How to avoid AFib after exercise?

I am a classic vagal Afibber who typically gets self-terminating episodes in the evening after a hard workout earlier in the day. Episodes are rare (1-5 per year). There is often a gastric trigger (swallowing cold water, gulping, belching, coughing etc.). I gave up endurance exercise a over a year ago after having 5 episodes in a single month and had no episodes (that I know of...) for the the ensuing year. I had a few episodes recently after hard workouts or daylong gardening etc. , again triggered by coughing or swallowing a few hours later in the evening (usually after 9PM). Sudden activity, followed by rest is also a trigger. I would like to return to some endurance exercise, even if it is way less intense then previous, however I am worried about pushing my condition to the point I need to consider ablation or drug therapy. I am currently unmedicated and have CHAD-VASc of 0 (or 1 maybe).

Does anyone have success in preventing post exercise Afib episodes?

BTW I am a longtime lurker who greatly admires this forum! Also a scientist by training and Australian by birth (so I welcome blunt comments and any criticism, constructive or otherwise.;-))

Hello Joe,
In the early years of having AFib one of my triggers was recovery between hard efforts while cycling. I was usually able to counter this by not letting up on the effort too quickly. In other words I would just ramp things back instead of just stopping the effort.

So far as endurace riding went, I rarely had an issue because the efforts were more consistent/sustained. The times I did have episodes during endurance rides would be if I went out too hard in the beginning. In those cases I would be in AFib within the first couple miles.

One odity to my AFib early on was if I was out on a ride and had an episode. Once I converted back to NSR I no longer needed to worry about having another one. Meaning what normally set me off didn't anymore.

Unfortunately AFib usually progresses and gets worse . As in my case the things I used to do to prevent it eventually stopped working leading to me having an ablation.

Hello JoeM - I am glad you are no longer "lurking"... Welcome. As related to your scientific training, do an online search for the connection between Oxidative Stress and the related cellular damage to and excitability of cardiac cells which shows up as a potential cause for arrhythmia after endurance exercise. The ROS damage is well documented as are the recommendations for optimizing the body's supply of antioxidants to blunt the oxidative stress damage. While I don't like to quote studies based on animal experiments, you'll see a lot of substantiation for cause and effect in your search.

Jackie

I had afib for 11 years (last 6 diagnosed). I never identified a relationship between exercise and afib. At the time, I jogged, ran occasional 5K races, did weight workouts twice a week and windsurfed up to 70-80 days a year, plus walking golf once a week. I do recall maybe a couple of episodes occurring while exercising, but I never thought exercise was a trigger. During the 6 years of diagnosed afib, I documented all my episodes and averaged 3 episodes a month for an average length of 9.5 hours per episode.

Hi Joe,

Chronic fitness was my path to afib. I found that long duration endurance exercise created a delayed vagal trigger for me. My first episode (over 14 years ago) was a day or so after a training run on a 14,000' (4,300m) mountain. Except for a period when I was overconsuming calcium, exercise as a trigger for afib has always been delayed. It took me two years to decide that endurance competition was likely a poor choice for me, subsequently I have abstained from competition as well as most endurance training. That being said, I remain very fit. I have determined that for me, it seems to be the product of intensity and duration that is the trigger. So I can do high intensity workouts like Tabatas with impunity. I can also go all day at moderate intensity, or all day with pulsed intensity. An example, I can ski the steeps all day at 12,000', off piste and be fine. One powder day, I was very stoked and added hiking to each lap. This turned into a delayed trigger for an episode after dinner. A couple of hiking laps would have been fine, but every lap was a poor choice. Another time I was skiing on steeps (~40 deg slope) and trying to see how many laps I could do in a day, so pushed every turn as hard and as fast as I could. I did 48,000' vertical that day (again at 12,000'). A more normal day would be 30-35,000' for me for this terrain. Again this produced a delayed trigger. I can do the normal (for me) day repeatedly all season without it being a trigger. Hence I have a subjective sense of how much is too much for me. I try to control myself and avoid doing this.

I now look at exercise training as what is the "minimum effective dose." I do a lot of bodyweight training. I've learned to breathe always through my nose, even on high intensity workouts and at elevation. I'm never out of breath. I look at the heart as plumbing plus an electrical system. Exercise may be good for the plumbing, but in excess is not good for my electrical system. To address the plumbing issue, I revamped my food intake to optimize metabolism and minimize any problems with the glucose insulin system. As well, I focus on minimizing inflammation by testing for and optimizing values for various cytokines.

My basic "system" to keep myself in NSR includes optimizing electrolytes with high dose magnesium, keeping calcium intake modest and adding in supplemental taurine. If I do this and can restrain myself from going over my subjective limit for activity (product of intensity and duration), my afib burden is miniscule (<0.01%). In my first four months of afib, my burden was 57%, which was inclusive of a 2.5 month episode. I know from repeated experience that if I fail to consume the magnesium, afib will visit very soon. Likewise if I go past my boundary on activity. There was a time, six years ago, going through a divorce where I was unknowingly overconsuming calcium. It took me about 18 months to figure this out and stop it. During that time, many things that are not normally triggers for me, became triggers. When I rectified the situation, they were no longer triggers.

Good luck!

George

So when I read your post, I take it to mean that sometime after exercising you find yourself in Afib?

Does this mean Afib didn't happen while you are exercising?

I'm still trying to figure out when I'm really afibing --- (and if there is a pattern or trigger) I am wondering if I have more afib when I am exercising, and wondering if this is something I should be aware of or taking into consideration as I recover, and work at getting back into shape after my ablation in a few weeks.

I had an stress echo test a few weeks ago, and this is what it said in regard to Afib:

The baseline rhythm was Sinus rhythm with runs of atrial fibrillation.
The heart rhythm during stress was atrial fibrillation.
Sustained atrial fibrillation was noted.

I take that to mean I have worse Afib problems when I'm working hard and stressing my heart. (But always, or just sometimes?)
Should this influence my recover?

Do most people with an exercise influence have afib during or after exercise?

Hi Rocketrich - I frequently get PACs following early termination of effort (e.g., after cycling up a hill, or after a sprint in a soccer game) and occasionally Afib (4 of 16 episodes triggered this way). I am wondering if this is some sort of 'vagal rebound' whereby parasympathetic nervous system is trying to lower heart rate following exertion. Interestingly I very rarely notice PACs after I have been exercising for a while, for example after a 30 min run. That said most of my Afib episodes come in the hours following prolonged exercise and are rarely if ever preceded by PACs.

Hi Jackie - good suggestion! it is well know that middle aged endurance athletes are prone to calcified plaque in their arteries, as opposed to the fatty plaque seen in more sedentary individuals. This may be a function of oxidative damage. The problem is that biological systems are so incredibly complex, that there is often more that one contributing factor. Several papers I have read seem to indicate that there may be a deeper Atrial Myopathy syndrome that causes Afib, which in turn could be caused by microstructural damage from excessive exertion.

From what I have read it is really unclear if Afib is the primary cause of stroke, through poor atrial blood flow, or a correlated risk factor, albeit a strong one. I think it was the ASSERT trial that found little to no temporal correlation between stroke and Afib in patients with implanted heart rate monitors. There was also an article by Nielsen in 2016 (European Heart Journal, Volume 37, Issue 31, 14 August 2016, Pages 2488–2489) that questions the effectiveness of ablation for stroke reduction. There are also studies that support ablation as an effective means for reducing mortality in Afib patients.

As a scientist it is clear that the science is not yet clear on these important questions..!

Hi Bolimasa - to clarify, I have had Afib during exercise 4 times, but each time it started during a sudden reduction in effort after sudden activity, like running up stairs with daughter on my back (episode #1) or during descent after mountain biking up a hill. I have never gotten an episode while jogging or riding at constant pace. Same pattern with PACs - they typically happen at rest or after cessation of effort.

I suspect there are other factors that need to be present to cause my relatively rare episode's (for now at least!) - like a gastric trigger, dehydration, alcohol, lack of sleep etc. My fear is that this relatively high threshold will come down over time and episodes will occur with single triggers, or none at all (I have never had a spontaneous episode to my knowledge).

The other thing I have learn is that Afib comes in many 'flavors'. I think I have the vagal type, likely driven by excessive exercise (relative to my physiology). I used to play Australian rules football in my 20's, then took up endurance running in my 30's, then moved on to triathlon in mid-40's before I dialed back in an attempt to slow progression of Afib.

There is even a name for this - PAFIYAMA syndrome, which stands for 'Paroxymal Afib in Young and Middle Aged Athletes'. Aside from being a horribly tortured acronym, it seems to describe what I have observed with my case,

Hi George - I have read a lot of your posts and see many similarities between our cases. Like you, I also hope to avoid the need for ablation (my episodes do not cause any discomfort other than the anxiety of worrying about a stroke and difficulty in sleeping). That said I do not rule it out, but at the minimum hope to defer until the procedure further evolves. Seems that Afib treatment has changed greatly in the past 20 years and will continue to do so. Of course I do not want condition to progress to the point that ablation would become less likely to succeed if I end up opting for that. I have had 16 episodes over 5 years, what always terminate after 2 to 5 hours. If that changes dramatically (frequency or duration increase) then I will reassess option with my Cardio. I do not have an EP at this stage.

Hey Joe,

One thing I should add. After my 2.5 month episode, I terminated every episode that did not terminate in a couple of minutes of changing position or jumping around with flecainide on demand. My goal was to be out of rhythm as short a time as possible, so I would chew the flec and swallow to get it into my system as soon as possible. In May, I happened to be able to convert by exhaling and holding my breath out for as long as possible to create a serum CO2 build up. I described it here <[www.afibbers.org] Fortunately haven't had occasion to test this again. I watched the conversion on this app <[www.marcoaltini.com] which uses the phone's camera & light as a pethysmograph. Hence I could watch the pulse waveforms change and become regular, not only in peak to peak distance, but amplitude.

Cheers,

George

Quote
JoeM
Hi Bolimasa - to clarify, I have had Afib during exercise 4 times, but each time it started during a sudden reduction in effort after sudden activity, like running up stairs with daughter on my back (episode #1) or during descent after mountain biking up a hill. I have never gotten an episode while jogging or riding at constant pace. Same pattern with PACs - they typically happen at rest or after cessation of effort.

I suspect there are other factors that need to be present to cause my relatively rare episode's (for now at least!) - like a gastric trigger, dehydration, alcohol, lack of sleep etc. My fear is that this relatively high threshold will come down over time and episodes will occur with single triggers, or none at all (I have never had a spontaneous episode to my knowledge).

The other thing I have learn is that Afib comes in many 'flavors'. I think I have the vagal type, likely driven by excessive exercise (relative to my physiology). I used to play Australian rules football in my 20's, then took up endurance running in my 30's, then moved on to triathlon in mid-40's before I dialed back in an attempt to slow progression of Afib.

There is even a name for this - PAFIYAMA syndrome, which stands for 'Paroxymal Afib in Young and Middle Aged Athletes'. Aside from being a horribly tortured acronym, it seems to describe what I have observed with my case,

I'm still trying to figure out what flavor I am... this all started for me, or maybe I should say I realized I had a problem, at the end of May.
I find everyone's stories interesting and it gives me an idea of the things I need to think about to try to understand my problem.

Not sure I've figured out much yet... It's harder when you can't tell you are in Afib and/or it doesn't seem episodic.
All I know is that I'm out of rhythm most of the time, and if it's Afib it mostly just a handlful of beats of afib intermingled with 5-15 beats of normal. That is unless the fast beats are really PAC's and not afib at all. My 30 day event monitor said I did have one 45 minute run of afib.. but it left me no way to tell if I could tell when that happened. I only hit the button a handful of times in 30 days...

Exercising recommendations for paroxysmal AF in young and middle-aged athletes (PAFIYAMA) syndrome

Interesting article. I love the part about avoiding alcoholic beverages while exercising. Never would have occurred to me!

Seriously, though. Reduction in intensity is good advice. I’ve gone down from running a 7-mile course in an hour to more like a 5-mile. I still keep it up 5-6 days/week. I’m up 20 lbs from my previous low, but maybe 6’0” and 175 lbs wasn’t right for me to begin with. CDC charts be damned, you gotta go with what works for you.

Quote
wolfpack
Interesting article. I love the part about avoiding alcoholic beverages while exercising. Never would have occurred to me! .

Obviously you have never participated in a cyclocross race 😁

Quote
rocketritch

Interesting article. I love the part about avoiding alcoholic beverages while exercising. Never would have occurred to me! .


Obviously you have never participated in a cyclocross race 😁

[www.huckleberrybicycles.com]