Lone AFIB and Exercise

Hello All,

Got diagnosed with Lone AFIB in Jan 2019. I have no other indicators (heart, etc) but spent a night in the hospital and now am on Metoprolol and Atorvastatin. I experienced this after a bout of intense exercise and have been a bit timid to go at it again. I'm 52, in good health (got 15 extra pounds after retiring from the Military) - I'd like to get back to exercise, but realize that it can't be at the level it was before January...
Pretty sure I've not had a bout of AFIB since - anyone have any experience with possibly exercise-induced AFIB? Or, how has anyone reworked their exercise routine after a tacking on the Lone AFIB medal

Thanks much,
Brett

The statin has nothing to do with a-fib. That's a cholesterol drug. The metoprolol is a beta-blocker, which is a rate-control medication. It slows your heart rate. Did the AF episode occur during exercise or afterwards? If afterwards, how long after? How did the AF episode end (on its own or cardioversion)? How long was it? A bit more information could help us give better advice.

As for exercise, there's no reason to fear it. You just find new limits and stick to them.

Mr. Norris:

I have a Holistic doctor that was doing some exercises and he went into AF (his first), he said he took some Hawthorne berry and converted into NSR. It seems that people that are Adrenergic (those that get their AF in the daytime after some kind of workout) Hawthorne Berry may help them. I saw my Holistic doctor a few weeks ago and asked him if he had gotten anymore AF episodes and he said no. So perhaps you could try Hawthorne berry, I am Vagal (get my episodes at night at rest), I did take some Hawthorne berry and it didn't stop my AF but it appeared to shorten it.

Liz

Here is a definition of adrenergic vs. vagal afib triggers <[www.afibbers.org]

Here is info on af & exercise: <[www.afibbers.org]

In my case, chronic fitness, in the form of endurance exercise was my path to afib 14.75 years ago. I'm vagal.. I had a two 1/2 month episode starting two months after my first episode. Had an EP who recommended I stay out of rhythm since my af rate was <100 (around 80 BPM). I suggested a "plan B" which he agreed to. This is what the plan has turned into that I have followed for 14.5 years and has been highly successful keeping me mostly in afib remission.

1) I cardioverted the 2.5 month episode with a loading dose (300 mg for me - >70kg of weight) of flecainide.
2) I detrained from endurance exercise while maintaining fitness. I can do HIIT Tabatas, bodyweight exercises (TRX Military fitness, Convict Conditioning), super slow strength training, hiking, rock climbing, alpine skiing off piste & etc. (I'm now 63).
3) I maintain electrolytes with magnesium to bowel tolerance, potassium (4 g/day of potassium as citrate dissolved in water consumed over the day), 4 g/day taurine.
4) I keep food intake of calcium low <500 mg/day.
5) I use a loading dose of lfec to convert me if the above fails.

I also maintain metabolic fitness with low insulin, low glucose, low BP & etc through diet, time restricted eating (22 hour daily fast) and periodic extended fasts (5-7 days water fast). I pay attention to circadian rhythm.

George

Wolfpack -
The AF happened about 5-10 min after I stopped exercising. It was some pretty high intensity stuff, so I was pretty breathless - then, my heartrate shot to about 155 BPM and I almost passed out....went to the ER...was in AFIB (I think) for about 20 min...then, never again. The episode ended on it's own. The Cardio said that it was "lone AFIB" and that it "just happens to some people." Felt that was kind of doubtful, honestly. Really having a hard time finding my limits and have not had my HR above 120ish in a controlled environment (gym) since JAN. Wondering if there is a "new" limit or what exactly triggered it. I've talked to 2 cardios and both swear that exercise has little to nothing to do with AFIB....

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Mr Norris
Wondering if there is a "new" limit or what exactly triggered it. I've talked to 2 cardios and both swear that exercise has little to nothing to do with AFIB....

So the bulk of the afib population are older than 60 at first diagnosis and have comorbidities (high BP, T2 diabetes, metabolic dysfunction, heard disease...). There is a smaller subset (~20%??) who are younger and fit at diagnosis. Chronic fitness is their path to afib. Fitness may be good for the plumbing, but may not be good for the heart's electrical system, at least for those who may have a genetic risk.

Many who are in the chronic fitness category are in the vagal trigger camp. With a vagal trigger, the afib happens after the exercise not during. For example, I have a friend who's first afib episode was carrying a deer he'd killed up a steep hill. His was clearly an adrenergic trigger. For those of us who have vagal triggers, there can be a material delay. In my case, it was a day or so after a training run up a 14,000' mountain. From your description, not sure which yours is, it could be vagal with the transition from heavy exertion to rest?

One tool I use is to always breathe through my nose in whatever I do. This includes skiing off piste' on the steeps at 13,000'. If your trigger is vagal, then it you are doing an activity with a high heart rate, if you create a slower transition to rest, it might mitigate the risk.

You describe an adrenergic trigger as it happened basically at the same time you were exercising. Vagal triggers would be hours after exercise, often evenings. Depending on the dose of metoprolol you may find it hard to increase your heart rate to what it was before. What is the dosage? 25mg 2x/day is pretty much the low end with 125mg 2x/day being the high end. Some folks cut the 25mg pills in half to achieve 12.5mg 2x/day which is safe as long as it's not the extended release formulation (met. succinate is ER, met. tartrate is not ER).

You may or may not be able to identify a specific trigger. Some folks can, others are all over the map. It just depends. You could ask your cardiologist for a Holter monitor or Zio Patch or something similar to wear for an extended period of time to see if and when episodes occur. If you're confident that they're not occurring or that you can easily feel them and diagnose them via radial pulse then I wouldn't bother wearing so many wires. Another option is the Kardia (many other threads about that) which attaches to your smart phone or tablet. It is useful for documenting when an episode starts so you can provide the tracing to either your cardiologist or an ER department if that's where you end up (try not to, they're awful). Rule for electric cardioversion is if an episode is under 48 hours in duration they will skip the trans-esophageal echogram (TEE) which is nice because it's painful.

Exercise certainly does have something to do with AF. AF rates among athletes are statistically much higher than the general population. In most cases, though, they're going to be vagally-mediated AF due to the increased tone of the vagus nerve that happens over years of chronic fitness. In a more immediate sense, exercise depletes electrolytes. The obvious being sodium and potassium but the not so obvious being magnesium which we know to be critically important in maintaining atrial refractoriness. Magnesium is another thing that most cardios will tell you doesn't affect AF, and yet another thing that they're wrong about. Cardiologists are well meaning folk, of course, it's just that we like to say they're essentially "plumbers". They put food on their tables by stenting coronary arteries. Rhythm problems are electrical, so we partner with the best electrophysiologist (EP) that we can find and tackle the beast as a team.

I'm not sure 100% that Wolfpack is correct on your being adrenergic. I say that because your exercise was intense, but the episode happened 10 to 15 minutes later.

I had a period of time when I was consuming excess calcium and became much more sensitive to triggers. One of those times was the time after orgasm. So my heart rate was relatively high at orgasm, then would cascade down. It was this cascade down which was the trigger. In my experience, it is a sharp change in autonomic function that can be the trigger, not the absolute level.

For example, my heart rate during sleep can drop into the 40's. But this is not a trigger for me. Early in my afib career, when I still competed in endurance events, my fasting heart rate might stay somewhat elevated above baseline for several days after the event. Then it would go below baseline. It was during this time that was a risk period for me.

Why this matters to you. If you are truly adrenergic, then I would advise to keep your max heart rate low. If you are vagal, then I would suggest lowering volume, but HIIT sessions might be OK.

When I detrained, I added weight. I countered this by changing my diet to a much lower carb approach, dropped the weight I'd added, plus that I'd added playing football in college and never taken off. I've maintained this for 10 or more years.

My friend, Dr. Mark Cucuzzella, is an MD, Professor at West Virginia University School of Medicine, an AF reserve Lt Col and has run something like 31 sub 3 hour marathons, including Boston. I've chatted with him about the negative effects of exercise. He is a huge fan of Phil Maffetone's approach. <[philmaffetone.com] Mark has taken this to the point that his anaerobic threshold is nearly his max heart rate <[naturalrunningcenter.com]



My point is Mark can do crazy things like long races very close together without apparent stress. He tells me he always aims to end a workout feeling better than when he started - not beat. Taking the attitude of how can I do what I want to do, without incurring a huge stress cost to my system, may allow you to do a lot without triggering afib.

Mark has a number of sites: <[runforyourlifebook.com] <[naturalrunningcenter.com]

My military son had the attitude that if he wasn't exhausted, it wasn't a good workout. I never could convince him otherwise. My military daughter and her husband are more amenable to suggestion.



Edited 4 time(s). Last edit at 04/15/2019 05:43AM by GeorgeN.

George:

What a great family you have, appreciate what your son and daughter are doing.

Liz

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In my experience, it is a sharp change in autonomic function that can be the trigger, not the absolute level.

Might be the same with body positions?

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Pompon
In my experience, it is a sharp change in autonomic function that can be the trigger, not the absolute level.

Might be the same with body positions?

I know that some body positions (or actions) can create a vagal signal (vagal maneuver). These can be useful to some to terminate an episode with an adrenergic trigger. Most likely, for some, this vagal signal could trigger an episode with a vagal trigger.

In my case, standing up abruptly from a resting position may likely cause what looks like a drop down in BP or trigger some ectopics.
Laying down without transition induces ectopics. Laying down slowly does the same, but less heavily and for a short period of time.
Laying down or even sitting down after meal can cause ectopics.
Happily, it seems now those ectopics can't trigger afib as easily as before. I'm nearly five months past my last touch up ablation, and things are going better. It seems I need a long blanking period...
While exercising, I may have some PVCs. They're probably stomach related. If I manage to breathe deeply by the nose to make my diaphragm pushing down my stomach, I'm fine.

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Pompon
In my case, standing up abruptly from a resting position may likely cause what looks like a drop down in BP or trigger some ectopics.
Laying down without transition induces ectopics. Laying down slowly does the same, but less heavily and for a short period of time.
Laying down or even sitting down after meal can cause ectopics.
Happily, it seems now those ectopics can't trigger afib as easily as before. I'm nearly five months past my last touch up ablation, and things are going better. It seems I need a long blanking period...
While exercising, I may have some PVCs. They're probably stomach related. If I manage to breathe deeply by the nose to make my diaphragm pushing down my stomach, I'm fine.

Pompom, you might be interested in this old Conference Room Session on Dysautonomia and LAF <[www.afibbers.org]

Interesting read, but some posts made me scratch my head... and open my dictionary!

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GeorgeN


When I detrained, I added weight. I countered this by changing my diet to a much lower carb approach, dropped the weight I'd added, plus that I'd added playing football in college and never taken off. I've maintained this for 10 or more years.

My friend, Dr. Mark Cucuzzella, is an MD, Professor at West Virginia University School of Medicine, an AF reserve Lt Col and has run something like 31 sub 3 hour marathons, including Boston. I've chatted with him about the negative effects of exercise. He is a huge fan of Phil Maffetone's approach. <[philmaffetone.com] Mark has taken this to the point that his anaerobic threshold is nearly his max heart rate <[naturalrunningcenter.com]
.

WOW!!! Allot of information to filter through on his site.

I was first diagnosed with paroxysmal AFIB just over 5 years ago, at age 44. Initially I thought it was a result of my love of wine - however episodes continued even after I cut drinking by 90%. Then I discovered Dr John Mandrola’s blog and this forum and realized that it was likely my love of hard endurance exercise that was the more likely culprit. I used to trail run and could sustain 90-93% of max rate for extended periods. Several of my approximately 20 episodes have occurred immediately after cessation of exercise. More commonly they occur in the hours after a hard workout and typically are triggered by swallowing a cold or carbonated beverage. While alcohol does not seem to be a primary trigger, it certainly seems to up the chances of getting post exercise AFIB. Dehydration and lack of sleep are also contributing factors.

I don’t exercise like I used to, but still get occasional swallowing induced AFIB episodes, albeit infrequently. I am not medicated in any way, as CHADS-VASC stroke risk is 0 or 1. At some point I will go on blood thinners, assuming this score goes up as I age (50 yrs old now).

Even with the ‘mild’ case of AFIB that I have (short, infrequent, asymptomatic episodes) it is still on my mind often and made me afraid to push myself re exercise. I may consider an ablation if things progress further, but given the rate at which this branch of medicine is progressing, I would prefer to defer it until risk of severe side effects is further reduced. I use beta-blockers when I have episodes so I can sleep and will ask my EP about pill in pocket flecanide at next appt.

My only advice would be to make sure your cardiologist is a true electrophysiologist and be sure to keep your Mg up by drinking the "Wally Water" which has been discussed at length in this forum. It's really easy to make and makes a big difference.