Cardio training with Afib

[Winnipegsculler]

I was diagnosed by a cardiologist with lone paroxysmal atrial fibrillation three years ago.  My condition stabilized after being prescribed Flecainide, Apixaban and Rosuvastatin (the latter as a preventative to lower cholesterol).  For the past two years I have been able to resume training in my single scull and on a rowing machine, as well as cycling, wilderness canoeing, hiking and inline skating.  It seems the Flecainide has made it nearly impossible to push my heart rate above 80% of my age-adjusted max.  This is fine for training, but will not allow me to push hard enough to compete in my single scull.  I have come to terms with this and feel thankful that I can push myself moderately hard without going into fibrillation.  There is quite good information about people such as myself who have been diagnosed with “athlete’s heart”.  However, I have been unable to find any useful information on appropriate methods of cardiovascular training (e.g., short intense intervals vs. long low-intensity workouts) for people with athlete’s heart.  Any help would be much appreciated!

[Hidden]

I guess you probably already know that “extreme” exercise and AF are not good bed fellows😱

Can I suggest you do some research on Dr John M Mandrola who is an American Cardiologist/EP who is or was, a professional racing cyclist/athlete and who suffers from AF. He has written a number of books, the most commonly known being The Haywire Heart plus others available from Amazon…….

[Winnipegsculler in reply to Hidden]

Dear FlapJack - thanks for being the first to reply to my first post on this website. I already have the sense that this is a caring and well-informed community, which is a great help since I have found it is easy to sometimes feel a bit depressed and alone. So, again, thanks to you and everyone else who has commented on my post. A few months into my diagnosis I discovered The Haywire Heart and consider it essential reading for people like us with this condition. I've purchased several paperback copies that I've given away to friends and keep my own handy on my Kindle. The balance of research and technical information with case studies in the book provides a very accessible and balanced way of thinking about and living with "athlete's heart". There is other quite good information available on PubMed, but it's written largely for cardiologists and electrophysiologists. Mandrola's book is the best readable and detailed guide that I've come across. Most helpful to me are chapters 4 (where he explanation how atrial remodeling occurs as a result of and chronic stretching/fibrosis in around where the four pulmonary veins enter the left atrium), chapter 8 (where he discusses the benefits and risks of antiarrhythmic drugs vs. ablation), and chapter 9 (where he discusses heart rate monitors and supplements and presents the case study of Jason Agosta). In the next edition of the book I hope the story of Kiwi sculler and Olympic gold medalist Rob Waddell, who lives with Afib.

[mjames1]

So I'm assuming you're only on Flecainide and not on a beta blocker or calcium channel blocker like bisoprolol or diltiazem? I always thought it was the diliazem that depressed my exercise heart rate, but maybe the flec as well, esp if you are on a higher dose.

So how much flecainide are you taking? I was able to titrate down to 25mg, twice a day, and maintain NSR for the most part. So, that's one thought, lowering your flec dose. Another is getting an ablation so hopefully you will be off the flecainide altogether. But as FlapJack said, too much exercise can be counter productive for those of us with afib. Both pre-ablation and post ablation. So maybe recreational skull makes more sense than race training, if you prioritize staying out of afib.

As to athlete's heart, my understanding is that it's nothing to be concerned about or requires any different type of training.

But back to your lower exercise heart rate. One thought is checking out the MAF training method, developed by Phil Maffetone. It actually encourages training at lower heart rate levels.

Jim

[Winnipegsculler in reply to mjames1]

Dear Jim - based on your recommendation I have just purchased two of Phil Maffetone's books and will give you my impressions in a few days. This is the first time someone (you) provided me with a concrete approach to aerobic training that might not provoke (and may even improve my tolerance to) Afib. I must admit that when I was training hardest (age 18-30 in the 1970s and early 80s) the "no pain no gain" ethos was prominent, played into overtraining, and probably contributed to developing Afib nearly four decades later. I am hopeful MAF training will be a helpful antidote. It is useful to reflect that since being diagnosed with Afib, I have focused on long steady-state low-intensity workouts and avoided high intensity intervals. As for flecainide doses, I currently take 100 milligrams twice daily. Other than my heart rate maxing out at 130 I don't notice any side effects, though I have read that prolonged use of flecainide can lead to pro-arrhythmia (specifically, atrial flutter). Going back to training in my single and on a rowing machine. Things are not perceptibly different now than before - at least up to 120 bpm. It seems that my effort increases exponentially when I move up each increment from 120 to 130. And virtually no amount of effort can budge my maximum rate much further. So I guess 130, rather than 150 is my new age-adjusted max, and we can assume that flecainide may be responsible for that. That being said, since I have no intention to participate in masters races there is no reason to get my heart rate above 120, which is 80% of my age-adjusted max. As an aside, I participated in a 44 km rowing marathon in my single last October with no ill-effects. My strategy was to treat the event as a long steady-state training row and to hold my heart rate at my sweet spot 120 bpm through the four hours it took me to complete the distance. I thoroughly enjoyed myself and didn't experience excessive fatigue leading to an Afib episode. That being said, it was difficult to avoid the temptation to push harder when a sculler pulled alongside or passed me. Bad habits are hard to give up. Your experience on putting such old habits to rest and working would be much appreciated. In some ways Nesko's comment (below) is helpful.

[mjames1 in reply to Winnipegsculler]

In my case, I work out closer to 70% of age related maximum and above that feels uncomfortable, however in addition to flecainide, I'm also on the calcium channel blocker, diltiazem, which also depresses my heart rate.

As to putting bad habits to rest, my experience is that if you don't put your bad habits to rest, your bad habits will eventually make you slow down. That's what has happened to me. So, you can either get ahead of the curve and slow down a bit yourself, or wait for your body put on the brakes for you. Or, if racing is just too important, go for it but understand and accept the risks.

Let us know what you think of the Maffetone method. My understanding is that you will also be working closer to 70% of your maximum,

Jim

[Hidden]

Jesus, you are 68 and you still want to compete ! Your heart has made several billions of contractions until now, so it is kinda "normal" that it is close to it's end. Preserve the remaining capacity to last longer, to enjoy the time with your loved ones, and leave the competitions to younger ones. If the heart is already sending to you signals that it has problems, then listen to it... BTW, nearly all of us here have "athlete's heart", meaning that we have not known how to use it wisely... Here is nothing but runners, cyclists, weight lifters, rowers...

[secondtry in reply to Hidden]

Yep totally agree.

[Jajarunner]

Studies on the internet tend to contradict each other, some blame high volume and say stick to intense stuff and others the opposite. Likewise the argument over whether exercise causes afib at all given that most athletes do not get afib. Sorry this is not more help.x

[BobD Volunteer in reply to Jajarunner]

The number of athletes who develop AF is disproportionate to those in the general population. This is well documented. Another similarly affected group is fast jet pilots. Both cases due to over working their hearts.

[Winnipegsculler in reply to Jajarunner]

Purely at an anecdotal level - I am comfortable training for 1-2 hours at 70-80% of my age-adjusted max heart rate. And I'm also OK doing 20 reps of one-minute intervals at 90% of my max with a minute's rest between each interval, though I have to admit I am less comfortable doing intervals than doing steady state. In both cases my heart rate doesn't peak much above my sweet spot of 120-125 bpm. But I am pretty sure that it pushing hard at an even pace over 1,000 meters (typical masters sculling/rowing race distance) would prolong the length of time beyond that "sweet spot" in the last half of the race and possibly lead to an Afib episode, in the way that a stress test on a treadmill is designed to do. Regarding why some athletes get Afib and others don't - there is surely a genetic component (inelastic pulmonary veins, high blood pressure, excessive anxiety in a racing situation) that is undoubtedly also influenced by such things as diet and training regimen. It would be great for the upcoming generations of young athletes to have an idea at least about what training methods can lead to optimal performance without compromising heart health. Maybe this is not possible, but it would be good to undertake the long-term research to find out. And it wouldn't be that hard for national sporting bodies to get certified coaches to begin tracking heart health, training philosophy/methods and eventually the incidence of Afib and other arrhythmias in later life. Some screening is going on in rowing, but only to identify young athletes before elite competitions who are at risk of sudden cardiac death. I think the problem is one of short-sightedness of sporting bodies and the reluctance of coaches to have a talk to young athletes about the long-term danger of engaging in high intensity training. The optics is perceived to be a bad-news message that will be a disincentive to young amateur athletes wishing participate in high-performance sport and represent their countries internationally.

[Jajarunner]

hhtafibathlete.blogspot.com...

Here's some research I did into afib and exercise, by the way. You might find it interesting. Xx

[Winnipegsculler in reply to Jajarunner]

Jaja - that's a massive amount of combing through the internet, reading, and digesting the essence of each of the articles you found. I read through your results, though plan to do so again more thoroughly. My preliminary takeway is that the link between Afib and lifetime endurance training is less robust than is commonly thought, and that there is a risk of self-referential circular referencing in metastudies. In a way, the process is not that different from how disinformation works (though I'm not suggesting the studies are disinformation - just that there is a kind of tautological logic that can be at play). Anyway, you've provided me with much food for thought. Thank you!

[Jajarunner]

I love that expression "self-referential circular referencing". Did you see that I added the latest meta-analysis yesterday - it's right at the end if I recall correctly.

Glad it helped. I did it because I got so upset that someone on here told me I had caused my own Afib - and research shows NO evidence for that for females. I should have listened to my EP who said all along that it was not leisure activity that shows a link but hard-core Tour de France type hours and hours of highly intense exercise over years and years. Definitely not me - my real pen name should be Jaja-veryslowjogger! And getting slower!!!