Exercise HR and AFib

I was reading through the transcript linked below from some EPs at Cleveland clinic and read the following question and answer.

"If you can't feel afib, is there a heart rate that you should stay below?

Walid Saliba, MD: It is recommended that good heart rate control indicates a resting heart rate of 90-100 beats per minute, with avoiding peak heart rates during exercise of 140 beats per minute. "

I've never heard that 140 limit before and I do HIIT on a stationary bike that gets my HR into high 140s/150. Anyone familiar with this 140 number?

[www.stopafib.org]



Edited 1 time(s). Last edit at 02/03/2019 02:29AM by Brian_og.

This was the reason I took up the higher intensity workout. Basically do what they did in this study.

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Brian,

Are you in afib during your exercise?

George

Hi George

No I'm not. Go into AFib every few months for a couple of hours. Self convert.

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Brian_og
No I'm not. Go into AFib every few months for a couple of hours. Self convert.

Then HR limit should not be an issue for you. As long as HIIT is not a trigger, go for it! I routinely do HIIT without issue. In my case it is the product of intensity and duration that is a problem. Too intense for too long... I can do long and relatively low intensity and high for short duration, like HIIT without issue. Long & high is a vagal trigger for me.

George

Thanks George.

The study you cite Malmo compares a form of HITT and a control group whose exercise habits (including whether they exercise at all) are completely unspecified even retrospectively.

The more recent study Kluchi actually compares HITT and moderate exercise for AF onset, albeit in a different type of cohort, and the results show the advantage of moderate exercise over HITT. This appears to be the only study of this type. There is actually a very detailed discussion of their results which is worth reading.

I wouldn't dismiss the guidelines of the Cleveland Clinic cardiologist. Along with extended fasting, hypothermia, restrictive diets, and mega-supplementation, there is no evidence-based study that shows the advantage of HITT over a moderate approach for AF, and may well incur some risk.

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safib
The study you cite Malmo compares a form of HITT and a control group whose exercise habits (including whether they exercise at all) are completely unspecified even retrospectively.

The more recent study Kluchi actually compares HITT and moderate exercise for AF onset, albeit in a different type of cohort, and the results show the advantage of moderate exercise over HITT. This appears to be the only study of this type. There is actually a very detailed discussion of their results which is worth reading.

I wouldn't dismiss the guidelines of the Cleveland Clinic cardiologist. Along with extended fasting, hypothermia, restrictive diets, and mega-supplementation, there is no evidence-based study that shows the advantage of HITT over a moderate approach for AF, and may well incur some risk.

Note that the question for the CC cardio is: "If you can't feel afib, is there a heart rate that you should stay below?

This question implies that the person does not know if he/she is in afib or not. Hence the answer assumes they might be in afib, and makes sense.

In Kluchi, the subjects were CKD patients. Afib patients with comorbidities commonly have adrenergic triggers. I would not be surprised that the HIIT triggered afib in that circumstance, and am not surprised that their outcomes were worse. I would not have thought it was a good idea for CKD patients to do HIIT. People I know with a sympathetic trigger have to be very careful in limiting their heart rates in exercise.

In a person who knows whether they are in afib, has no comorbidities and also knows that HIIT is not a trigger (as in many vagal afibbers), the outcome well may have been different.

I don't think a generic prescription is warranted. It should be based on an individual's circumstance. Nothing wrong with moderate exercise.

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GeorgeN

In a person who knows whether they are in afib, has no comorbidities and also knows that HIIT is not a trigger (as in many vagal afibbers), the outcome well may have been different.

I don't think a generic prescription is warranted. It should be based on an individual's circumstance. Nothing wrong with moderate exercise.

Possibly, but there is the issue of how aware you are of afib and/or comorbidities. Further, triggers may be delayed or cumulative and otherwise difficult to identify. And although the outcome might be different, the fact remains that it is the only study directly comparing HITT and moderate exercise.

Also, afib is not only linked to endurance exercise but weight lifting. HITT may be more related to the latter in some ways: for example, what is peak blood pressure for HITT?

Until there is a better data I don't see the advantage of HITT over moderate exercise with afib. It is more important to me not to have recurrence of afib then somehow obtain peak conditioning with less time exercising