly gained confidence to enjoy running/cycling again without pushing myself quite as before, I completed the Paris-Brest-Paris 1200 km audax event in 2019 (5th completion of this ride) in good style.
I maintained SR for almost 4 years continuing with my sports but in April 2021 returned to persistent AF. Another cardioversion did the trick and when offered the chance of an ablation in September 2021 it was an easy decision for me to accept.
The procedure at Barts went well and I followed the HealthUnlocked guidance taking it very easy for 3 months. After that I built up to gentle jogging/cycling and have continued to make a good recovery. Since my original diagnosis I always exercise with a HR monitor and accept that, at the age of 61, it is time to slow down but still enjoy getting out running/cycling/swimming/kayaking/wing foiling with like minded folk. I wouldn't be able to do these things at a fraction of the level I do if I was still in AF.
We are all different of course and it may be that you are able to still run/cycle at a level you are content with whilst in AF. If not then an ablation could be the next step.
Thanks for your response - I think if I was in the situation you were in then a decision to have an ablation would be relatively easy for me to, however because my heart rate is controlled and my breathing is not too bad, even with relatively strenuous exercise, then it is harder for me to decide what to do. On the one hand my quality of life is still fairly OK, but on the other hand I am still relatively young at 62 to remain in Persistent then Permanent AF and have to set my bar lower.
The small - but not insignificant - serious risks associated with an ablation do prey on my mind and if it remains the case that with my presently well controlled Continuous AFib there is no conclusive evidence of a reduction in my overall stroke risk from a successful ablation (as I have read and my Cardiologist advises) then I find myself presently still undecided. By the way because my one and only cardioversion reverted in a few days the Cardiologist is not recommending trying this again.
Well done on doing PBP by the way! I am a member of Audax UK but have only managed a 300 km longest ride to date, still hoping to do a SR series and maybe further at some point
I have seen both sides. AFib runs in my family - we all have it to a greater or lesser extent. We are have all been very fit all our lives, my 2 bothers were international class athletes, my sisters both competed at county level in several sports and I played semi-professional football and competed internationally in martial arts. One of my brothers is in permanent AFib and still cycles, kayaks and swims. He maybe doesn't break records anymore but he would give someone half his age a run for their money! I have paroxysmal AFib but am still cycling and hill walking. I have elected to have an ablation mainly as I am only 53 and still want to maintain my part-time military service and outdoor pursuits. Ablations have come a long way and the risks associated with them are much less than they once were. Additionally, the success and likely complications are determined by a whole host of factors many of which people don't share (understandably) when they tell their stories. My advice is get advice. I have spoken to 3 different cardiologists who specialise in this field (2 privately and one in NHS) and their advice was strongly to recommend ablation BASED on my particular circumstances and lifestyle.
Thanks Kenny - good luck with your ablation - I think if I was still paroxysmal (and it was regularly flipping which mine wasn't before I became persistent) and your age (I'm 62) then I would definitely go for an ablation, but presently I am undecided. I have an opinion from one specialist Cardiologist (consider not chasing sinus rhythm) and one general Cardiologist (he would refer me for one in my circumstances) and probably could do with getting a further specialist EP opinion, preferably from someone who is very active as well! Also your point about a host of factors coming in to play with success vs risk is well made and something I am aware of.
As I matter of interest did your brother (who is in permanent AFib) elect not to have one or more ablations? Possibly as similar to my situation it is well controlled and the benefits weren't cut and dried, or did he have an ablation(s) and it was not a success? Either way glad to hear he is still exercising at a good level so that's positive.
My brother is 62 as well! He discovered by chance that he had AFib and every indication was that he had it for some considerable time (he has a slight enlargement of the atrium). That in itself is interesting as he discovered this shortly after retiring from the military so he has gone through annual medicals and this hasn't been detected. His EP basically said to him that after looking at all his test results (low-medium rate permenant AFib ) to go away and enjoy his life! I've come across this opinion from EPs and cardiologists who say that low rate permenant AFib does not necessarily require treatment especially if you have no other conditions.
Thanks again Kenny - perhaps that’s the case with me - although as I mentioned I have had a mild heart attack recently and also a history of hypertension…
I’d heard that AFib can run in families, but none of my 3 brothers has it and our parents and grandparents didn’t either- as far as I’m aware- although of course it could have gone undetected!
😀 - mind you there IS a family history in my case of cardiovascular problems - so I guess there’s some overlap
Hi, the best bit of information I can offer is to research as much as you can about Dr John Mandrola. He is an American Electrophysiologist Cardiologist who has AF and was also a professional cyclist and the link below will take you to his webpage but there’s a lot more stuff available on Google.
However, the general thinking from medics that I have heard talk on the subject is that extreme sporting activity and AF are not good bedfellows. I guess this is borne out by the number of young athletes who have AF but we also know that for the majority of these passionate folk, tempering their passion does not come easy. At the end of the day, only the individual can decide which is the most important, but from what we hear, a good many find a compromise which works for them.
There are also many here who would empathise with your cardiologist view that it’s not always a good idea to chase sinus rhythm. I did, and I have no regrets but I know a good many (mainly elder folk) who are lucky in that their persistent/permanent AF is well managed with medication and they are able to live relatively normal lives and would not consider any form of invasive treatment.
Clearly you have not totally discounted the possibility of pursuing the ablation route but the chances are you would need more than one procedure and of course, there are no guarantees of total success but it’s rare for any one to say they regret having their ablation(s). We hear quite a bit about the Hybrid MiniMaze procedure which although has been around for years, there have been some advancements in the way it’s carried out so it’s something you may wish to research. It is available on the NHS but in truth, availability is limited to a small number of hospitals mainly in England but it is also available privately.
As Jean has said, there are a large number of members with sporting interests but they tend to be younger so are probably focusing on things other than this forum during August. Maybe after you have explored some of the options, you might get some more good responses if you re-post in September……hope this helps.
Yes, thanks, that's very helpful, I will have a look at the link you suggest and do some more research.
I am certainly past extreme sporting activity, if I ever was! But at 62 I did think there would be a few more years of challenges ahead without having to compromise (too much) but if that is indeed what I have to do then as things stand I can still be relatively active, so that's good and obviously gives pause for thought before considering one (and probably more) ablations further.
As I have mentioned in replies to other responses I also have a general Cardiologist's view that in my circumstances he would definitely refer me for an ablation and thinks I would be a good candidate.
Hi there, I’m a long term racing cyclist and Two years ago I had an encounter with the AF beast…I had paroxysmal Af which at first was only when I excercised, I had all the tests and it was picked up on a stress treadmill ecg… I tried the meds for about 16 months or so…bisoprolol and Flecainide…they didn’t really work..I was finding I was getting increasing frequency of AF episodes and not just when excercising…sometimes just sitting watching tv or having a cold drink!! I was less and less able to excercise which was really screwing with my head and spoiling my life basically…I made the decision to have an ablation after having a lengthy chat with my electrophysiologist who didn’t sway me one way or the other but when I’d said I wanted it he agreed it was probably a good decision for me….I had the Cryo pulmonary vein isolation ablation at the end of April, it was not as bad as I thought..In fact it was an interesting experience, I was told it had gone well. Then the recovery months…I went for walks for the first six or seven weeks, then started to ride an e bike that I had bought to allow me to get out and keep my sanity before the ablation, I stopped all meds on the consultant instructions two months after the ablation, which is now 6 weeks ago, I am so happy to ditch the meds as I hate to take tablets, I have had very short lived af runs during the last 3 months but that is normal im told, and they are only about 5 to 10 minutes max instead of the 24 to 30 hours a couple of times a week pre ablation. I’m now moved off the e bike and back onto my normal bikes and all seems to be going ok fingers crossed,,,🤞My situation is a bit different to yours but all I can say is I am 100% glad I made the decision to go for it…you have to weigh the quality of life you have at the time versus what you would like to have and take into account the associated risks, Good luck with whatever you decide to do, it’s your decision in the end don’t be swayed one way or the other, it has to be what you want! All the best Sam
Thanks Sam - as I mentioned in another reply, if I was still paroxysmal (and it was regularly flipping which mine wasn't before I became persistent) then I would definitely go for an ablation, but presently I am undecided in terms of balancing the pros and cons. I am also mindful that at my age (62) and with my circumstances I would need to remain on most if not all of my present medication, including a beta blocker, so the gains from getting back into sinus rhythm would be only partial compared with where I was a few months ago.
On the flip side I could be many years in permanent AF, which can't be good, even though the evidence (as I understand) is currently that there is no overall benefit for an ablation in terms of prolonging life and reducing stroke risk (so a recommendation is generally symptoms driven). I am also told that my longer term risk of heart failure is no worse if I end up in permanent AF, because my AF although continuous is well controlled in terms of heart rate.
In terms of where I am at present, and as I mentioned, I do have a relatively good ability to do moderately strenuous exercise, even though I am in persistent AF, so I am not ready to buy an ebike just yet!
It's almost exactly one year since my ablation. My paroxysmal af had progressed quite rapidly to the point where it was more or less persistent, and very symptomatic. Flecainide had worked for a while but after a few months became less effective and left me in a near constant state of af. I was a keen cyclist, non-competitive, but the long rides I had hitherto enjoyed came to an end. For me, at 48, it was an easy decision to have the ablation, and it was very much recommended by my consultant. When I was admitted for the procedure and hooked up to all the kit, it turned out I was not only in af, but flutter as well! No worries they said, we'll deal with that before going into the left atrium! I didn't find the procedure scary or unpleasant, and the skill and care at the QE in Birmingham was second to none.
One year on and I've had to recalibrate my ideas of success. If it's defined only as a return to unalloyed sr, no meds, and normal life, then my ablation was a failure. The procedure was pronounced a technical success and I recovered well, all the while in sr. After a while though I started getting some skipped beats here and there, and when I tried coming off the flecainide it got really bad. I went back on it and was mostly ok again. So I'm still on the flec, don't think I've had any af, but do get some skips everyday, and sometimes some denser spells that eventually pass. Ironically I ride my bike much more than I used to as I started riding to work, which is 30km a day for me. This kind of scratches the cycling itch to a large extent and I'm not that bothered anymore about the long rides I used to do, tho I do often get out for 2 to 3 hours at the weekend. I've also quit booze completely and lost a few pounds. Overall, I feel great and consider my ablation a success, albeit qualified, as my quality of life has improved a lot and I really appreciate feeling my heart in sr rather than being all over the place. Will have to see how it goes with the meds, but for now I'm happy.
That's my story anyway, for what it's worth. Good luck with whatever pathway you choose!
Thanks for your reply. I think in your circumstances I would have done the same. As a matter of interest who was your Cardiologist at the QE? Only it's possible that it is the same EP specialist who I have been seeing (privately through work originally)!
I am under no illusions that ablation is a 'magic bullet' so coupled with the fact that my decision is not at all cut and dried this is on one side of the balance.
I certainly agree with you that feeling your heart in SR has to be better than being haywire!
I realise you have said you don’t want an ablation and so this may not be of interest to you but surgery could get you back in NSR with no drugs. Keen cyclist John Miosh it’s worth reading his posts. Still afib free after 5 years and doing what he loves, cycling.
Thanks. I will have a look at John's posts. I haven't actually decided whether to have an ablation or not at present and I am still weighing up the pros and cons. With my circumstances it is looking like an evenly balanced decision that I have to make! As I have mentioned in my replies to others, with my age and overall medical history I will unfortunately have to remain on a lot of medication, even if I did have a successful ablation!
Hi there, I just had a skim through, are you thinking you will still need to be on blood thinners as stroke risk is not reduced?
Surgical ablation is a different procedure (also known as mini maze) with a much higher success rate for long term persistent afib. At the same time the surgeon closes the left appendage (usually by a clamp) which stops the need for blood thinners.
If you want to know more about the mini maze vs what your cardiologist is currently suggesting (the mini maze procedure would be done by a cardio thoracic surgeon) please read my posts and Johns and I am happy to answer any questions 👍
Hi Caradoc, long time club cyclist (46 years and counting) I had undiagnosed paroxysmal AF for a couple of years, which I identified by old ride records. It became persistent in 2017, and I was treated initially with bisoprolol for rate control, which was more debilitating than the AF. I was waiting for an appointment to start fleconaide, when I was offered the chance of hybrid ablation. I took it immediately, and have had no AF since. I am now a little slower than I was, but this is actually by choice, as I decided not to push myself too hard. Read the haywire heart by John Mandrola
73 keen cyclist currently on holiday cycling in the Pyrenees. AF for 14 years. Controlled by medication and a cryoablation. They are suggesting that I need a tickle-up ablation. Also have LBBB controlled by a pacemaker that kicks in below 50bpm. I have found that an electric bike is extremely useful keeping my heart rate down, aim110bpm max.
Not a huge amount to add from the good replies above, but one thing stuck out is that you are worried about the effects of bisoprolol. There are regular discussions about side effects of this drug here and it’s very mixed - some people have problems, others don’t. But, I noticed that your dose is very low and some people are on 4 or 8 times higher doses per day.
Again, not a medical expert, but I would assume a higher dosage if you were having high rhythm issues. (Only because my dose has been gradually dropped as my rhythm issues reduce).
My advice from the sport front would be to consult a sports cardiologist. You can probably get a consultation for the fraction of the price of a decent road bike. I did the same and it put my mind at ease and enabled me to get back out on the roads running and cycling.
Thanks-yes I was aware that I am on the lowest dose of Bisoprolol-I started on 2.5mg but as my normal resting heart rate is already very low it was dropped to 1.25mg-perhaps it is not having a significant effect on my exercise I really can’t be sure, maybe the persistent AFib is very much the main factor…
Your suggestion about a Sports Cardiologist is a good one which I’ll look into.
You didn’t mention your own situation. Is your AF persistent as well?
Mine is persistent, I’m on 2.5mg of bisoprolol (amongst others) although my symptoms have reduced under medication and I’m quite lucky so far. Some days are very quiet but sometimes I have episodes where, rather than a racing heart, I get frequent, regular ectopics (sometimes 20+ per minute, which is not the most comfortable experience). If I have an episode like this I generally take it as a day off (or more depending on severity and how long it takes to clear). Generally, if I have infrequent/mild palpitations, exercise tends to help.
I’m trying to build back up my training/exercise at the moment with a view to getting back to a level of fitness that is closer to that I enjoyed pre-AF. I’m currently on a cycle of 2 days of exercise and one rest day and this seems to be working. It’s a balancing act because exercise, fatigue, dehydration etc. can kick off or make the AF worse, so
Running is the toughest (I find). It seems to cause more issues and gives me more palpitations, even on lower heart rates than cycling. At the moment I’m just run/walking in short bursts - but this could be to do with the heat (currently 35 degrees or more every day where I live). I can’t manage much running and usually can’t do anything the day after, but I am managing to slowly increase the short bursts of running.
I also find running harder going than cycling! So it’s jogging and walking (Jeffing) these days. As the Cardiologist has told me, from my stress test, my rate control is good and I don’t get many palpitations (when I do it’s mainly at rest) but I do have spells of feeling a bit lightheaded/muzzy - plus occasionally some intermittent chest discomfort that flits around (mostly at rest again) - not sure where that comes from as I’ve had my arteries checked after the heart attack (with 2 stents) or is it AF related… the Cardiologist doesn’t seem sure or particularly concerned though 😂
Were you not offered an ablation or did you decide against it… or did you have one or more without success?
No ablation, hasn’t been presented as an option just yet but was discussed as a possibility. Medication seems to keep things under control for now. I’m on a holter every month and down from thousands of ectopics per day to a few hundred, or less on the last one - obviously with the ‘my heart behaves it’s best when being monitored’ rule. I’m less than a year into the journey so we’ll see. I just moved and my new cardiologist seems to have different opinions to the last and he’s cut a lot of meds (I was on 6, so that’s a relief!)
I used to run when in my 20s-30s, doing 80m a week easily, which may be why I am now in permanent af. AF diagnosed about 13y ago. I'm on no meds at the moment (am 59, no Chads-vasc score) and have since February been parkrun-ing. I have asked 2 GPS, one in passing and one specifically about whether I should exercise with AF. It's fair to say neither was concerned ('as long as I felt well') but the first was so unconcerned it made me seek a specific appointment to see the latter.Can't help you with the ablation as my consultant said early on I could not be helped (as did the second opinion).
So at the mo' I do 5k runs about 3 times a week, plus I go to the gym with Mrs omniscient to do weight training as muscles tend to go off with age as you probably know.
I’d be happy with 32 minutes at present! - I tried a Jeffing 5k recently and it was about 36 mins ☹️ - mind you not having as much a running as cycling background a sub 20 minutes 5k run would never have happened 😂 - my Parkrun PB set when I was 58 (so 4 years ago now before the heart attack and persistent AF - although I was on Flecanide at the time) is 23:40. As I’ve mentioned in other replies I’m finding cycling relatively easier at present.
Hi I am 66 and still love to exercise particularly cycling. About 5 years ago I started falling off my bike apparently for no reason then I had several dramatic episodes of AF so I was prescribed drugs Bisoporal, Flecanaide , Apixaban etc but gradually the AF got worse and it was very symptomatic it turned out the falls were mini blackouts so I had to stop cycling. I was terrified of having an ablation but it wasn’t too bad and took the advice in the Recovery leaflet and took things slowly and I bought an electric bike. It has transformed cycling for me just having a back up when I get breathless and tired is marvellous and I have been able to rejoin my cycling group and enjoy rides of 50 to 60 miles and have just returned from a weeks cycling holiday in France. It depends on why you exercise if it always has to be a challenge then you may be disappointed if an ablation doesn’t return you to where you were pre AF but if you love being out on the road with friends for a sociable ride then being symptomless brings its own rewards.
Good luck with your decision but as Bob often reminds us ablation is really only to improve your quality of life.
Thanks for your reply and glad to hear you are back active and enjoying your cycling 😊 -cycling was actually my first passion and I originally started with the CTC as a 13 yo in the 70s - so although we did some harder long distance rides it was primarily a social touring group and it’s only relatively recently that I’ve got more competitive (within the limits of my age 😂) - so the bottom line is yes if I can still go at a modest pace and for a reasonable distance then that’ll be enough if it comes to it. So this is largely why, along with the my persistent AF symptoms not being too bad, having an ablation is not an easy decision for me. But the other key consideration is that having an irregular heart beat just doesn’t feel right and I’m not convinced being in persistent AF for potentially (hopefully!) many years is the right approach without giving ablation a chance.
I am also a cyclist and mainly a runner but at the moment have PAF but lately my spells in afib have been lasting over 8 days with some lasting 14 days. I will run and cycle when in afib but it makes a huge difference to my running. I can sometimes manage 5 to 7k but heart rate and effort are greatly increased. It doesn't affect my cycling so much as I'm not that good at it but sometimes after a long cycle ride I have gone back into sinus rythym but not always. Like yourself I would hate not to run and I have been encouraged by my cardiologist to carry on. At the moment I have a knee injury which is stopping me from running and i hate it but I can cycle so at least i can still get some exercise. Like yourself I have been told I can't use flecainide and at the moment they dont think i need ablation.
Thanks for your response-I must admit I am missing running, particularly fell running, which being fairly obviously particularly strenuous is just not an option at present. I did a hill walk today and climbed a mountain for the first time since my heart attack and going into persistent AF - and that was hard enough! 😂 - I also find cycling easier than running and have always done so 😊 - when my AF was paroxysmal it wasn’t really a problem as I had so few episodes, so I sympathise if you’re in and out regularly. At least with my ‘well controlled’ (as the Cardiologist calls it) persistent AF at present and relatively mild symptoms things are fairly stable, So do I want to gamble (if that’s not too strong a word) on an ablation hoping things will improve and that being back in sinus rhythm is better for me overall in the medium to (hopefully) long term (even if the Cardiologist says that’s not necessarily the case)? Not expecting an answer to that by the way it obviously has to come from me.
I’ve been lucky so far and not had to consider an ablation as a cardioversion and flecainide worked for me initially and I’m now also off the flecainide. I am a very keen cyclist, runner and triathlete but when I was in persistent AF I struggled to train to maximum intensity as the beta blocker I was on made me feel very anxious when exercising. After my cardioversion it took a few months to build up but I now exercise at maximum intensity to a even higher level than I did pre AF. I did have to stop taking the bisoprolol on the advice of my cardiologist as it made my sinus rhythm heart rate too slow even at minimum dose. I’m 57 this month and because I love exercise I would consider an ablation should I return to AF. I know it’s more complicated for you to make the decision given the risks but just wanted you to know it is possible to get back to a normal exercise routine. Good luck whatever you decide.
Thanks Daisy - glad to hear you’re doing OK - - I guess that’s the key point… will I regret not having an ablation and giving myself the chance of getting back nearer to where I was… question for myself 😀
HIunlike you I HAD AN embollic STROKE rather than heart attack.
But like you diagnosed with AF and rapid persistent H/R day 186 & 47 night on Metaprolol. Terrible sweating on any exertion, having to stop for the 02 to catch up and around my body. Fatigue on any outing.
1 yr 3 mths I demanded a specialist.
4 days into my hospital stay diagnosed with Papillary Thyroid Cancer. Removed 4 mths later with my triage of Drs arguing 'now' 'a.s.a.p' but one The Encrinologist (deals with hormones in body) wanted at least a 6-mth gap. 2 onto 1 the surgeon and anaesthetist won. And just got the cancer as out of 12 lymph nodes removed, 2 were already affected.
I was changed to Bisoprolol which the my Dr kept rising the dosage. Still the exertion and sweating continued. Due to high day H/R of 156. The breathlessness stopped immediately.
I wished to get back to walking, sports etc.
A locum Dr suggested a private cardiac specialist. He was interested in my history and said that I needed to be CONTROLLED.
the CCB Calcium Channel Blocker performed. On 180mg (1/2. dose) I dropped 105 H/Beats per minute within 2 hours.
With twinking I take 120mg Diltiazem am and 2.5 Bisoprolol pm (BB).
Apart from a marked improvement - no sweating, it was not until I had a TVT Kit (Johnson & Johnson ) Mesh removed in March that within weeks I experienced more energy and more exertion was noticeable. . The female recognised for her concern and work (renown for removal of this ghastly stuff, she said that the mesh was causing inflammation and damage.
I think that most of the group recognise that it is inflammation in the body that can cause AF
You say that you are breathlessness on Bisoprolol. Bisoprolol does not play on your lungs or breathing. Used for AF patients and those with troublesome asthma.
Looking further or is your trouble that exertion causes you to slow or stop to allow the 02 to circulate eveningly around your heart and body.
Hi Joy - first of all sorry to hear about all your troubles- in my case with my (apparently as I’ve been told) well controlled persistent AF I don’t actually get TOO out of breath, partly because I can’t exercise hard enough! (and I’m comparing things to a previous version of myself!). Not sure how much is down to the irregular heart rate itself and how much the Bisoprolol. Your point about getting the oxygen round the body is interesting but beyond my lay persons knowledge! Also I suspect I am my own worst enemy on the inflammation front due to the amount of sugar I’ve consumed over the years…
Hola! I'm a serious cyclist and sometimes racer. I'll. Be brief. AF is awful to ride with. No power. Drugs work (Flec for me) but degrade performance. Beta blockers even worse. Ablation is a great alternative. There is nothing like riding in sinus rhythm. Risks are pretty small. But personal decision. Only question - if you have to continue on beta blockers permanently than it's not such a plus. But I don't know why you would do that. Good luck and ride on!
Thanks for that - and all good points- indeed it (would I still need to take a beta blocker after a successful ablation) is a key question I will be asking at my next Cardiologist appointment!
I'm 78 and still training racing post major stroke. 3 years ago. Was on Bisoprolol at first but did not like it so the EP suggested I came off it and only take the Apixaban and that has worked OK for me together with dietary changes.
I rarely get any SVT events now. You have to experiment with what works for you though as everybody is different. My original SVT heart rate went to 240bpm. Nowadays it is normally a max of 154 bpm on a steep hill climb. I don't worry as long as it's below 200 bpm. Stay unstressed and have a regular bed time (most important). I put out about an average of 180 watts for 1.5 hours three times a week as that seems to work best for me in terms of maintaining and increasing performance.
Cheers Roy - sounds like you’re doing OK and you’re absolutely right that trying not to stress too much is so important-and on so many levels. Pretty sure I couldn’t manage a 180 W 1hr FTP equivalent at present, let alone 180W for an hour and a half. Although in my defence I’ve always been a bit of a lightweight likes climbing sort of cyclist 😀
I can't help you with this although I am a cyclist/runner who has had Afib. I've had three unsuccessful ablations since May 2020 and am now trying amiadarone. All I wanted to add was that the science of Exercise = Afib is very unproven. MY EP says its mainly the eyeballs out, seven hours per day, Tour de France type trainers who get it. I actually did a study into this which I published on my blog. I can share the link if you are interested. Wishing you all the best and never give up xx
Thanks-first of all sorry to hear your ablations weren’t successful-yes that link would be of interest-and I’d heard similar. Although I’ve pushed myself over the years it’s rarely been ‘eyeballs out’ stuff -more like steady long distance
I would consider your hearts ejection fraction as well, a measure of how much blood your heart is pumping. I ,while in afib showed my heart pumping blood down 20%. Like you I exercise daily. Just having less blood flow is obviously aging and detrimental. My two cents, get the PF ablation, much safer, quicker and better outcomes. Your ejection fraction/blood flow will go back up.
They have to do an echo cardiogram. I want the most out my body, I am 67 and dont usually accept a doctors opinion what is normal as the general population is generally unhealthy. When i learned my ejection fraction was 52 and did some research it convinced me to get an ablation. Also i suggest to look into the PF ablation. Its new and the data shows its safer and more effective. Lastly IMO all these drugs have long term side effects in addition to we recognize when we take it daily. Some of them we dont know about due the lack of funds to test further. I would not settle for popping pills so an ablation was the only game in town for me.
Many thanks FindingCaradoc and all the excellent replies. I’m very interested to read all of this; my situation has many parallels, and, of course, differences too.I’m a keen distance cyclist, I took it up 12 years ago. I’ve just turned 60. Always been slim and fit, done plenty of rides in the 150-300km range, but only socially.
I had occasional irregular heart rate from about 4 years ago and just over 2 years ago, when AF events were more frequent, I got a formal diagnosis and had a discussion with an experienced Oxford cardiologist. He emphasised that for me, there were two issues: risk to health and quality of life. The first will be addressed with blood thinners when I turn 65 and my CHAD score goes above 0. ( The age of 65 is obviously arbitrary, I do wonder whether it might be wise to start earlier? My wife is a German doctor, I think that over there they may trigger earlier). The second, QOL, issue was ok 2 years ago: I almost never had AF when excercising, more likely when recovering from a ride or when relaxed in the evening, or overnight.
Today this is different although I probably don’t get more episodes, I think they last longer (often 12 hrs, one just started as I type! I get 2-3 a week) and, importantly they sometimes occur when exercising. Sometimes I can be in AF and then get on the bike and it goes, but sometimes it doesn’t or AF starts part way through.
Perhaps like others here, my AF manifests as an irregular rate (of course) and a higher rate. I think it adds about 35-40bpm, so where resting is say 55 in SR it would be 80 in AF. Brisk walking would be 90 in SR and 130 in AF. Hill climbing steadily on a bike would be maybe 130 SR and 170 AF.
Of course, any tougher exertion would be doable at, a manageable 155 in SR but unachievable in AF. On a Wattbike I can average 260W for 6 mins in SR but only about 180 in AF. This means that in AF I can cycle with my wife or my fatter friends, but it’s certainly not as enjoyable. If I’m out on the bike and in AF, and then it goes and I’m back in SR, if feel like superman!
I’ve never taken any medication but am now considering an ablation. I too, worry about the small risks, because, to be honest, life is pretty good. I read of a few serious risks (dying, heart failure, etc.) and they may each only be less than 1% but could add up to 2-3% risk. Do I want to roll the dice on a disastrous outcome on a 1 in 40 risk?
I wonder whether such stats are skewed by a section of the population with other complications that as an otherwise fit person I don’t have? Or do those stats apply to my profile too?
I’m going to discuss to possibility of an ablation with a private and an NHS cardiologist later in the year I think. Above input has given me food for thought. Any comments or answers to my queries above most welcome (but I don’t want to hijack the thread!
Thanks - no that’s fine - and you make some good points - as you say there are similarities as well as differences with my situation- but the key question to yourself (which is what I’m asking myself!) is if things aren’t too bad and manageable is it worth (as you put it) a roll of the dice (better odds mind you) for a not certain better outcome… ?
For me what would definitely tip me into having an ablation is if evidence develops that as well as potentially improving symptoms (and heart performance) it also reduces my overall stroke risk and prolongs life…apparently that’s still not the case in terms of the balance of available evidence - I also understand being in persistent AF long term can lead to heart failure, but my Cardiologist tells me that shouldn’t be the case with my ‘well controlled’ persistent AF.
Your point about personal as opposed to general risk is worth checking out and I will be asking about that at my next Cardiologist appointment.
Regarding blood thinners my CHADS score is now 2 I understand (due to hypertension and the recent heart attack) so even though I’m less than the arbitrary 65 it’s anti coagulation for life for me unfortunately, bleeding risk and all in the round. Not happy obviously and I shan’t be doing faster group rides anymore (even if my fitness allowed) or any technical off road riding as I obviously want to reduce the risk of falling off and hitting my head.
Overall though, and as one of the replies previously, I’m trying to keep some perspective and not stress too much 😀.
One of my best friends is a retired cardiologist who has paroxysmal AF. He’s on Amiodarone to stay in SR. As I have the same, (but only on Bisoprolol in my case) we discuss our mutual ‘friend’ from time to time. He would never ‘consider an evasive and risky procedure such as ablation with such a doubtful success rate’. (His words). Neither would I, because my HR is well controlled when in AF and, apart from a lower exercise threshold, I do not experience any other negative effects. If my quality of life would deteriorate for some reason, I might consider PFA, it even then I would take the risks involved into account. All the best, and keep up the good work!
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