Low rate, asymptomatic AFIB

Hello everyone,
I have asymptomatic, low rate AFIB. I passed a cardioversion 2years ago. The sinus rhythm continued until I received the Covid vaccine when my AFIB returned.
I went to several cardiologists. Some recommend ablation others recommend doing nothing because I do not feel anything. But, lately it appears that recent and very important studies clearly indicate that living with AFIB causes heart damage.
Has anyone had the same experience?

You should start Eliquis to lower your risk of a stroke. If one is to get afib, the best kind is a low rate and no symptoms. As crazy as it sounds you are fortunate you are not getting higher heart rate, pounding and dizziness. At one time I was like you and my EP told me to live with it. IMHO you have time and should wait until the pulse technology is perfected. Were you offered Multaq as an anti arrhythmia drug? It’s one of the mildest.



Edited 1 time(s). Last edit at 05/11/2021 03:55AM by susan.d.

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Liliana Kleiner
But, lately it appears that recent and very important studies clearly indicate that living with AFIB causes heart damage.

What studies are you talking about? I know of no such studies and I follow this stuff closely. Millions of people live with persistent AF and as long as they keep their heart rate under control and take an anticoagulant, there's absolutely no difference in lifespan between them and people without AF. AF only causes heart damage if a high heart rate is allowed to continue uncontrolled for prolonged periods (weeks or months, not days).

So if your heart rate is consistently under 100 and you're taking an anticoagulant, you have no need to do anything at all. Your AF will not cause heart damage and if I were in your shoes I wouldn't consider an ablation.

If you can exercise/climb many floors of stairs ect. and not feel weak or dizzy or your heart rate does not shoot up though the roof because of that i would wait to get an ablation but this malady does not get better with age so more then likely its just a matter of time when you will need 1.
My brother in law has perm. Afib + does not feel it he says + i took his pulse + its around 90-100 but when he does anything strenuous HE FEELS
WEAK way quicker then he used to.....when a person tells me they don't feel Afib i say to them.....stress your heart strongly with exercise + then tell me you still don't feel it.....only then is when i believe them because when i was in afib i was like a 4cl. car running on 3 cl. at best + if i put my foot on the gas peddle i sputtered + near stalled quickly + i am extr. healthy + fit....although i was pretty normal in park + i hardly felt it also....but we don't live our lives in park.

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vanlith
If you can exercise/climb many floors of stairs ect. and not feel weak or dizzy or your heart rate does not shoot up though the roof because of that i would wait to get an ablation but this malady does not get better with age so more then likely its just a matter of time when you will need 1.
My brother in law has perm. Afib + does not feel it he says + i took his pulse + its around 90-100 but when he does anything strenuous HE FEELS
WEAK way quicker then he used to.....when a person tells me they don't feel Afib i say to them.....stress your heart strongly with exercise + then tell me you still don't feel it.....only then is when i believe them because when i was in afib i was like a 4cl. car running on 3 cl. at best + if i put my foot on the gas peddle i sputtered + near stalled quickly + i am extr. healthy + fit....although i was pretty normal in park + i hardly felt it also....but we don't live our lives in park.

That’s why some permanent afibber’s are on controlled rate drugs like a beta blocker so their hr doesn’t score. Liz has permanent afib and doesn’t feel it and does gardening etc at 84.

Thank you all for responding to my post. It helped a lot.

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vanlith
when a person tells me they don't feel Afib i say to them.....stress your heart strongly with exercise + then tell me you still don't feel it.....only then is when i believe them because when i was in afib i was like a 4cl. car running on 3 cl. at best + if i put my foot on the gas peddle i sputtered + near stalled quickly + i am extr. healthy + fit....although i was pretty normal in park + i hardly felt it also....but we don't live our lives in park.

I know several people who have been in longstanding persistent afib for years and also compete in marathons, cycling, and even triathlons. It's actually pretty common for persistent afibbers to be completely asymptomatic even while exercising. In fact, there's a long list of world class athletes who competed while in afib.

It's the paroxysmal afibbers who are usually highly symptomatic and that makes it hard for them to imagine someone not feeling it at all, but it's true that many persistent afibbers don't. In fact, afib often goes undiagnosed for years because many doctors no longer do routine ECGs on apparently healthy patients with no symptoms. Big mistake, IMO.

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Carey
I know several people who have been in longstanding persistent afib for years and also compete in marathons, cycling, and even triathlons. It's actually pretty common for persistent afibbers to be completely asymptomatic even while exercising. In fact, there's a long list of world class athletes who competed while in afib.

It's the paroxysmal afibbers who are usually highly symptomatic and that makes it hard for them to imagine someone not feeling it at all, but it's true that many persistent afibbers don't. In fact, afib often goes undiagnosed for years because many doctors no longer do routine ECGs on apparently healthy patients with no symptoms. Big mistake, IMO.

I presume those people had persistent afib, but at a low AVG rate ?
I can't imagine them taking BBs or other meds...
Do we know whether they had afib while exercising or not? (You wrote "persistent" afib, not "permanent" afib).
May we imagine their HR had nothing wrong while intensely exercising?

The fact is I've never tried exercising while in afib. I've just tried static bicycling while in afib just to see if I could get back to NSR that way, but it didn't work, so I did not try any more.
I don't feel good while in afib, since my HR stays around 120-130 BPM, so I'm not keen stressing my heart with exercise. Do you think it could be dangerous doing that?

Some don't have a rapid rate but others do, although probably not super high. Hard to imagine a rate of, say, 180 going unnoticed for long. If they're over 100, they definitely need to be on rate control. At least two of the people I mentioned (the marathoner and the cyclist) are on beta blockers. It doesn't seem to bother them at all.

Allowing a rate of over 100 to continue for long periods (weeks, months) can lead to heart enlargement and ultimately heart failure. I know (knew) an individual who allowed his 125 bpm rate to continue for several months and ended up in heart failure. He ignored it because, according to him, his EP's nurse told him not to worry about it. So that's what he did -- he just ignored it for several months. I don't know where the communications failure happened there but it ended up being fatal for him. He died last summer of complications of heart failure.

I've tried a BB, but even the smallest dose makes me feel bad. I'm hardly reaching 90-100 BPM while climbing stairs at full speed, finishing completely breathless .
The only benefit I get from BB is a lower HR while in afib, but I think it's not worth it, since my (weekly) episodes are short and self-ending.
I'm still amazed hearing about people having persistent afib and remaining healthy athletes. I guess their bodies got used to this somewhat "stable" condition.
It's likely different for paroxysmal afibbers, isn't it ?

Yeah, the marathoner I mentioned only found out he had AF when it was discovered in a routine physical. He said he hadn't had a physical for several years before that, so who knows how long he was in AF without realizing it? This is how people die of strokes. But the typical paroxysmal afibbber feels every damn beat and knows instantly when they're in AF.

I'm the same way with BBs as you are. I absolutely despise them because even a low dose makes me feel like someone strapped weights on my arms and legs. Easy things like just climbing a flight of stairs becomes a chore. Climbing a long, steep hill on my bike? Forget it.

Have you noticed how few persistent afibbers we have here compared to paroxysmal? That's because a big percentage of persistent afibbers have no symptoms so they see no reason to join forums to talk about it. The same explanation applies to people who've had a one-and-done successful ablation. They don't come to forums because they have no need to talk about it or seek solutions, and this leads to the perception that ablations always require multiple procedures (I've heard those words stated here more than once). But a quick look at any of the studies available proves that wrong. Even among average EPs about 70-75% of all ablations are successful and require only one procedure. Among top EPs, the numbers are much higher.

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Carey
Some don't have a rapid rate but others do, although probably not super high. Hard to imagine a rate of, say, 180 going unnoticed for long....

Allowing a rate of over 100 to continue for long periods (weeks, months) can lead to heart enlargement and ultimately heart failure. .

~16 years ago, I had a trial lawyer in his 40's who had unknowingly stayed in very high rate afib (180 comes to mind) for many weeks before it was discovered. It really compromised his ejection fraction. He ultimately could not practice law and stay out of afib or in afib at a rate <100 (stress was too great), so went on disability. I tried to get him to go see Natale, but was unsuccessful in convincing him to do so.

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Carey
Have you noticed how few persistent afibbers we have here compared to paroxysmal? That's because a big percentage of persistent afibbers have no symptoms so they see no reason to join forums to talk about it.

I have a good friend right now who is not persistent (yet). He feels nothing, but he does jog and noticed his heart rate going wonky on his monitor. Also afib was caught on a routine physical. He got a Kardia and confirms he's in and out of afib. He's materially overweight with a large waist circumference. Also on treating meds for hypertension. I've tried to get him to pay attention, but he's very casual about it. I suggest to at least get anticoagulated and also plan for rate control if he goes persistent (his afib rate can be like 150 - which he doesn't feel). He was very fit in his 20's (now 65) and his resting heart rate is in the low 40's, so chronic rate control is not a good plan now. He's very fatalistic and says if he only makes it to 75, that is fine. I've tried to convince him that stroking and not dying would not be a good plan.

I've a stepbrother having high BP and cholesterol, but he doesn't stop smoking for (he says) he's not been sick enough to find the motivation to do so.
I'm a strongly demotivating guy, an argument for those who pretend it's not worth exercising and eating healthy food...
5 years is little experience with afib. Are there risks exercising while in afib, as long as I can ride my bicycle securely? I've no other health problems than ectopics and some afib (about 1/100 of my time)...

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Pompon
Are there risks exercising while in afib, as long as I can ride my bicycle securely?

Nope. The only risks would be for people who are prone to syncope during afib, but that falls under the heading of riding your bike securely.

Thanks. It's not easy to ignore those bad sensations in my throat, chest and stomach...

Permanent afibber here for many years... male 72.5 yy.

Exercise 7 days a week (fast-pace walking 5 days, resistance training for 2). During exercise, I know, from experience and my breathing, when to back off in intensity. Usual HR < 80, at rest < 70, exercise < 120.

On Eliquis and 12.5 mg of atenolol, plus many of the supps we all take: mag plus Mag Water, D3, Co-Q10, fish oil, and saw palmetto. No smoking, booze, street drugs, sugar, honey, soda, juice, coffee or tea. Mod Keto diet.

Stress tests, echo, lipids, holters, brain scan for TIA / stroke, blood work including A1C — all excellent / normal. ECG — Afib (rate as above). BMI = 22.8.

Area to improve: amount & quality of sleep (78 yy wife diagnosed with MCI a couple of years ago, and a problem son).

Seen twice yearly by my EP in Naples, FL. Claims I’m the healthiest patient in the practice.

Totally agree with Carey’s posts here.

So thankful for this forum... which I stumbled upon two decades ago when my AF was inadvertently diagnosed (before a minor hospital procedure), and so appreciative of our members past and present — of course, Carey, Jackie, Erling, Shannon, Hans and so many more — for sharing their individual knowledge. This group is at least partly responsible for my current health status.

All the best to everyone!

/LarryG