Working out after AFIB

[Elizka]

I saw my EP for a 90 day check up post ablation a few weeks ago.

One of my questions was when can I resume more intense cardio workouts?

I'm back to weight training, yoga, walking and rowing (on machine), but am nervous

about getting my heart rate too high.

My history: 3 (that I knew of) episodes of AFIB) then put on Flecainde. Ablation 4/20/ of this year

and stopped Fleciande about two months after ablation but still on Eliquis.

EP said she couldn't advise me regard working out; and there are NO programs like cardio rehab for patients after ablations.

I know my heart isn't as fit as it was when I was working out more and that is not good. I'll probably only do Zone 2 cardio workouts. Maybe 1 day of HIT riding.

Any advice on cardio workouts? How long to wait? How to get over the fear? I have been in sinus post ablation. No issues except resting heart rate is higher than it was prior to ablation.

EDIT: Thank you to this amazing community!

[Hidden]

This is not something you will want to hear but it is commonly known that extreme sporting activities can cause AF. The chances are that you could be on course to wreck all the good work which has been done to treat your AF which is probably why your EP said what she said. I think you have some important decisions to make. Moderate exercise is good

[Elizka in reply to Hidden]

No worry on the "extreme sporting" isn't an issue for me and never has been. I want to stay strong, and able to age well is my focus.

[Ossie7]

Morning Elizka, I asked exactly the same question to my cardiac arrhythmia nurse who seems quite knowledgable . He advised to aim for the ‘submaximal ‘ HR , which he suggested was 20% below maximum . However on beta blockers and a rhythm control drug ( dronedarone ) I am unable to get my heart rate anywhere close to this level as the nature of the drugs slow your heart rate down and make you feel extra breathless when exercising . As others have said too, extreme exercise is not advisable when you have AF , so moderation is the name of the game .

[Tryfan]

You join all the frustrated marathon runners, long distance cyclists, who post Afib or ablation ponder the same question. Did excessive exercise cause it. How much is excessive, and how much can I now do. As already written I don't think anyone can give you a straight answer.Only advice I can proffer. Listen to your body. I would also add, stay out of the red zone. For me it's now moderation in all things.

David.

[Speed]

I concur with all the comments above. Suggestion from EP is that the Ironman training MAY have brought forward my genetic predisposition (both parents AF). After 2 ablations for AFlutter, I’ve now developed PAX AF and it is triggered (but not exclusively) by my HR going over 140bpm, so no more intervals / HIIT for me. Came off Beta blockers in agreement with EP as they crucified my HR (maxed out at 110). QOL decision - I still wanted to enjoy exercise, though at a lower intensity.

I still do cardio (running / cycling / swimming) but despite dialling it back, my AF has increased in frequency and my EP is on standby for a further ablation if we consider it desirable.

Strangely (or maybe not?) my former infrequent PAF has progressed to frequent episodes of A Tachycardia @ 110 bpm, that after a few hours after PIP Flecainide switches to AF (@85bpm) and eventually NSR. All usually within 12 hrs max.

We are all different but the consensus “norm” seems to be that AF will progress and anything other than mild exercise is likely to accelerate this. At the end of the day, it’s a personal choice and all about quality of life, short term v long term.

[kitenski in reply to Speed]

Speed I've not seen or read anything to say "anything other than mild exercise will accelerate AF". Can you point me to any research saying that?

I do agree that endurance/long/too regular efforts do seem to be a possible trigger, but nobody has been able to tell me if I hadn't exercised so much would I still have got AF.

[Speed in reply to kitenski]

I think it’s a bit of a lottery. Certainly not all endurance athletes get AF but I believe there is evidence / generally accepted that there is a higher occurrence of AF in endurance athletes (and fast jet pilots come to that!). Whether there is a gene that makes some people predisposed to it?

As far as the other than mild exercise, it’s maybe a bit clumsily put.

I believe it’s generally accepted that AF begets AF so the more you have it the more frequent it occurs. This can be very gradual. My point was that if by doing more than moderate exercise results in triggering AF, then over time this will accelerate the progression.

For me, I’m trying to exercise below the trigger point, (generally HR of > 140bpm when running) and so by avoiding unnecessary episodes, I hope to minimise the progression. I do however expect it to progress despite any restraint and in fact it has started to happen spontaneously, though that may be down to high levels of stress currently.

Hope that clarifies.

[kitenski in reply to Speed]

 Speed yeah that helps thanks! I dont know if you saw my thread on coming off flecainide, but I'm trying to work out what that means for my heart and exercise. I've done a Zwift race and a fairly fast run this week deliberately to see what happens and touch wood it appeared fine afterwards with no AF.

Do you get AF as soon as you go > 140bpm? My run HR (as pictured) shows a few peaks so I wonder if indeed that was little arrhythmias or just "normal"? My cardiologist who is also a runner said the main thing to check is that the heart returns to normal HR and drops after exercise which it appears to be doing.

run pace and HR

[Speed in reply to kitenski]

Your HR trace looks fine - if I go into AF it will go from 145 to 210 - can’t miss it, though interestingly, I will only be aware I’m in AF by seeing the rate on my Garmin. I’m sure however that should I not noticed it then after 10 minutes or so I will start to feel it through increased fatigue. When I do go into AF, then usually it will last 8+ hours. One thing to note, I understand that some variability in your heart rate short-term is good and a gradual increase in heart rate that you see in your trace is quite normal.

On my heart rate that triggers AF it’s only indicative and generally I try to keep below 135. However yesterday, probably a bit foolishly, at the end of a 5 mile run I felt so good that I increased my pace towards the end, running the last few minutes at 147 without triggering AF.

This was after having been in AF for 10 hours two days ago but also after an excellent nights sleep the night before. There are so many variables that I believe impact my AF that it’s almost impossible to predict exactly what and when will bring an episode.

I recently did a half marathon where I was briefly in AF on waking up in the morning, took some flecainide pip, returned to normal sinus rhythm, but as I set out on the run flipped straight back into AF. I decided to carry on with HR bouncing off to 210 (at one time even at 210 walking) sometimes jogging sometimes walking and to my surprise without any further flecainide, several miles from the end I went back into normal sinus rhythm. No rhyme nor reason!

I am under quite a bit of varying stress accompanied by poor sleep hygiene at the moment and I’m sure this is having a detrimental effect on my AF in frequency and character of episodes. Once this settles, It’ll be interesting to see how the AF plays out.

[Speed in reply to kitenski]

So here’s an interesting one. Bike ride this am - first for 6 weeks or so, but needed to drop car off for MOT so thought ride back. No sooner set off on bike than flipped into AF / Tachy with HR peaking at 185 In NSR it would barely have hit 120 at that pace / incline. Decided to just able home and then after several minutes, back in NSR. Ended up doing 18 miles steady at respectable 16mph with no further problems and with HR peaking at 135 on the hilly bits.

Now I’ve had this before, but it seems particular to cycling. Altogether different profile with running. As far as swimming goes, never noticed in AF but then I don’t wear a HR monitor. 🤔

Click on the image to see the start.

Ride HR Trace

[kitenski in reply to Speed]

Speed there seems to no rhyme or reason sometimes as to why episodes occur!! I gave up trying to find something specific, I tend to keep a diary now in case it points anything specific when I try and ask why the heck !!

Unless you were out on the lash all weekend and severely dehyradated 😅🤣

[Speed in reply to kitenski]

Unfortunately those weekends on the lash were an early casualty of the dreaded AF (although with me it started as A Flutter and that was very predictable: always the day following a big session, either in the bar or on the bike!)

[CliveP]

I would suggest a cautious return to more intense exercise. That’s good advise for everyone but definitely worthwhile after an ablation.

You might also look for information regarding exercise and heart health from experts rather than people on a forum. There are various podcasts from world leading experts on the subject which will help you to make your own informed decision.

Personally I did no exercise at all for 3 months after my ablation 2016. When I restarted running I ran really slowly with lots of breaks.

Over a period of several months I slowly increased volume and intensity to the point where I was back to 60km a week with 2 speed sessions a week. My fitness and performance level is as high as it’s ever been (depending on training) and I have zero problems with running as hard as I can.

I’ve also had zero experience of AF since the ablation.

I should stress that doing too much too soon is probably a bad idea but a return to competitive levels of exercise may well be possible.

I can’t help but feel that the over cautious approach espoused above may be somewhat overstated.

[Ala2145 in reply to CliveP]

Intrigued! Would you be able to pass along any links? And also, I’m curious about the protocol you used to get back to it.

Thanks!

[1Golf in reply to CliveP]

What an enlightening report, I’m curious of your age without being so blunt. I question whether this approach will work for someone mid-70’s. Since I’m an ex-?Olympian this AFIB has been a drag but working through it.

Dede

[mjames1 in reply to CliveP]

Glad things worked out and I agree with much you say, however no exercise for 3 months post ablation can lead to serious de-conditioning for many of us, especially seniors. Just like over doing it, de-conditioning can also be counter productive to recovery. The important thing is to build up slowly and listen to your body. I took the first month very with easy short walks and little other exertion. Now at 3 months, I'm starting to gradually work up to per-ablation exercise levels. As far as exercise "experts" are concerned, there are as many approaches out there to exercise as there are to diet. Everything from the low heart rate MAF formula to HILT like interval work. Personally, I favor first building up a base with low-moderate HR work and then gradually introducing intervals. But in my mid 70's, I've found that the unexpected "benefits" of interval training can be sore/strained muscles and tendons

Jim

[Elizka in reply to mjames1]

Brilliant! Weight training is my biggest focus, but I know cardio is important.

[Speed in reply to CliveP]

Interesting. Are you on any medication post ablation as if so, it doesn’t appear to be impacting your exercise at all?

[Ala2145]

I wonder the same. I’ve not yet had an ablation as I have been able to control Afib for 18 months now with dietary and vitamin changes. I’ve seen four EPs and while they say I’m clear to run, no one has any guidance or foresight on how it will go.

I’ve not yet seen targeted guidance for anyone looking to add back exercise. I’ve found protocols for things like POTS but not Afib, so I would be interested to see if CliveP could send along links to these sources and the protocol they used to get back to it.

Interestingly I think this may tie back to a post earlier this week from OzRob who posed the question of if a lot of our advice and experiences may be different based on the type of Afib we have - vagal or otherwise. I suspect how we tolerate exercise may be different based on our triggers and highly individualistic, maybe that’s why there is no research or guidance?

Edit - one suggestion for getting back to it, maybe find some trusted workout buddies? Help take your mind off of the heart rhythm worry. My old running buddy saves the end of his workout to run intervals with me. We run 0.2 miles, walk 0.2 miles, repeat, at easy paces. He handles the distances and I follow his cue on when the interval ends so I don’t have to look at my watch during the run but I still can look back at HR data later. This lets my mind stay in conversation mode and not slip into worry mode and has had wonderful results so far - I’m happier and fitter and having fun on runs again instead of on the edge of despair. We will very slowly increase the running distance and effort. Good luck!

[Elizka in reply to Ala2145]

Edit: I hired my coach to come over and monitor me and my heart rate as I do my first faster ride, but nothing too overwhelming. Good advice. I'm worried about being decommissioned as I haven't pushed myself since first afib on Dec 1 of last year! Cardio-wise.

[Ala2145 in reply to Elizka]

Good idea! Have fun with it, and good luck!

[mjames1]

Listen to your body and gradually build up over the next few months. When body says too much, then take a step back. There is no reason why you can not eventually return to pre-ablation levels as long as it's not the kind of long distance endurance training that is associated with afib. A raised resting heart rate post ablation is a positive sign and may continue for some time. It is associated with better ablation outcomes per study below:

pubmed.ncbi.nlm.nih.gov/160...

Jim

[Elizka in reply to mjames1]

Thank you for the insights and link!

[Elizka]

Thank you. Yes, my resting heart rate could be saying I need more time. 67 while I sleep when it used to be 55 or even 52.

[Buttondog]

Hi Elizka

My AF has come back after 3 years, this time in Silent form. My watch confirms this; significant exertion leads to big, sudden HR increases and now my HR is 20% higher irregardless of effort. I am trying to stay away from medics. I am an indoor cycle Zwifter and used to doing hard rides. Previously I identified AF via my HRM. I am trying to work out how to replace the intensity that now feels risky. Zwift, like other smart systems, offers a number of variables eg speed (RPMs), gear, HR, resistance (climbs) and power. So you can start trying to figure out how to ride at what speed, up what % climb, at what power, in what gear while keeping an eye on HR. HR can look erratic with AF on the Zwift display but it’s possible to check that independently. Does anyone know if cycling for longer is risky? None of this replaces the loss of exertion but it can distract you for a while.