Exercising with afib

I am new to this site but really appreciate the articles. I was diagnosed with Atrial Flutter and Afib in 2016 and had an ablation in 2017. While I still deal with short runs of tachycardia, there is nothing sustained over the last three years since the ablation. I am thankful for that. I had been almost daily runner for over 35 years and now have had to slow it down to walking as my tachycardia seems to kick in when I load my heart through exercise stress. It is bit discouraging but not as discouraging as an ER visit for AFib or Aflutter. During the ablation and a follow up heart Cath, it was determined that I had a lifelong ASD and so now I am on eliquis for the rest of my life and as long as nothing changes, my cardiologist says just leave the defect alone but of course if pulmonary pressures or other things occur we have to re-visit the idea of closure even though the location would demand a chest opening rather than laparoscopic closure. Hoping to avoid that. I am generally encouraged with the prognosis and appreciate this community. I was wondering if anyone else deals with post ablation, exercise induced tachycardia and whether or not it is safe to run with that problem? Thanks in advance for any guidance with this.

Hi Robbie,

First, I'm not an ablatee, nor do I have exercise induced tachycardia. However I've had afib for over 16 /12 years, chronic fitness was my path. I am 65. 16 years ago I created a program that has kept afib burden low. In the last two years I've been in afib 0.01% of the time (after a 2.5 month persistent episode in the first 4 months of having afib). Part of my plan was a subjective "how much is too much" with exercise. The trigger for me being the product of intensity time duration. When my now 35 year old son-in-law in the military presented with afib about 5 years ago, I decided to quantify what my limits are for him. They basically correspond to Zone 2, MAF heart rate, or just breathing through the nose all the time. Qualitatively, they are similar. There are links to all of these in this post I would encourage studying Phil Maffetone's MAF approach (linked in the link). He basically is trying to develop your mitochondria and get you to be able to do more at the same low heart rate. I have a doc friend who has trained this way for 20+ years (he's 52). He calls it "loafing" when he goes out for a run, however he's run 30 marathons under 3 hours. I knew of a similar approach in the 1990's, but didn't follow through. I'm guessing if I had, I never would have presented with afib. The idea is to be able to take the stress on the system away, but still get the benefit from exercise.

George

Robbie, can you describe your tachycardia a bit more?

How fast is it? Does it always occur after exercise or just sometimes?

I would say my tach kicks in when my heart rate gets up to around 130 beats a minutes and jumps to approximately 180-200 instantaneously. So far I stop, rest and up to this point have gone back into sinus rhythm each time. It’s only happened 4 or 5 times because I stopped running after that and started walking with intermittent jogging. The tach is regular not irregular so I am assuming it is not afib but possibly a flutter. I did a treadmill and it picked up under load short runs of svt. It’s just annoying because I feel it every time.

I'm curious. Once you have an episode. Are you able to continue exercise after you convert back having no further issues for that time frame? approx. how long does it take you to convert back?

Sounds like some type of SVT, probably flutter. Is it safe to continue running? Yes, as long as you don't experience things like dizziness and fainting and the episodes terminate fairly quickly.

Hi Robbie,
I don't know all of your details, but when I exercise I take a beta blocker a couple hours before. It keeps my heart rate around 100 and I no longer have ectopy emerging when I get my rate above that 130 range. I am 68 yo and I am no longer trying to be Superman (I don't even think I could give Superwoman a run anymore). So you might run the idea by your doctor first, I am not one... just a thought.

And welcome to the site.
Jeff W

I really appreciate the responses. I have not continued when I go into tach and then convert. So far I have waited until sinus returns and then just walked home anxious that it will happen again. It seems like a vicious cycle...run,tach, anxiety, rest, convert, more anxiety, etc... I think I have to work on my response to it honestly. It seems odd that I have friends that are in it constantly and are not even aware and I seem to feel every pac or pvc even singles. The tach is extremely obvious. An enigma to me.

Some people are symptomatic. Some people aren't.

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Robbiecriss
I have not continued when I go into tach and then convert. So far I have waited until sinus returns and then just walked home anxious that it will happen again. It seems like a vicious cycle...run,tach, anxiety, rest, convert, more anxiety, etc... I think I have to work on my response to it honestly.

For several years I dealt with flutter that routinely hit rates as high as 250, and more than once an episode hit me while I was out biking. The end result was finding myself 20 miles from home in hilly terrain with no cell signal and a heart blazing away at 200+. I had two options: I could sit and wait it out, which could take hours, or I could get back on the bike and ride back home. So I would just turn around and head back home by the flattest route I had available. I went slowly, and it was sure as hell no fun, but eventually I got there and suffered no harm in the process.

Don't let it scare you. It's uncomfortable, yes, but it's not going to do you any harm. If you're physically able to continue an easy jog or walk back home, that's what I would do.

I get little episodes like this, mine are like 7-10 fast beats then big beat back to normal, my ep says it’s sinus tachycardia and nothing to worry about.... but I thought sinus tachycardia was Whalen you did something your heart naturally goes up, inappropriate sinus tachycardia is when it happens for no reason like mine, which I’ve read is more serious🤷🏻‍♂️🤷🏻‍♂️

Inappropriate sinus tachycardia is a totally different thing and not at all what you're describing.

A run of 7-10 fast beats that have a normal QRS is nothing at all to be concerned about, and probably not worth trying to treat. What your EP means when he says it's sinus tachycardia is that the QRSes are normal and that he doesn't see anything to be concerned about in the ECG. In fact, 7-10 fast beats isn't even long enough to be considered an arrhythmia. If this really bothers you, just keep in mind that it's a mental thing. There is no actual danger and you can safely ignore it and keep running. Alternatively, there are meds you can try, but I wouldn't if I were you. There are also alternative treatments you could try on your own, many of which are discussed here at length. Increasing your intake of potassium and magnesium would probably be the first thing to try, and how to do that is also discussed here at length.

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Juggsy75
I get little episodes like this, mine are like 7-10 fast beats then big beat back to normal, my ep says it’s sinus tachycardia and nothing to worry about.... but I thought sinus tachycardia was Whalen you did something your heart naturally goes up, inappropriate sinus tachycardia is when it happens for no reason like mine, which I’ve read is more serious🤷🏻‍♂️🤷🏻‍♂️

If it were me, I'd try the MAF approach I linked here. Dr. Maffetone's approach is to exercise at a level he created empirically and has a way to customize it to you. The idea is, at this level, you should be improving your fat burning system and mitochondria. If done correctly, you should be able to do more at that level as time goes on. The temptation is to think it is too easy. My I know folks who have done this and ultimately can do a huge amount of work at this level, as their "engine" gets more efficient. There are a lot of ways to exercise, but I look at those of us in arrhythmia from excercise space as having bodies telling us, "I'm not too happy with what you are doing." My approach is to not do those things and then see if I can change body's adaptation to be able to do more at the level it is happy at. This has been my approach fo 16 years and it has worked pretty well, when I follow my plan. I'm 65 and while I do have limits (my trigger being the product of intensity and time), I remain very fit, can ski hard, at 12,000' rock climb, carrying a 60# pack up very steep approach trails with nasal breathing at elevations above 7500' and do on. I weigh what I did in grade 10 and my body fat is in the low teens. I don't follow my friends who want to go do century rides and the like as they are contraindicated for me.

I was first exposed to this concept 30 years ago. I didn't follow it and pushed myself much harder. If I had pursued it, there is a good chance I'd have never gotten afib.