AF returns

Dang! Didn't make it 3 years, as I write this.

I took off from a crosswalk signal while doing my daily run and I could feel the beat get really hard instantly. Then the rate didn't come down in the shower afterwards, and by the time I got a new battery to replace the dead one in my AliveCor (Kardia) since I haven't used it in forever I was able to record it. 122 bpm and irregular as all heck.

Grrrr!!!!

Thing is it doesn't feel bad at all. Really light floppy feeling, that's it. Hope it goes away soon, because I don't have any meds. Haven't since 2015.

Sorry to hear this and hope you convert soon.

Rate starting to slow. Probably will soon.

Funny thing is it doesn't feel bad at all. I'm tempted to go run again to see if that'll do it.



Edited 1 time(s). Last edit at 04/23/2018 02:49PM by wolfpack.

Glad its turning for you.

Sorry to hear this. Whilst it feels ok, if I recall correctly pre-ablation you never had AF over 100BPM even on no meds? If this recurs, do you see yourself heading to Natale’s door?

Keep us posted - fingers crossed for conversion to NSR soon.

Going to try for chemical cardioversion with propafenone tonight. My cardio got me in this afternoon.

This is really weird. I’ve never had an adrenergic triggered episode and there were zero warning signs. I haven’t had PACs in a while.

Funny thing is I’m taking my dad to see my EP tomorrow for a flutter consult. Won’t he be surprised when I bring in my rhythm strip!

Converted. Only had 12.5mg metoprolol and 150mg propafenone a couple hours ago. Maybe that did it, or maybe it was the beer and pizza. Either way, don’t care!

Very surprised at the TOTAL lack of warning signs and the adrenergic onset. I’m totally open to ideas here.

I’m beginning to think it might be time to de-train from the running. 5 miles/day, 6 days/week might be too much. I never would’ve thought so, because I’m not fast (10 min miler) but evidence is evidence.

Groan...

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wolfpack
I’m beginning to think it might be time to de-train from the running. 5 miles/day, 6 days/week might be too much. I never would’ve thought so, because I’m not fast (10 min miler) but evidence is evidence.

Groan...

Yeah, I'd say it's time to back off a bit. After all, 5 miles/day x 6 days per week is pretty rigorous, slow or not. You know as well as I do there's a strong link between endurance sports and afib.

I failed to mention the 10 mile bike rides I’ve added in the evenings now that the weather has warmed up. Again, seems like not that much but arguing with the data is kind of dumb. I am an engineer after all!

Glad you are feeling better!

Altogether 7 hours of the most comfortable AF I’ve ever experienced. Weird.

At this point I’m not tempted to rush headlong into ablation #2. I’ll take a wait and see approach.

Cardio wants me on Eliquis for a month. I’ll get a second opinion from the EP, and maybe even a third one from yours truly. Honestly, I don’t see the need. Opinions?

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wolfpack
I failed to mention the 10 mile bike rides I’ve added in the evenings now that the weather has warmed up. Again, seems like not that much but arguing with the data is kind of dumb. I am an engineer after all!

I'm sure this is all individual.

For me, the exercise trigger seems to be the product of intensity and duration. Hence Tabatas on the fan rower or bike are fine (8 reps of 20 seconds max, 10 easy or 4 minutes total), casual bike rides (6 MPH) for several hours are fine. Alpine skiing laps all day is fine (as each run is only five or seven minutes), adding hiking for more vertical to each lap, not fine.

One of my metrics is everything has to be done breathing through my nose and easily. I can actually do a lot this way, including the Tabatas.

Sorry to hear you went out of rhythm, glad you converted!

George

My bike rides typically include hill work which really elevates the pulse. But not for very long, maybe 5 minutes.

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wolfpack
Cardio wants me on Eliquis for a month. I’ll get a second opinion from the EP, and maybe even a third one from yours truly. Honestly, I don’t see the need. Opinions?

You're CHADS-Vasc < 2? If so, and if these episodes aren't frequent and don't last more than a few hours, I'd probably skip the Eliquis.

CHADS-Vasc is 0 for me. Cardio wanted me on it I think in preparation for a cardioversion, which clearly won't be necessary. I'll ask at today's follow-up.

One thought I had was the fact that I did increase my iodine (potassium iodide) supplement from 250ug to 1mg/day a couple months ago. I wonder if that has anything to do with it? I certainly don't feel hyperthyroid (not that I'd know what hyperthyroid feels like), but perhaps I overdid that? Maybe a blood panel would be a good idea.

Wolfpack - There's an abundance of info out there about the negative impact that endurance exercise produces in hearts that become irritated from the continual extra oxygen intake (oxidative stress) and the resultant ROS factor that produces cardiac fibrosis. In some cases, apparently, the heart gives negative responses but the fibrosis issue is not limited to just the heart, as this ROS fibrosis occurs in all organs... and you don't typically know, initially when that's occurring.

So, again, AF is the canary in the coal mine indicating something is amiss in the body... and it pays to look into adjusting stimulators of oxidative stress and reducing inflammatory cytokine production along with optimizing antioxidant function.

And of course, it's individual as George notes. The more you've been at it... the more damage and eventual tolerance limits occur.

Jackie

It's tough to figure out the right "dose" of exercise. Zero, obviously, is a poor choice. What's too much? I guess it's a learning process.

Maybe I'll alternate running and cycling days instead of piling them on top of each other.

If AF progresses, though, I think it might be time to give TCAI a chance. I'm 44 years old and in otherwise fine health. There's no reason to be scared of travelling.

I should also add that I did start d-Ribose at 5g/day a few weeks ago. As I understand it, this is supposed to be helpful - not the opposite. But it does bear mentioning as a recent change.

I also used this product on my vinyl siding last Saturday.

[www.sprayandforget.com]

It's supposed to be non-toxic (citrus based I think, at least it smells that way). I used a power sprayer but the wind literally bathed me in that mist. Should've worn more than shorts and t-shirt. The bottle doesn't say what's in it, but it does make you cough in fits if you get it up your nose! Maybe I inadvertently poisoned myself? Admittedly, that's a guess. Big guess.

If you go to the Products page on their site and click the product you used, look for the tab labeled SDS. Click that and it's the product's safety data sheet. Looks like pretty benign stuff mainly.

Thanks. Missed that.

Like I said, big guess. Red herring, in fact.

Asked my cardio his opinion on exercise. He seems to think there’s no upper limit short of triathletes.

I’m not so sure.

My exercise trigger was always recovery from a hard effort when cycling or running. Although my affib did start back when I was into body building before I took up cycling.

I do often wonder if the cycling did contribute to the progression of my affib. I used to ride at least 25 miles 3-4 times a week with an additional 80-150 miles on the weekends. This habit usually lasted from march through October. I'm an avid hunter so mid october through January were usually dedicated to spending sedentary time in a treestand with some short rides or CC skiing mixed in.

After my ablation in 2009 I did cut back quite a bit but was also riding my bike to work so I was still probably riding the same amount of miles a week but many were not at the same intensity. But again I wonder if I didn't cut back enough.Especially now since my ablation in January was unsuccessful and I an unable to exercise at all right now which is driving me nuts.

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rocketritch
My exercise trigger was always recovery from a hard effort when cycling or running.

Ditto. I have never experienced afib or flutter during exercise, but I have many times in the hours following it, especially when it was a long bike ride in warm weather. I think I know why.

For two years I watched my potassium levels carefully because I was able to control my afib/flutter almost 100% with potassium. I had a potassium meter and could measure my level in less than a minute, so one day after a long, hard ride I measured it hourly just out of curiosity. What I found was very interesting. Immediately after the ride my levels were quite high, higher than normal for me, but over the next 6 hours or so they dropped significantly and rapidly. Why is that, I wondered?

Well, I came across a study conducted on professional football players in the UK. They measured their potassium levels during and after training exercises. It turns out that during intense exercise, your potassium levels soar to levels that would be considered dangerous in normal situations (as high as 8.0, which could be fatal under normal circumstances). But then after the training exercise those levels dropped rapidly, often dipping into hypokalemic levels.

That's all perfectly normal physiology, apparently, but if you happen to have afib, low potassium levels are not your friend. Long story short, this led me to the discovery that I was severely under-hydrating during exercise even though I thought it was enough, and I needed to add large doses of potassium to go along with it during and after the ride. Once I started doing that, the post-exercise afib episodes stopped.

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rocketritch
My exercise trigger was always recovery from a hard effort when cycling or running.

Me too. Concur with Carey that potassium is a big actor. In my case the delay could be quite long, as much as two or three days on a really heavy effort (haven't seen that long delay recently, but also quit doing the long duration intense stuff a couple of years into my 14 year afib career). My first episode was after a training run on a 14'er for a race that went above 14,000'. It was several days later, as I recall. In the ER, my serum potassium was ~3.2. So I initially focussed on potassium. Later both Mg++ & K+. In me, if I keep mag high enough K is usually OK.

A suggestion would be to use potassium citrate powder, because the citrate will convert to bicarb in the body & you'll get that benefit, too. Some I know have worked up to 5 g of K/day as citrate.

I haven't found any direct relationship between exercise and afib, but I did do a fair amount of aerobic work as a competitive swimmer at the highest level. Up to 6 miles a day of training, but that ended at age 23. Afib didn't show up until age 51. However, my wife and I did do a number of 5K races in the years preceding the afib, but training was at a minimum of + or - 5 miles a week. Nothing serious.

After my successful ablation11 years ago at age 61, we did train and run a half-marathon, but just enough training to finish, no more than 5-15 miles a week for a few weeks.

If there was/is a relationship between my exercise and afib, I wouldn't go back and change anything.

I'd strongly suspect the iodine supplementation upsetting the thyroid. Have you checked values? Even if they are within 'normal' range it may not be right for you.

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Ken
If there was/is a relationship between my exercise and afib, I wouldn't go back and change anything.

I concur. Although, I think that when I have my next ablation I will approach my exercise a cardio exercise a little differently.

I haven’t stopped exercise. In fact, after converting a Monday night I was on the treadmill Tuesday afternoon. No problems. Did my daily 5-miler Wednesday and today with biking in the evenings. No issues.

The Hope is that this episode was a “blip”. The plan is to move onto more advanced EPs if (when) it isn’t. I just hope I don’t have to fire my cardio to make that happen because I really like the guy. But AF, as we all know, is very much a “me first” game. Has to be.

Hi Carie,
Can you give more details on the potassium meter?
Where can one purchase it?
I wish there was a magnesium meter as well.

Thanks
Leah H.

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Carey
Immediately after the ride my levels were quite high, higher than normal for me, but over the next 6 hours or so they dropped significantly and rapidly. Why is that, I wondered?
.

The sympathetic nervous system influences the heart cells to increase Na+ and Ca2+ influx which displaces K+ into the extracellular fluid.

Conversely the parasympathetic nerve forces K+ back into the cells and Na+, Ca2+ out.

Could be that in us AFers that mechanism is imbalanced.

Another episode today lasting about 1 minute. Not sure if that counts but I guess it does. All because I swallowed a big chug of water after a bike ride. Self converted with rhythmic breathing. Tough while driving a car!

Also figured out my Kardia is dead. Battery leaked inside of it (thank you, China). Guess I’ll just have to buy another one. Argh!