Previously, no issues with my heart and previously pasted all tests; no artery disease or stenosis.
Out of nowhere, I had my first AFIB episode in December of last year. Restored to NSR in 30 minutes with medication. I have had 2 more, once during a stress test, which after first time with AFIB, I was stressed about doing the test.
Recent CT coronary arteries test showed: Marked left atrial dilation.
I asked the EP if the dilation caused AFIB and she said AFIB caused the dilation.
Huh?
I've only had 3 episodes? Doctor replied: it must be a result of "silent afib." I wear an apple watch and keep track of my heart rate, especially during cardio. Never saw evidence of afib.
I did see a few random times over the last year or so where my heart rate shot up to 175 or 180, but then dropped right back to normal for me. This wasn't during exercise that I can tell. Was that "silent afib"?
So what comes first? AFIB and then atrial dilation or dilation then AFIB?
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Elizka
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I guess I was just surprised that you managed all that in half an hour! However, I suppose you mean that once you'd got to the ER they gave you the medication which stopped it quickly. Fortunately, I think, I never got as far as being given Flecainide.
Yes. Good point. First time: I had it at home for about 45 minutes. I tried to relax and took a Xanax and one of my husband's metoprolol. Didn't work. We live 5 minutes from ER and once they administrated the Flecainide it went into NSR in 30 minutes.
Welcome to the forum Elizka, you'll find us a friendly bunch of people, willing to help when we can.
AF comes first and then heart dilation, but medication can reduce that dilation and make your heart it's normal size again. Think of a part of your body being overworked like one of your arms, that arm muscle would grow bigger - the enlargement of your heart is just like that.
I think I too had silent AF for many years before getting diagnosed. My heart would bang in my chest when I walked up hills, but I thought everyone's did that. That symptom was cured by my first ablation.
I'm both grateful for this forum but honestly not happy I'm a member 😀
My husband had afib, which was the least of his heart issues. His afib was "cured" with a Maze procedure during surgery for a huge aneurysm. AFIB saved his life because the aneurysm had no symptoms and is not something you are routinely checked for.
I appreciate your insights: It is good to hear that medication can return the heart to normal size again. My apple watch didn't pick up the silent AFIB, but I remember some racing heart episodes lasting only a few seconds. (I've had a lot of anxiety since my husband's surgery in November of last year--actually, since he was hospitalized in March of last year, and we spent months getting final answers on the best way forward for his heart. )
I'm on 100mg of Flecainide and scheduled for an ablation in April. I've been told that since I have had few episodes the ablation has a high success rate. I'm still not 100% sold on the ablation (I feel fine now, have no episodes, etc.), but I want to get off the medication at some point and get back on my Peloton bike and be able to let my heart rate get past 110.
You've had three ablations? the first sounded successful?
My hesitation on the ablation is that I'm healthy, fit and pride myself on lifestyle choices that keep me that way. A heart procedure? Yikes.
I have started to think of the ablation as an intervention and some protection from developing permanent AFIB.
Hello ! I am also a fan of steady state rowing and would like to get my HR a bit high.
I surmise that your husband had a full maze during his surgery. I had a (keyhole thoracoscopic) mini-maze three months ago, which I fretted about, like yourself, but it was easy for me and a month after the operation I walked about 10kms with no issues.
Hello and welcome even though you'd rather not be here. Your main question has already been answered. Months of stress will have likely triggered the AF and alas it can be hidden as we 'manage' it, putting it down to tireness, stress etc and if the feeling is fleeting, we'll often leave it. I don't know about reliability of apple watches. Like many here I use a Kardiamobile. Having a healthy lifestyle is an excellent start and ablation may be a good option for you.
Be nice to yourself- having AF is not a weakness - it can happen to anyone due to a combination of circumstances. Take some time getting to know about it and how it feels for you. Then you'll be in a good position to make a decision about your best options.
Peleton bike eh? One of the categories of people who are most prone to afib is extreme exercisers - cyclist and runners -as stressing the heart for long periods is actually not as good for it as moderate exercise- though having been a Bharatanatyam dancer I can attest that the cardio workout of rehearsing and performing gave a much better high than walking does! You might find that if you try to go back to what you were doing before you will undo the benefits of ablation and the afib will return.
Just this morning my granddaughter who is 40 has posted some tracker information. I think she is in training for the London Marathon.
Workout time 2:0:34 Distance 14.21 KM
Average Pace 8'29"/KM Average Heart Rate 145 BPM
I hope she hasn't got a tendency to get AF. However, I suppose it isn't doing too much harm as for quite a while my heart was beating at an average 145 for 24 hours or more.
Actually, I think it is the continual pushing of the heart to go faster than it wants to is what causes AF.
Yes I've had three ablations. The last one about 6 years ago I still have AF (permanent now) but the rate is never high and usually between 60 and 90bpm. I can live a fairly normal life these days.
Ablations can be an instant cure for some, but not others. My first two ablations made my AF attacks worse. Third one helped. I think my attacks were extreme and I was often admitted to a hospital ward. Good luck with your ablation.
No. I get out of breath if it's a longish and steep climb but just 'normal' high heart rate that behaves properly and slows down if I stop for a breather. Thank you for checking. I used to get horrible leg ache too.
hi Jean I remember when I had my stress echo back in August the Cardio said all well with heart function except some mild dilation. You mentioned some medication that can help get it back to normal. Do you know what that medication is?
I'm taking Bisoprolol now and feel a lot more energetic than when I was taking Metoprolol and Flecainide. Looking at my ECG my cardiologist said Flec was probably doing more harm than good to my heart rate.
Thanks Jean, yes I went off Flec as it may have brought on the Atrial Flutter mid December, had a CV 2 days after and since on low dose of Metopropol 12mg twice a day, for a few more months then wait to see next consult whether we drop that too. I guess the Bisop is similar to Metopropol?
I used to take 12.5mg of Metoprolol, alongside the 100mg Flec and both twice daily. Now I feel more alive on 2.5mg x 2 of Bisoprolol. I started taking it in hospital last October, was on 7.5mg when my heart took off racing because I had Covid and pneumonia.
Now I get these periods of feeling really well and then they suddenly disappear. I forgot to take my morning Bisoprolol twice this week and my heart took off in AF - first time for ages - wont do that again! It wore me out for a day or so and reminded me how awful AF can make you feel.
I could never understand why, as a quite fit person my heart would bang away when I hiked up fells and mountains. Haha, well I never! Didn't realise it was to do with AFib.
Yep, let me tell you that other people's hearts don't bang in the chest like that. Nor does mine now. Poor heart must have been in dreadful stress. If you still get it now and can, then see what your rate is at that time.
I honestly didn't connect AFib with that. I'm not able at the moment to go hiking up hills as a separate health issue - spinal stenosis, has now afflicted me. I used to say to my partner 'doesn't your heart feel like it's banging right out of your chest right now?' when we were half way up a hill and always thought I must just be unfit as he was absolutely fine.
Hmm, don't know about that. I can only guess. When my heart would kick off in AF my heart rate could go up to 200bpm and continue like that for hours. My GP described it as working out at my most extreme for hours on end and that's why an attack would wear me out for days afterwards. Now it's not normal for any athlete to exercise or compete for hours at their topmost rate. Saying that we get lots of people on this forum who have pushed their bodies to the extreme and ended up with AF. My personal belief is exercise is good, but we should not stress our hearts to the extreme for hours on end. Just my opinion.
I am 81, wear an Apple Watch that automatically monitors my HR. I have decided to stop and breathe deeply when exercising (or anytime) my HR goes above 10. I understand that to be working my heart at 50%. I think I am noticing I can exercise (mostly yoga) longer before reaching 100 as I continue. Thank you. Very much appreciate your answer.
If you are an elite athelete a larger heart means better performance.
The problem comes as you age and you continue to push hard as your body loses elasticity and muscle, especially heart muscle can become thick and fibrous and can stay enlarged.
If the HR is uncontrolled (high) for an extended period, not hours or days but more like weeks or months, then remodeling of the left atrium can take place. If it's extensive then the left ventricle can experience cardiomyopathy to compensate. There have been many animal studies done and human evidence as well that if the rate gets controlled (under 100 bpm) and/or NSR, then these effects can be reversed to a degree!
Picking up on BobD's comments, I agree. When diagnosed in Jan 2010 I was put on Bisoprolol for HR control. Back in those dark days I was prescribed 5 mg of Bisoprolol ..... for ever ! Continuously !
Hey, magic stuff that's just what it did and has done ever since.
Prior to my diagnosis my HR was always and continuously at the 88 to 95 bpm mark... always, day in day out. At diagnosis when admitted to A & E it was clocked at 156. Once I settled into my new life with Bisoprolol it settled to around 64 to 67 bpm. If I showed you that data produced by my tracker you would be bored with the results 60 to 67 bpm. TBF though there are times during the day my daytime HR drops to around 55 and at night when asleep as low as 46. All totally random and unpredictable.
My diagnosis also included the remark that there are times when I can be asymptomatic. That is, in an AF event, but experiencing no symptoms. In this regard my tracker is of no use. The only device that will pick up the naughty little demon even in asymptomatic mode is my Kardia 6L. But then hey ho unless I use it randomly to take a recording of my heart ( and it shows AF) I'm not likely to feel unwell or even be aware I have AF kicking off.
In addition, I eventually found food and food ingredients triggered the AF, so I used the dual mechanism of drugs and diet to attack the beast. These days, 13 years down the track as far as I can tell I only get an AF hit once or twice a year. the dual attack has ensured that my HR stays low and my BP also stays low ( fer an old bloke) generally speaking I'm around 131/70 ish and a HR around 66 - sorted.
Of course there is plenty of anecdotal evidence to show that sporty types, runners, joggers and cyclists - unless they cease their interests are likely to suffer AF well into the future and again its known that those at National or Olympic levels can die from an AF event. Certainly documented in Britain and Australia.
I rejected an ablation right at the beginning when it was discussed with me as a way forward. Incidently, the mind set back in 2010 generally was feed the patient Bisoprolol daily for life. Today the mindset seems to use the pill in the pocket approach of whatever drug is fancied by the healthcare bod ... take it, don't take it, take it, don't take etc and so on. Flec seems to be one such drug used in this way ( there maybe others) .......... so to my way of think its like not holding the heart to a steady constant regular beat ... it is being jerked on and off on and off - no wonder many Flec users get lured into the ablation mind set - because the on/off approach doesn't work long term.
If a persons normal natural healthy heart beats at a regular beat, why treat it with medication that does differently.
carneuny,Bisoprolol and Flecanaide snd Amioderone made me unwell. Two ablations failed. I now take Digoxin twice a day and Propanalol as a pip. We all react differently to medications.
Yeah, I get that but it seems to me, just reading all the posts over a long period of time is the the healthcare professionals seem not to be trying for a stable heart beat by virtue of going for a PiP programme.
Not sure how I can express it .......... but they either seem to wait for an event in a patient then PiP it and hope it settles, or as in my case they adopt a more long term practice of slowing the heart so that maintains a nice steady constant rythmn and beat ( which it was originally designed to do) over the long term.
The first step seems to be a way of preparing a patient for ablation which may or may not be a success, short or long term.
Carneuny are you still on 5 mg of Bisoprolol I was given the same 6 years ago but dropped dose to 1.25 because of a low heart rate but it seems to be up to around 85 BPM at moment also I am on digoxin
Yes, still at 5mg. My GP increased the dose to 7.5mg in ( I think from memory) February 2021 ...... as a blood pressure control mechanism. For most of the first 12 months after that it seemed great, then suddenly I began to feel like the Zombie from the Land of the Living Dead. Rang my GP for an appointment but nobody rang back, so following the normal protocols with this drug I cut myself back to 5 mg and told her after I did it. She wasn't a happy bunny and we have a strained relationship ever since.
Back on 5mg and am great. Incidently going up to 7.5mg did nothing for my Blood Pressure control. I have been on direct BP control meds for years and still am ... Ramipril 10 mg, Felodopine 2.5mg I'm now 78 and average BP is around 131/76 with HR of around 64. That's good enough for me and good enough for my employers company doctor and good enough for DVLA. I still drive buses usually double deckers, 30 hrs a week on a College contract. Weekends and all College vacations off.
thanks John good information I am talking to my doctor regarding medication as I to reduced my Bisoprolol dose to 1.25 on my own account my blood pressure is about same 138/86 but heart rate is higher but await discussion with doctor two week wait for appointment on telephone…Bill
Thanks Bill, I do wish you well and I hope your chat with your doctor later on gives you some happy results. The service these days is such that one just has to listen to ones own body and make ones own decisions.
Oh wow Bill ! that sounds like an amazing bike ... amazing, bet you trip into AF as easy as anything when you open her up on the highway (just jokin' 😂😂). Totally awesome !
My neighbour is 70, doesn't drive a car at all, never has but he has this awesome motor bike .... when I see him out and about he looks like a 70 plus year old 'Bikie' all dressed up in his leathers. Looks like a right member of the local aged Bikie Gang
Yes, do let us know the outcome of your call, that'll be interesting.
well I see it this way, if a person has a predisposition to cardiac issues, which maybe possibly identified through family/genetic traits, and in particular AF it would seem unwise to tempt fate. What I quoted is true, so if one pursues extreme sports/ athletics and you have a predisposition AND you can be asymptomatic too then you are really pushing lady luck. Anecdotally, AF has been identified with Fighter pilots.
Certainly in my family strokes (paternal side) and AF have been identified with family members for a couple of generations, including my daughter who was diagnosed with AF with each of her pregnancies. Stopped breeding, AF ceased (well for now anyway).
I do not pursue any of these so called healthy activities, never have been a fitness fanatic at all and I am confident enough to say I have AF tamed and kicked into touch and am sooo glad I have no interest in this sort of stuff.
Look if you have a car that has an engine that constantly gives trouble, are you really gonna take it for a round Britain drive and push it to its limits. Same with a heart ! If you have a dodgy heart are you gonna really seriously cycle or run as a fitness freak does. And that in no way considers the state of ankles, knees and hips in later life. An orthopaedic surgeons delight. An EP's delight. So, back to what I said, AF has killed some sporty types/athletes on some occasions during a marathon event. Who knows, perhaps they had AF and were asymptomatic and tried running/cycling their marathon when in AF but they had no symptoms ! Goodnight Vienna !
I'm not doctor and don't know everyone's personal medical history here, but outside of AFIB and assuming you can keep AFIB away, keeping your heart strong is important. Cardio fitness is important for those of us who can safely do it. Not at an insane level, but a reasonable level.
I had intermittent Afib for years and only went in for an ablation when it became persistent to the point that I was nearly fainting just getting up to walk to the bathroom. So here's what I understand about Afib - it tends not to go away on its own. It tends to get worse. If an ablation will fix your intermittent Afib, then you might consider doing it sooner rather than later.
While each of us is different and there are many forms of electrical issues with hearts, for many of us, ablation fixes a misfiring heart. Plus throw in the fact that you already have an enlarged heart due to this disease, it sounds like an ablation will definitely help!
For me, I was a classically trained ballerina so I truly appreciate being in top shape - Afib has taken that away from me. Now, after my second ablation 10 days ago, (the first did not get all of it), I am looking forward to getting back to some basic hiking!
Good luck and please let us know how your procedure goes.
Thank you! Your reply made me feel better. My first cardio doctor said the success rate could be as high as 80- 90% for me, but who knows. I agree that I want to fix the misfire and protect my heart from other issues. There is also new research that showed ablation earlier in the afib progression had better outcomes than mediation alone.
How did your ablation go? Did you have the CYRO ablation?
This second one went much, much better than the first. I was worried I'd have to add a second "death day" to my calendar
And here's the thing - they were not able to fix all of it the first go-round. That procedure was six hours under. And they found I had sick sinus syndrome - thus the need for a pacemaker.
This second ablation was well under three hours and so far all the signs point to it having worked. I am still in and out of afib but that's to be expected while the heart heals. I am going out of Afib much more frequently and my heart rate is usually well under 100bpm. Previously, I was usually at 120-130bpm.
I wish I'd been brave enough to do the second one much sooner after the first but water/bridge. Just know that you may need a second to get "all the little misfiring buggers". It's very common, especially if you've had it going on for a while.
And yes, the clinical reports are trending towards doing ablations sooner rather than waiting for it to become persistent. Like with any part of the body that gets out of wack, the heart remembers and tends to want to go back to its previous state - so the sooner fixed, the less chance of reverting back to Afib. I mean, don't quote me, this is just what I've read and I am not a cardiologist!
My first was RF - radio frequency and I'm not sure but suspect my second was as well since heat was a bit of an issue in one of the three areas they worked on.
Hello LPE44, I just had to respond to you having trained as a professional ballet dancer - I did too, and although I am now 71, I have never before ‘incidentally’ come across another ballerina ! I wonder if all that training stored up the trouble for us, with it being an acknowledged fact that extremely fit people are more prone to Afib ? Like you, I have had to accept that all that aerobic fitness has been left in the past - and I am really cross about it ! I always strode up hills briskly, chatting happily whilst companions were rather more breathless. Marching along pushing grandchildren’s buggies up and down sloping streets without needing to adapt my pace…. All of which went out of the window when I was hit by Afib when I was 66. In my thirties, I happened to call into a mobile heart station which was there to encourage people to get their hearts checked. I was told my heart was in incredibly good condition and they insisted I must have been doing regular intense sport - which I wasn’t at all - just bringing up two small children….. but that keeps you fit 😂. I haven’t been offered an ablation yet but my episodes have become almost daily now, though not very debilitating as the high dose of Bisoprolol keeps the rate down. It seems, from reading this forum, that the medics don’t want to jump in too soon with the ablations, especially if drugs do the job, but neither do they want to leave it too late because there is less chance of success - perhaps the people who have recovered really well from their ablation have had it done at exactly the perfect time ! I hope you recover quickly and are able to get back to some grand jetes and pas de chats !
I have familial AF - I probably had it for a number of years until it was diagnosed , as all of my sisters have it. Totally asymptomatic. Mine was discovered after I was prescribed an anti-biotic for an infected wound I sustained after a confrontation with an Aloe plant in my garden. The anti-biotic caused copious vomiting until I was vomiting flecks of blood,. I Immediately phoned the doctor, went to the surgery, had an ECG and AF was revealed. I was then packed off to a Cardio (the GP would not allow me to drive -h ad to locate my son on a Friday afternoon) by the time I got to him I was was in NSR. I was kept in the Cardio ward for the weekend, and discharged with usual Biso and anti coag. This was 5 years ago. Two years ago it was noted that the right side of my heart was slightly enlarged, but the Specialist attributed this to my mild Asthma and slight COPD , not to AF. The left side is perfectly normal.
My vote is to see if you can postpone the ablation for a year. In the meantime double down on lifestyle choices eg breathing only through the nose for Nitric Oxide and here comes the difficult bit substitute the Peloton for only two brisk walks per day. Keep a diary. Remove stress in every possible area. Having an ablation doesn't mean all drugs will be stopped automatically.
Flecainide 200mgs stopped my Lone PAF 9+ years ago and ever since I have been working on Lifestyle changes and still am. Never be complacent and believe the changes without side effects you make will help on many other fronts.
I doubled down on mediation, yoga, and updated my supplementation to include more magnesium. And continue to find ways to lower stress such as a vegus nerve reset, turning off all devices at 9pm, letting things go more, and more long walks etc. I do feel less stress about the afib and don't check my heart rate constantly as I was doing.
I was diagnosed with AFib April 2021 although looking back I suspect I had it for many years putting it down to palpitations. I was a runner 5-10k 3 times a week after work and much longer at weekends. I had an ablation in October 2021 and the AFib has been kept at bay with no medication (fingers crossed it lasts) I haven’t returned to running although I miss it so much but instead I brisk walk the distances instead. A lot of the data I have read has shown that returning to high cardio exercise can bring the AFib back and that, I definitely don’t want,as I have a young family and need to be fit and well to look after them 😁
go for the ablation if assessed as suitable but take a creative view of the future exercise plans - take cardiologist advice - a peloton May not be the wisest.
Thank you. I have good doctors and I trust them both and they advise it. even the senior cardio doctor advised doing the ablation. Prior to AFIB I only did 2x Peleton rides a week and mostly in zone 2 and some quick upticks to zone 4. Since AFIB, have been advised to keep heart rate under 110 in all exercise for the time being. I don't overtrain or keep my heart rate elevated for long periods of time.
Hi, if you look up ‘causes of enlarged heart’ you will find the term ‘Athletic Heart Syndrome’ which includes enlarged ventricles and arrhythmia. Since your Apple Watch hasn’t shown AF you might do a bit more research on effects of over exercise before an ablation otherwise it is possible the ablation won’t be successful.
Left Atrial Enlargement can also occur from pressure overload issues and things like High Blood Pressure, Diastolic Dysfunction, Mitral Valve disease, Pulmonary Hypertension, Sleep Apnea, etc. LAE does go hand in hand with AFib and can be the trigger for AFib or as a result of AFib. Typically the larger the left atrium, the more AFib you have and the harder it is to ablate and stay in NSR. If your AFib burden is low, you will probably have succes with medication therapy and lifestyle changes as well as procedures (ablation, mini maze, pulse field ablation) when needed.
I wonder, were those high rates no more than accidental blips on your watch (which mine can be prone to if not seated well on my wrist) or genuine episodes that were sustained for some time, even seconds, and thus a form of tachycardia?
If the Apple Watch didn’t register them as AF, this is because what happened during them must have included a single “P” impulse being sent from the atrial pacemaker to the ventricular pacemaker. The Watch looks for these electrical signals, as well as an irregular pulse, in order to register the rhythm as AF.
I’ve read also that AF can induce heart changes differently according to the individual. I don’t think science knows why this is but perhaps it’s in much the same way that some people’s muscles and skin stay elastic when they lose weight, whereas in others, they stay sagged?
There’s certainly some evidence that the “stretched” heart cells of an enlarged atrium can sometimes resume normal electrical activity when they are no longer stretched (remember that heart cells can never increase in number, only change in shape or die).
So your doctor will be right, and whether this is reversible if the AF stops, might be a genetic aspect?
Good insights! I showed my regular cardiologist the quick heart rate upticks and she didn't seem concerned. the senior doctor said that just like your skin getting wrinkles as you age, your heart can age. Real helpful--not.
I had read once that the skin and supporting underlying tissues tend to reflect the inner state, too, but I have never read this in recent times. Your doctor seems to have the same thoughts! It's interesting, too, because when I see elderly people who are healthy, they tend to look younger than their years!
hi Steve I have an Apple Watch which picked up AF twice last year for me. Correct me if I’m wrong but I think it only alerts you if you are in sustained AF for 10mins or more and then if you have more 10min episodes it sends notification to you that you maybe in AF. If you have an AF episode for say 2 mins then nothing after it will not alert you.
Hi there, James. I didn't know that and it's interesting. I never use mine in that way, permanently looking out for AF episodes, partly as I seem to have AF so very irregularly, but also because I was told from a 2-week Zio study that it showed that I do have fleeting AF-like episodes, and the Watch wouldn't, I guess, be able to recognise these.
I've always thought that when not using the two-touch AF sensor, the Watch looks only for potential AF via pulse irregularity using the pulse sensor on the back?
not sure how it works really hopefully someone here might be able to clarify. I usually use mine to monitor heart rate during a brisk walk or golf to make sure it’s not rapid and within expected range . In the past when rate is 10-20 beats higher during say slow walk ie. 100 then I suspect something amiss. I usually take it off at night and recharge as I don’t want to be obsessed by it. Mainly use for reassurance
I’m pretty sure that I’ve read somewhere that the heart rate sensor detects heartbeat as tachy, brady or irregular (this one might be suggestive of AF) - and does so only when the Watch is stable.
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I know what triggers AFIB. 
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What next? Afib advice please
