Diagnosed with Afib as a healthy 27 year old and looking for advice

Hello everyone

I am a 28 year old male and was diagnosed with Afib 4 months ago at 27. I will preface my post by saying I have never smoked, don’t drink alcohol and don’t even drink coffee (or anything other than water, so I virtually have no caffeine). I have always maintained a healthy lifestyle and have lifted weights every day for ten years.

A few months back when I was in a stressful period of my life my heart would go out of rhythm every day or every second day for about 4 hours per day. I didn’t know what it was at the time and I had a few terrible Afib attacks (which I thought was a panic attack even though I had never had those previously). Long story short I was diagnosed with Afib and the 24 hour holter, which ironically I wore on a day with barely any symptoms, said I was in Afib 5.5% of the time and heart rate maxed at 205 (wasn’t exercising at the time).

I have been put on flecainide 200mg per day and a low dose of beta blocker. I seem to tolerate the medicine quite well and it has stopped the Afib for me. However on 2 instances I forgot to take my medication and was back in Afib (or at the very least had ectopic beats) 12 hours after the missed dose was due. Even after taking flecainide it took 7 hours for NSR to return.

I live in New Zealand so I don’t have a huge variety of specialists to choose from compared to a country of greater population. I am on a waiting list to see another specialist and have been told I will likely need an ablation. I have read around these forums and some people say to avoid an ablation at all costs and I see others saying to have it as soon as you can (though an experienced electrophysiologist who specialises in ablations is key, which I doubt my country has). I’ve also seen others say that flecainide is very harsh on the body and stops working one day. Is it possible to have some Afib while on flec and not realise? As I am aware that Afib begets afib and I figure since I got this so young I may be a terrible case as I age (ie permanent Afib).

There is a lot of information on here, for which I am very grateful but there is also a lot to navigate which is challenging for someone who didn’t even know what Afib was 4 months ago. Any tips or insights are much appreciated. For now I am continuing with my medicine and intend to switch to a Mediterranean diet and supplement with magnesium, whilst adding some daily cardiovascular exercise.

When I have my appointment in a few months to assess me for an ablation I’m unsure what to do. I can live on the medicine just fine but want to do what’s best for me long term.

Thank you in advance - sorry for the long and incoherent post.

Ablation is probably the best choice given your age. While it’s good that the medications work for you, there’s almost no chance that they will continue to do so for another 60 or so years. And why risk the side effects for that long?

How much weightlifting do you do? And what type? Lifting huge weights, especially the bench press, puts a lot of mechanical strain on the heart and can cause the atria to dilate which is the “fertile ground” for AF.

Thank you for your response. I haven’t had any side effects from the flec. Yet I heard about people having a horrible time on it. I assume it’s possible for side effects to appear later? I am fine with having an ablation but New Zealand is a small country and there is no one on the list of approved ablationists. Is it better to travel somewhere for that and pay a lot of money?

I do a lot of bench press unfortunately and deadlifts and squats etc like a body building routine. The bench press is reasonably heavy, usually between 220-300 pounds for working sets. That stuff is my passion though - do I need to give that up or does it not matter now I’ve already got afib? I had no idea weight lifting stressed the heart I thought it was a healthy thing to do

Early in my afib career (14 1/2 years), remember reading about a guy where weightlifting was his trigger. As I recall, he ended up with a MAZE and reduced exercise dramatically. Most who come to afib via exercise get there from an endurance background, but that doesn't mean weights can't be involved.

I'm checking with a doc friend in NZ whom I highly respect to get a recommendation for an ablating EP.

George

From my friend in NZ:

"The best cardiology group in Auckland is Auckland Heart Group. He will need to ask them who their interventional cardiologist for ablations is.

Sorry cant be more specific.

There won't be many in Auckland, at most a handful of interventional cardiologists. He will need a referral from his GP."

Thanks for your reply George. By ‘trigger’ do you mean the general cause of his afib or it would trigger Afib episodes. Prior to taking my medication my episodes were usually caused by work stress and I would be in Afib just sitting in my desk at work for about 3-4 hours a day and it stop around 3pm most days.


For now I will try ensure I don’t go above 80-85% of my 1 rep max for my workouts to try reduce stress on the heart. I hope that is sufficient

Thanks again George. I am from Wellington but I will contact Auckland heart group and look into it. Thanks so much

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Zb3
Thank you for your response. I haven’t had any side effects from the flec. Yet I heard about people having a horrible time on it. I assume it’s possible for side effects to appear later? I am fine with having an ablation but New Zealand is a small country and there is no one on the list of approved ablationists. Is it better to travel somewhere for that and pay a lot of money?

I do a lot of bench press unfortunately and deadlifts and squats etc like a body building routine. The bench press is reasonably heavy, usually between 220-300 pounds for working sets. That stuff is my passion though - do I need to give that up or does it not matter now I’ve already got afib? I had no idea weight lifting stressed the heart I thought it was a healthy thing to do

My money’s on weightlifting as the root cause. AF or not, continuing with it risks valve damage as well. When you press extraordinary amounts of weight, you essentially squeeze the daylights out of your heart. It can’t pump against that. That creates immense back pressure, pushing blood backwards across the tricuspid and mitral valves and stretching the relatively thin atrial walls. It may be worth considering to de-train a bit.

Discuss this with your cardiologist, of course. By all means solicit his or her opinion on the weightlifting. I’d be interested to hear the response.

I am also from New Zealand (Otaki) and wanted to go to Hamilton and see a Dr. Martin Stiles and was told I could go to Wellington or pay for it.
At $40K to 50K, I decided I would either go to Bordeaux at about $40K or try the natural way. I have chosen the natural route which won't suit everyone. If I were in your position I would get an ablation in Wellington and if you needed a 2nd ablation go to Bordeaux.

We can all say this caused it...that caused it. Who knows? Bazillions of people lift weights why isn't there an epidemic in the weightlifting community??
There's some basic defect or fault that only certain ones of us get afib. Who knows??
I can say I have went into afib when the bar has come down onto my chest and put pressure from the outside.
Flecainide works well and the time it works varies from person to person. For me after a while it caused me other issues.

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Zb3
Thanks for your reply George. By ‘trigger’ do you mean the general cause of his afib or it would trigger Afib episodes. Prior to taking my medication my episodes were usually caused by work stress and I would be in Afib just sitting in my desk at work for about 3-4 hours a day and it stop around 3pm most days.

As it was over 14 years ago, when I read the article, I don't recall.

In some adrenergic afibbers, the weightlifting could be an immediate trigger. I had an uncle where this happened. However he was not metabolically fit. I'm guessing the metabolic issues were the root cause and the weightlifting a trigger.

In your case, I'd bet, like wolfpack that the weightlifting is a root cause and your work stress is a trigger, if you get where I'm coming from.

Certainly all who lift weights don't get afib. Nor to all pro basketball players or endurance cyclists or ultramarathoners... Clearly there is likely something genetic and the exercise is an epigenetic trigger. Very few people younger than 50 get afib if they don't exercise. On the flip side, moderate exercise appears to help older couch potatoes who get exercise.

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Zb3
For now I will try ensure I don’t go above 80-85% of my 1 rep max for my workouts to try reduce stress on the heart. I hope that is sufficient

I'm an "endpoint" guy. In my case, like colindo, I wanted to find a way to keep my afib burden very low (after an initial 2.5 month persistent episode. Hence I detrained dramatically - no endurance training, or competition, as that was my path to afib. I found that by doing this and adding in electrolyte supplementation, I could reduce my burden to a very low number (a range of 20 hours/year to 1 hour every 2 years). I then increased my activity level, though still avoiding outright endurance. I found my trigger to be a product of intensity and duration.

In your case, the heavy weights may be causing dilation of the atria. Larger hearts are more prone to afib. If it were me, I'd try to get to a place with no afib and no meds, if possible via detraining and electrolytes. Then see what activity I could do - working up from a stable base. This may not be possible, in which case an ablation is warranted.

Thanks again guys for all your responses. Shame there isn't a multi quote button on here

@wolfpack- that certainly sounds very grim. I have given it a cursory google search and what you are saying seems sound - that lifting does indeed stress the heart. A shame that its not really emphasised at all, I had no idea until today and I have been lifting for years. I did have some scan on my heart (I think it was just an x ray and a heart echocardiogram or something) and they said my heart was structurally normal. I assume that also means that my heart was not enlarged and this aorta vein thing or atria (sorry not up with all the heart anatomy just yet since I am new to afib) was normal? Or would that type of test not look into that aspect of it.

Not trying to discount at all what any of you guys are saying, I just really like lifting weights and its my passion and it would be really hard to stop. Is there any way you can work out objectively whether something is a trigger or is it just something that you kind of feel out? If it helps I have an identical twin brother and we train together and have done for years and he does not have afib. I would assume we have the same genetic predisposition?

@colindo - wow $50k?! thats a lot. Can you use health insurance - I think there are some comprehensive plans that cover preexisting conditions after 3 or 4 years or does that not extend to afib. At 28 I had never really thought about health insurance but may call some tomorrow and try find out. In that sense I could put off an ablation for 3-4 years then get one done by someone expert at it.

@tsco - what sort of issues did flec cause for you? I heard it had a lot of sides and was scared to start taking it but then I did and there were no sides. And now I am under the assumption - which seems to be a mistaken one - that since there are no sides for me now that I will be trouble free on it for as long as I like. Is that really not the case? Also how does it stop working? I would have thought that since it prevents afib there would be no way for the afib to progress to a more persistent state because you wouldn't be having any episodes.

@georgeN - The concept of being able to eradicate - or at very least greatly mitigate your afib just through supplementation and avoiding triggers perplexes me a bit. I guess what I am asking is what is so bad about an ablation or a life long commitment to flec that makes you want to take that route? Is flec really all that horrible? I mean I have been fine on it so far but any insights into what the medication can do long term is really appreciated. Google just provides a generic list of sides like every medicine. Likewise with an ablation - if you get an experienced ablationist isn't that essentially a cure?
I seemed to be getting a lot of afib when I was stressed out due to work being really hectic and some relationship stressors as well - I had my cortisol levels tested and it was extremely high - stress is something that you cannot really actively eliminate. I mean of course I could make some healthy lifestyle changes but if its an outside agent like work or a relationship causing that stress it seems like its something I cannot control. Maybe the weights have some impact too but I've been pumping as hard as I've liked all my life (albeit young life) so far and no problems. Are there any more tests I could do to confirm whether weights are the trigger? Just seems a depressing predicament to have to limit the activities I do in my twenties because of this. I wanna live my life ya know... And of course in your situation there is always the added risk of being in afib whilst not knowing you are in afib all the while having that increased stroke risk? Just wondering what made you decide that route over the medication/ablate route.

Wasn't it Hippocrates who said (paraphrased): 'First ask the person who wants a cure if he/she is willing to change what brought the problem on' ?

I really feel for your predicament!
What have you got to loose if you give up weights and just exercise with rubber bands? Easier on joints as well? If it doesn't make any difference then you can go back on busting yourself weight lifting.
Another trigger might be your high cortisol levels. Look into mindfulness, yoga, tai chi etc - you can manage it!

What is your HR (apart from the 200+ when you were monitored)?

If you mange to control your HR then your atria will reduce in size again (should it be oversize now) An ultrasound would tell you.

If you stay on medication for control for a while you (we) might be lucky and the ablation procedures may improve markedly with the help of technology?

I'm on Flec (50mg 2x/day) right now - no noticeable side effects.

FWIW, if i were in your shoes i'd continue informing myself (as you are already doing) and not rush into anything

All the Best!

First I'm a weird case my med tolerance sux. Flecainide may work well for years for you. I developed left bundle block at higher heart rates. Typically that wouldn't be an issue for most (they don't feel it) but at a certain heart rate (125 bpm) I would get a sharp pain in chest and breathlessness with some feeling of dis-rythym . When heart rate slows it went away. Flec does delay the beat from the atria to the ventricles. Again most never experience that.
It stops working by just not working. You eventually may start having more ectopics and then more afib breakthroughs. It's like your heart gets used to it. I've have read where some go on for years tho.
I look at it this way (this is my case, my experience) the afib is in there and your heart is very adaptable (almost in a strong self preserving way) . The heart is constantly remodeling itself and for whatever reason thinks the rogue rythym is the correct rythym. It seems to constantly try to find a way or a path for the afib to rule. A successful ablation blocks that path (hopefully permanently). Drugs can delay the process and sometimes with some people the afib subsides becomes weak and stops bullying the heart.
Trust me I know telling a weightlifter to stop lifting is like telling a bear to not crap in the woods. I tend toward stress being a bigger factor. Why cut something out that relieves stress for you. If you are over lifting I'd watch that.

I doubt you will get any insurance now you have a pre existing condition for afib, give it a go, I would interested to know how you get on.

My afib first started when I was weight lifting when I was several years younger than you. I then transitioned into endurance sports and as time went on my afib progressed to me having my first ablation in 2009. In hind sight I probably should have had the ablation done sooner than later. By 2009 my intermittent affib had progressed to the point I could not participate in cycling anymore. I spent the couple months leading up to my ablation doing little more than sitting around.

IMHO, afib is better dealt with in its early stages as it will only progress.There is also a good chance that the Flecanide will stop working then its on to stronger and less desirable drugs while all along having your heart create more pathways.Treatment for afib has progressed quite a bit since I had mine done back in 2009 and knowing what I know now I personally would not wait.

If as you suspect your afib is largely stress induced, then perhaps taking a low dose of beta blocker (nonselective) daily but saving the flecainide for extended episodes is worth considering. Beta blockers get a lot of negative comments due to side effects, but much of this may be dose related, and therapeutic dosages vary widely. Also, there is evidence they do not build tolerance or lose efficacy. The electrolyte supplementation has scant supporting evidence in the general population for paroxysmal afib. I would get your levels tested before megadosing, and if you choose some non-standard test make sure you understand that the accuracy of the test is largely irrelevant if the normative population rages are not properly validated. As for atrial enlargement and other physiological abnormalities, have some imaging done and get real answers and not speculation.

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Zb3

@georgeN - The concept of being able to eradicate - or at very least greatly mitigate your afib just through supplementation and avoiding triggers perplexes me a bit. I guess what I am asking is what is so bad about an ablation or a life long commitment to flec that makes you want to take that route? Is flec really all that horrible? I mean I have been fine on it so far but any insights into what the medication can do long term is really appreciated. Google just provides a generic list of sides like every medicine. Likewise with an ablation - if you get an experienced ablationist isn't that essentially a cure?

I seemed to be getting a lot of afib when I was stressed out due to work being really hectic and some relationship stressors as well - I had my cortisol levels tested and it was extremely high - stress is something that you cannot really actively eliminate. I mean of course I could make some healthy lifestyle changes but if its an outside agent like work or a relationship causing that stress it seems like its something I cannot control. Maybe the weights have some impact too but I've been pumping as hard as I've liked all my life (albeit young life) so far and no problems. Are there any more tests I could do to confirm whether weights are the trigger? Just seems a depressing predicament to have to limit the activities I do in my twenties because of this. I wanna live my life ya know... And of course in your situation there is always the added risk of being in afib whilst not knowing you are in afib all the while having that increased stroke risk? Just wondering what made you decide that route over the medication/ablate route.

First, I know when I'm in afib. I always have a "sense" when I'm in afib. I can confirm with my radial pulse, a Kardia device or whatever. I keep my CHA₂DS₂-VASc score at zero. My goal has been to absolutely minimize the amount of time I'm in afib. Since my 2.5 month episode was terminated with 300 mg flecainide over 14 years ago, I have used on-demand flec to terminate episodes. I use it infrequently enough that I still have lots of flec left when I get a new one because of the age of the meds. Most of the time my episodes are terminated in an hour or maybe two.

" if you get an experienced ablationist isn't that essentially a cure?"

Even with the best in the world, it often takes two ablations. This can involve work on the left atrial appendage. This can (in ~60% of cases) then require lifetime anticoagulation or another procedure to place a device like the Watchman if you don't want to take the meds all your life. If you don't have access to the best in the world, then even an experienced ablationist can give you poor results. There are a number of posters here who can recite horror stories and many ablations till they were able to get to Dr. Natale for a fix.

That being said, if my situation ever deteriorated significantly, I'd be making an appointment with Dr. N in short order.

As to flec for life. In many cases, flec can lose its efficacy over time. At 200mg/day, you don't have much "headroom" to increase your dose, especially looking at the rest of your life from age 28.

As to lifting heavy all your life, I competed in high altitude (for example a 21 km race topping out at 4300m) races without issue, till I was 49, then I got afib. I can't say that the lifting is a problem for you. It is just likely suspect.

In my case, the path I've worked out for myself isn't bad. I do pay attention to stress, meditating most days. I pay attention to metabolic health. I eat in a 2 hour window and routinely water fast for 5-7 days. I eat some fish, shellfish and eggs and my diet is otherwise mostly plant based but I avoid grains, legumes, nightshades, industrial seed oils and seeded veggies. While I don't do endurance training. I maintain reasonable fitness for my age (63). I use a military fitness program developed by the TRX suspension trainer people to get people ready for US Navy SEAL training (only the strength, not endurance component) along with other bodyweight programs. I routinely do superslow to failure training at the gym and HIIT Tabatas (8x20:10) on fan bikes and rowers. I can carry a heavy (23-33 kg) climbing pack up steep approaches at 2100 m elevation and rock climb for 6 hours. I can ski the steeps at 3,900m 6-7 hours without taking any breaks. I don't do like my 32 year old friend and skin up and ski down as that has a large endurance component. I can do all of these activities and exercises 5-7 days fasted. I have a subjective line on exercise that I don't cross. I know how much is too much for me and a trigger. For example, hiking up the hill with my climbing pack, I don't push it. I also maintain nasal breathing continually in all my activities, including Tabatas and at altitude.

I know that the wall between afib and NSR is not thick for me. I have to pay attention. Primarily I make sure I take my high doses of magnesium daily and I don't cross my subjective exertion (as I mentioned, it is time x heart rate elevation - high heart rate for short time is OK, moderate heart rate for long time is OK, high heart rate for long time is not OK) limit. I can do many things I enjoy and am in much better shape than many my age. I have friends that do 100 mile (161 km) bike rides in the mountains near where I live. I don't join them, even though it would be fun.

If I'm lucky, I'll be able to continue this for the rest of my life and not require an ablation. I don't consider it a bad place to be.

I'm not saying what works for me would work for you (or anyone else), just this has been my approach and I'm happy with it. The method of looking at my situation and identifying possible variables may be useful. My afib started with episodes lasting 6-9 hours every 10-12 days. Within two months, it had progressed to the 2.5 month persistent episode. This was not an auspicious beginning. Being able to change that to going as much as 2 years between episodes that last for an hour or two (or a few minutes with my exhaled breath hold conversion <[www.afibbers.org] ) is something I'm very happy with.



Edited 1 time(s). Last edit at 01/15/2019 09:53AM by GeorgeN.

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Zb3
@wolfpack- that certainly sounds very grim. I have given it a cursory google search and what you are saying seems sound - that lifting does indeed stress the heart. A shame that its not really emphasised at all, I had no idea until today and I have been lifting for years. I did have some scan on my heart (I think it was just an x ray and a heart echocardiogram or something) and they said my heart was structurally normal. I assume that also means that my heart was not enlarged and this aorta vein thing or atria (sorry not up with all the heart anatomy just yet since I am new to afib) was normal? Or would that type of test not look into that aspect of it.

It's just a theory on my part, by no means certain. You should just be aware that it is a risk factor. What you're going to want to ask your cardiologist for is a stress echo. From what you describe maybe you've already had one? When was it done? A stress echo involves you being hooked up to an EKG while on a treadmill. You gradually work up incline and speed while the cardiologist records and monitors your EKG. At the end of that test, he or she will put an ultrasound machine probe on your chest and image your heart. That shows blood flow, approximate chamber size and valve morphology. If that sounds at all like what you've already done and it was recent then you can trust the results you've already gotten.

Sorry you have to deal with this awful afib. You're so young !
I've no other advice than those offered by previous posters. It's a good thing flecainide works for you. It's among the less horrible rhythm drugs, and it can be used as PIP, which is an advantage.



Edited 1 time(s). Last edit at 01/15/2019 02:34PM by Pompon.

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wolfpack

Thank you for your response. I haven’t had any side effects from the flec. Yet I heard about people having a horrible time on it. I assume it’s possible for side effects to appear later? I am fine with having an ablation but New Zealand is a small country and there is no one on the list of approved ablationists. Is it better to travel somewhere for that and pay a lot of money?

I do a lot of bench press unfortunately and deadlifts and squats etc like a body building routine. The bench press is reasonably heavy, usually between 220-300 pounds for working sets. That stuff is my passion though - do I need to give that up or does it not matter now I’ve already got afib? I had no idea weight lifting stressed the heart I thought it was a healthy thing to do
_______________________________________________________________________________________________

My money’s on weightlifting as the root cause. AF or not, continuing with it risks valve damage as well. When you press extraordinary amounts of weight, you essentially squeeze the daylights out of your heart. It can’t pump against that. That creates immense back pressure, pushing blood backwards across the tricuspid and mitral valves and stretching the relatively thin atrial walls. It may be worth considering to de-train a bit.

Discuss this with your cardiologist, of course. By all means solicit his or her opinion on the weightlifting. I’d be interested to hear the response.

Sounds to me like you need to modify your Weight Training program to exclude exercises that put excess strain on the Heart and Stretch the Atria. This doesn't mean you need to abandon Weight Lifting.

What do I know but to me too sounds like you need to go more aerobic than anaerobic as in lots of reps with light weights to get ultra-fit and lean (low BMI less strain on heart in general) without stretching those atria....less CAN be more!

Thank you so much for all your responses, much appreciated.


In terms of the tests I have had, I have not had a stress test but I was lying down and had a heart ultrasound? Would that be able to give me the answers I would need re the enlarged artrioc vein thing or not sufficient?

As I have already been prescribed with this flec and beta blocker I am a bit reluctant to come off it without seeing the cardiologist first to assess triggers. For now I will try and increase some reps in my workouts and reduce heavy weights slightly to try and protect my heart. I have enquired about some health insurance to see if afib can be covered as I am aware they will cover preexisting after 3 years.

Certainly very interesting to hear everyones views - I never realised you could end up on blood thinners after an ablation. I suppose those have their own host of side effects too.

I think at the moment I need to keep all my options whilst I assess what may be the best for me going forward (ie medication, ablate or natural methods to control it). To that end, what supplements does everyone recommend . I know magnesium is good but different types and maybe some coq10?

I have heard some people recommending heart calm - if I just get that would that be sufficient? I will also look into getting a Kardia if they will ship to New Zealand. That sounds like a very good thing to help with monitoring.

Re the CHAD score - is there a way to calculate that myself to know what my stroke risk is? I suppose I can google that but figured I would get more insight trying here as you all seem to be experts in afib which is encouraging and makes me feel less alone so thank you all.

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Zb3
Re the CHAD score - is there a way to calculate that myself to know what my stroke risk is? I suppose I can google that but figured I would get more insight trying here as you all seem to be experts in afib which is encouraging and makes me feel less alone so thank you all.

https://www.mdcalc.com/cha2ds2-vasc-score-atrial-fibrillation-stroke-risk

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Carey

Re the CHAD score - is there a way to calculate that myself to know what my stroke risk is? I suppose I can google that but figured I would get more insight trying here as you all seem to be experts in afib which is encouraging and makes me feel less alone so thank you all.

[www.mdcalc.com]

Why the "female" point? And if one gets their BP under control (even with meds) does it reduce the score? I still don't know if my BP is white coat but I figure high is highm

The point for being female is because women have a slightly higher stroke incidence. However, many EPs don't consider the female point to be "real" and don't count it.

You get the BP point even if your hypertension is controlled with meds. Sorry. I get that point too even though my BP is controlled with meds. If you want to see if your hypertension is whitecoat just buy a home BP monitor and check it yourself.



Edited 1 time(s). Last edit at 01/18/2019 06:31PM by Carey.

I concur with the advice / support offered here so far. Just to add: I've been a circus artist my whole life (now 48, female), lifting people, and my own bodyweight, and I've found that if I jog on the spot, in order to gradually increase my heart rate, before basing a 3-hi (2 people standing on my shoulders), and then, when it's over, I keep the slow jog going, I can avoid the AF trigger. It seems my heart can withstand the intensity of sprints or lifting, but it needs to ease into and out of it. my heart doesn't like going from 0 to 100% instantly.
Also, I follow many of George's protocols. Nasal breathing, lots of magnesium, taurine, CoQ10; i'm still fit, but I've 'de-conditioned" so I can still use my body in the mountains and in circus. and I've quite radically changed how I manage emotions, so that I am, literally, 'listening to my heart' in a different way than when I was performing around the world, so I can reduce the effects of stressful situations (relationship/ work) that used to trigger AF for me. There's many ways to change emotional response, some will suit you more than others; I've used an active rhythm meditation (TaKeTiNa) and more recently, SE.