I had an ablation 3 years ago for afib/a flutter and during the procedure it was discovered I had a congenital Atria Septal Defect that was sizable but not shunting so my cardiologist said because of the location closure would involve opening my chest rather than the less invasive method. He put me on Eloquis for life and said that would protect me from strokes and unless something changed we should just leave it as is.
I have several questions that perhaps some of you can help me with...
1. What percentage of protection does a blood thinner give to potential cross flow embolisms that could lead to a stroke?
2. My afib and short tachycardia bursts have come back while exercising heavily but nothing sustained so is that considered “corrected” or should I have another ablation so they never return?
3. Are there any long term effects of eliquis that I should be aware of besides being wary of bruising, etc...?
I am a 64 year old male with no other medical issues. Thanks in advance for any advice you can offer.

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Robbiecriss

1. What percentage of protection does a blood thinner give to potential cross flow embolisms that could lead to a stroke?

Generally, anticoagulation reduces stroke risk by 50-60%. If you go through the CHA2DS2–VASc data, you'll see that some controllable issues, such as hypertension and T2 diabetes increase your risk even more than this. So you should make every effort to not have those issues, as the 50-60% applies to whatever your latent risk is. Hence reducing your latent risk makes sense.

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Robbiecriss
2. My afib and short tachycardia bursts have come back while exercising heavily but nothing sustained so is that considered “corrected” or should I have another ablation so they never return?

You might want to prioritize higher volume Zone 2 exercise. If you listen to this podcast [peterattiamd.com] between Peter Attia & Iñigo San Milan ( researcher and coach of the 2020 Tour de France winner), you'll note that Z2 actually tunes up your mitochondria. The easy way to do this, without lactate testing is to implement Phil Maffetone's heart rate approach: Attia interview, website

The interesting part about training this way is it not only "improves" your mitochondria, but also your lactate disposal in Type 1 muscle fibers. When you switch to anaerobic metabolism, the lactate is generated in Type 2 fibers but must be disposed of by Type 1.

If "heavy exercise" means strength training, then using KAATSU blood flow restriction might be useful. These pneumatic bands create a mild hypoxic environment in the muscles. Working out with 30% of your 1 rep max with say 30 reps the first set to failure and 3 other sets with lower reps to failure with a 15 second rest between sets on arms and 20 second on legs can have the same metabolic effect (growth hormone, VEGF & etc.) as say 7 or 8 reps to failure at 80% of 1 rep max. So you get the benefit without the stress and perhaps avoiding your afib/tachycardia.



Edited 1 time(s). Last edit at 02/20/2021 01:58PM by GeorgeN.

Thanks so much for your well informed response. I don’t do strength training but I have been runner prior to my ablation for over 30 years. Now I am mostly walking regrettably because of discomfort caused by exercise induced tachycardia.

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Robbiecriss
I have been runner prior to my ablation for over 30 years. Now I am mostly walking regrettably because of discomfort caused by exercise induced tachycardia.

So, look at it from the other side, an opportunity - if you can get up to your MAF heart rate walking, or whatever you can do below it. Then think about that you are training your mitochondria and your lactate disposal system. Persisting with volume at this level may allow you to do more (faster) work at the same level.

In my linked interview between Attia & San Milan. Attia noted that when he dose a Zone 2 workout wearing a continuous glucose monitor, his glucose drops during the session. This caught my attention, because with harder workouts, my glucose will increase mildly. So I tested it, and my glucose was unchanged after a workout. Then did a 30 minute sauna, which will typically increase glucose (mildly). Again, no increase. Then consumed a 60 gram glucose (starch) bolus from millet and sorghum, and no response after an hour. I'd typically see a material blood sugar response from 60 grams of glucose. So very unstressful, metabolically, on the body. I've repeated this with the same results numerous times.

I'm not a fan of doing one thing for 60 minutes, so figured out I could create my own workout from all kinds of things, just keeping my heart rate in the MAF/Zone 2 range. It works well. I use all manner of bodyweight exercise, jump rope, a Schwinn Airdyne fan bike, Schwinn fan rower, Nordic Track, TRX, isometrics, core, you name it. I'm 65, so my MAF heart rate is 115 (and no deducts as no meds or any other conditions). Also, everything I do is with nasal breathing.

So they get all technical about Zone 2 using a bike and measuring lactate. The Maffetone, MAF approach gives the same result for our purposes (perhaps not if you are training for the Tour de France).