EXERCISING WITH PERSISTENT ATRIAL FIBRILLATION – ALSO CONSIDERING AN ABLATION

[FindingCaradoc]

I am new to this forum and would like to hear from anyone who is a keen cyclist and/or runner who has developed persistent atrial fibrillation 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 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 which caused me (presumably related) to go into AF and which has 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 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.

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 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.

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 (rather lengthy sorry) post and many thanks in anticipation of some helpful responses.

[Identiy]

I have a friend, now 72, who in his youth was a champion swimmer.He went into AF in 1998 and has been in it since.

He continues to swim several kilometres most days, when training in the pool

[FindingCaradoc in reply to Identiy]

Thanks, that sounds positive, that your friend has been in persistent then permanent AF for well over twenty years but still manages to exercise so well. It would be interesting to know if he tried any options (if appropriate for him at the time) for getting back into sinus rhythm, or just accepted things as they were as he has obviously still been able to be active.

[Ewloe]

There’s others on this site more knowledgeable than me who I’m sure will reply. But I thought a failed cardio version meant that subsequent ablation was less likely to be successful??I had a STEMI almost 12 months ago which left me in persistent AF. my cardio version 3 months later was successful. But I’m left with PAF and other arrhythmia’s. Apparently it’s the electrical signals over some damaged heart muscle that’s not working properly. I’m seeing an electrophysiologist who specialises in arrhythmia’s after a heart attack next week. As the treatment options differ after a HA. I’m really pleased I’m seeing this specialist as my cardiologist has said an electrophysiologist is the expert in this area. Good luck.

[FindingCaradoc in reply to Ewloe]

Thanks for your reply. I wasn't aware that a failed cardioversion had any bearing on the success rate of any subsequent ablation attempt, but as I mentioned in my post the Cardiologist I see (who I should add specialises in heart rhythm problems and electrophysiology) has stressed that if I am to try an ablation - having been in persistent AF for almost 3 months now - it should not be delayed much longer, so I have a difficult (for me) decision to make. He did say he would not recommend any further Cardioversion attempts as my procedure only kept me in sinus rhythm for less than a week unfortunately. As you say treatment options differ after having had a heart attack, the main problem for me is that Flecanide is no longer an option and other possible drugs that might get me back into sinus rhythm have significant side effects I believe. I hope you get your own paroxysmal AF sorted.

[Tommo1947]

Hi. I'm 75 now, and was fit as a fiddle until 2 years ago when, for some reason, AF kicked in.My Papworth consultant advised against Cardioversion or Ablation ( less effective with age, apparently) and has modified the medication.

My heart rate is still uncomfortably high with palpitations, but I play regular golf, tennis ( doubles) and 7 mile walks. I simply can't face any of the cardio stuff I did before ( spinning and jogging) and, frankly, any of the exercises I can do are followed by a long snooze in the afternoon !

So, although we'll never be 20 again, it's probably best to exercise as much as possible for all the other benefits it brings, mental as well as physical.

[wischo in reply to Tommo1947]

Golf, tennis and 7 mile walks at 75 is brilliant and I thought my 5 mile daily walk at 72 was exceptional. What do you mean you were fit as a fiddle? as you obviously still are.

[Tommo1947 in reply to wischo]

Kind of you to say so, but everything takes a lot of effort. As it happens, the consultant has started me on Digoxin today, which should moderate the heartbeat ( currently well north of 100 bpm). We'll see....

[FindingCaradoc in reply to Tommo1947]

Apparently, if I decide not to try an ablation, but find the intermittent palpitations I still get too bothersome, then Digoxin is the next step for me. Fortunately my persistent AF resting heart rate is generally slow and remains reasonable even with fairly strenuous exercise (hence the Cardiologist's recommendation that I should not rush into an ablation without weighing up the pros and cons carefully). I hope the Digoxin helps your situation.

[FindingCaradoc in reply to Tommo1947]

Thanks for your reply to my post. It sounds like you are doing pretty well, considering you get spells of high heart rate palpitations. Fortunately my own heart rate in persistent AF is presently controlled well and I don't feel too bad exercising most of the time, just not at the level I have been used to until recently. As I said in my post I'm seriously thinking should I just be grateful for what I still have rather than striving for any further possible improvement and trying an ablation!