Re: Exercise causing A-fib???

Hi George,

I’m 57 years old and started experiencing AFib at 50, with 1 to 2 episodes per year. Now, for the past 2 years, I’ve been having 4-5 episodes per year. Cardioversion with pills (propafenone) has always worked for me.

This year, I’ve started playing high-intensity pickleball, 2 hours, 4 to 6 times a week, with a heart rate between 95-160, and 80% of the time at high intensity. I’ve noticed over the past 4-6 months that my episodes have become more frequent, and I’m wondering if this might be related to the exercise.

I’m considering signing up for the new technique 'pulse field ablation'. Has propafenone worked for you over the years?

Thank you.



Edited 1 time(s). Last edit at 07/31/2024 09:54PM by Dannyboy2.

To clarify why Danny is addressing George, Danny posted this to a thread that's over a year old, so I moved it to its own new thread.

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Dannyboy2
I’m wondering if this might be related to the exercise.

Has propafenone worked for you over the years?

See the thread on "The Haywire Heart" book, on this topic. Yes, excessive endurance exercise was my path to afib 20 years ago.

I've never taken propafenone (but know people that it has worked for). I have taken flecainide, primarily as "pill in the pocket" to convert episodes for nearly 20 years (though I've not needed it frequently as my remission plan, which includes keeping long duration activity to a "Zone 2" or what I can do with nasal breathing level has worked very well). Flec has never failed to convert me.

This is the 2004 paper that talks about using flec or propafenone in the on-demand to convert context.

{edit} didn't see Carey's post while I was composing this one.



Edited 1 time(s). Last edit at 08/01/2024 11:58AM by GeorgeN.

I just started on propafenone (Rythmol) in June, so far it has worked really well for me. It took me a few weeks to adjust to it. But other than an odd taste and some trouble getting to sleep (when I first started it) no real side effects.

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Dannyboy2
This year, I’ve started playing high-intensity pickleball, 2 hours, 4 to 6 times a week, with a heart rate between 95-160, and 80% of the time at high intensity. I’ve noticed over the past 4-6 months that my episodes have become more frequent, and I’m wondering if this might be related to the exercise.

For me, exercise as trigger is the product of intensity times duration. Hence long duration activity that is low intensity, such as my previously mentioned Zone 2/nasal breathing is not a trigger. Short duration high intensity activity, for example max 8x Tabata (20 seconds max/10 seconds easy) sprints on a fan bike are not. Long duration activities, like several hours at high intensity, would definitely be a trigger for me.

My arrythmia story is very similar to yours. Not sure when I first experienced what was eventually diagnosed as atrial fibrillation......probably my mid-60's. After my diagnosis was prescribed propafenone as a "pill in the pocked"......told to keep it at home, at my office, in my car, in my brief case, in my golf bag, etc. It was very effective.

However, as I learned (primarily from this site}, arrhythmia was most likely progressive and events would occur more frequently. My condition progressed and did experience events more frequently, to the point that the quality of my life was impacted. After extensive research and much consideration, opted to have a Natale ablation in March 2011.

I have played sports all my life and am still very active, and was a high-level racquetball player until bilateral knee replacement (2008 and 2009) affected my level of play. Interestingly, I had an opponent/friend/client who also had knee replacements and had started to play pickleball in the early days of pickleball. He convinced me to start as well. Played for a couple of years. But at that time most pickleball courts were outside on tennis courts and subject to availability and to the weather. Unfortunately, I lost intertest.


Steve
Klein, Tx

My afib may be a result of my competitive swimming history (1955-1968), but when I was having episodes during my afib career (1995 - 2024), I never found exercise as a trigger. However, there were a few times where anxiety was very high when doing a few things physical where afib kicked in, so I figured that the anxiety was a trigger, not the physical exertion.

Per Ken's comment. I should note that most of my exercise triggers were not during the exercise (which would be an adrenergic trigger). My triggers were delayed vagal (parasympathetic) triggers. The delay could be a few hours and even up to several days in the case of many hour training sessions or races for long duration high altitude (>14,000') races. In one case I recall, the afib was several days post the event. What I recall was lets say my normal resting heart rate upon waking was 50 BPM. Then the next day (maybe two) after the event, my resting morning heart rate was 60 or 65 BPM. Then the following day it was 45 BPM. It was during the 45 BPM time that I was at risk. It wasn't the rate, per se, it was what it was indicating about the autonomic nervous system status. I learned fairly early on, not to participate in those sessions. However my heart rate during sleep today commonly bottoms out in the high 30's BPM. These low sleeping heart rates are not a trigger.

I am a newbie to the forum, but if I was posting a new topic, it would probably be titled, "Do I have to give up golf?"

I'm male, 73, fit and lean, 52 bpm resting heart rate, normal BP. I have had paroxysmal afib for the last 3 1/2 years. First time it set in for 3 months, and consultant scheduled an ablation inversion - electrical, I recall. But the condition subsided on its own, and as it seemed more off than on, we cancelled the procedure. However, it still periodically - paroxysmally - comes on, and most often during a round of golf. For me this is a fairly strenuous walk (here in Scotland we don't use carts / buggies) and being a high handicapper, a lot of swings, and a lot of hope / disappointment. I don't indulge in displays of anger, but I admit I have trouble not taking the whole thing too seriously. Therefore I wonder about the association of afib with stress and adrenaline. I play a couple of times a week, but it only happens about once / month. (For the sake of brevity I shall not describe my brilliant 6-iron shot to the green on the 18th yesterday at Gleneagles Queen's Course, but it triggered another episode. Which tarnished the glory somewhat.)

I treat episodes with 100mg flecainide, plus 100mg more the next day if heart rate goes over 100. This pill in the pocket does not have any effect on the afib, just lowers the heart rate. Inversion or reversal seems to happen unpredictably after 48 hours, and has been associated with a good walk, some cardio exercise, church singing, and even another round of golf. I'm on apixaban, of course.

I'm pretty fed up with this. The episodes make me tired and a bit depressed. I will read other sport related postings with great interest.

Thanks for your time reading this. Hope it helps someone else.

Geoff
Edinburgh, Scotland

Geoffrey Stevenson
Edinburgh, Scotland



Edited 1 time(s). Last edit at 08/15/2024 04:48PM by NotAJock.

Hey Geoff,

There certainly can be an association with afib and stress. From your description, it sounds like this could be the case. Here is an off the wall thought. Many people overbreathe, leading to low levels of serum carbon dioxide. Contrary to popular thought, proper CO2 levels are beneficial for many things. CO2 is a vasodilator and as well can potentiate the effective use of oxygen through the Bohr effect. Overbreathing, which may not be overtly obvious, can potentiate sympathetic nervous system activation, anxiety and even arrhythmia. It can even cause hypoxia in the brain. There are ways to train away from these habits. If you have any interest in pursuing this, let me know and I can be more expansive and provide references.

Expanding further on the implications of the Bohr Effect: In tissues: Where CO2 production is high, the Bohr effect causes hemoglobin to release more oxygen, which is then available for the tissue's metabolic needs. In the lungs: Where CO2 is being exhaled and pH is higher, the Bohr effect allows hemoglobin to bind oxygen more readily, facilitating oxygen uptake.

"We have documented cases of hyperventilation inducing atrial fibrillation, atrial flutter and paroxysmal atrial tachycardia”’ p6 paragraph 3 of this older paper: "Hyperventilation in Cardiac Rehabilitation "



Edited 1 time(s). Last edit at 08/17/2024 07:36PM by GeorgeN.

Hi Geoff, and welcome

I'm sure giving up the links in Edinburg would be stressful itself! I too am triggered by stress and adrenaline, and was given flec as a pill in the pocket remedy- it never worked for me and made me feel worse. So much information here was very helpful. Making sure my electrolytes were in balance, for me one of the best remedies. And I started taking about 500mg magnesium spread over the day, When I felt fib coming on I would pop an extra 100mg capsule and a 200mg l-theanine as my pills in the picket. It works within the hour, and the l-theanine brings my heart rate down. Making sure I'm hydrated, getting enough potassium and adding in taurine has really helped when I have an active day.

The hardest part is working on the stress and adrenaline, something I had no problems with before getting covid, which also gave me fib. For now stress seems to be the only trigger. I'm now down to VERY rare and short fib episodes after having it 24 hours a day for almost a year. With the shutdown and not able to see doctors for so long, this forum was my main go to for so much info and help!

You'll find lots of stories from members re sports and physical activities causing fib, so read here and I'm sure you'll find many answers that might help you. Good luck!

Thanks for those posts. Somewhat abashed, I confess that the current episode of afib abated within 2 hours of taking 150mg of my flecainide, ground up for quick absorption. I had been taking too low a dose, it would appear. It does say 150mg on the prescription, but previously that had made me dizzy. And I am not a pill popper by nature.
Next time I will be far more responsive and take the full dose as soon as I'm aware of an episode, pill in the pocket, etc. I'll wait to see my consultant before trying 300mg (or more), as recommended in the Afib Resources.

Quote
NotAJock
Thanks for those posts. Somewhat abashed, I confess that the current episode of afib abated within 2 hours of taking 150mg of my flecainide, ground up for quick absorption. I had been taking too low a dose, it would appear. It does say 150mg on the prescription, but previously that had made me dizzy. And I am not a pill popper by nature.
Next time I will be far more responsive and take the full dose as soon as I'm aware of an episode, pill in the pocket, etc. I'll wait to see my consultant before trying 300mg (or more), as recommended in the Afib Resources.

What is your weight? 300 mg is max for those 70 kg (154 #'s) or over. It is 200 mg for those under. If you do go up, I'd go up in steps (after talking to the consultant), say 50 mg increases at a time, to find the minimum effective dose. I've chewed flec taken on-demand for the same purpose as grinding. Some have had a similar quick absorption by allowing the flec to dissolve under the tongue sublingually. I've used flec on-demand for a few months shy of 20 years, so quite a bit of experience. I weigh 170#'s and 300 mg was initially prescribed (and I weighed 35#'s more then). I've noticed runs of what appears to be atrial flutter in my afib episodes in the last 5 or so years. It appears that the 300 mg may have been at least partially responsible for the apparent flutter. I reduced the dose to 200 mg and with much less of the flutter in the episodes.