Exercise causing A-fib???

Hello - I’m interested if others have had similar experiences with A-fib during/after exercise and any suggestions/advice from folks that have.

Background: 57yo male, 6ft 3in. 220 pounds. Active. High blood pressure for 10+ years that was controlled with HCTZ. First Afib episode was March 2022. Converted on my own 12 hours later. Initially, doctors thought it might be “holiday heart”. But, second episode was 5 months later (Aug 2022) and I had to be cardioverted. Since then, I’ve gone into A-fib 6 more times. Converted on my own 6 to 24 hours later on all except episode #7 - cardioversion again. Current meds are Ohmesarten, Diltiazem, and Propranolol. I also take a multivitamin, magnesium, and a baby aspirin. No alcohol in 12 months. No caffeine in 20 years. Low salt diet.

Situation: I’ve been playing competitive pickleball for just over a year (June 2022). Over the past 8 months, the last 5 a-fib episodes occurred soon after playing. At first, I suspected dehydration as the cause and started making sure I was drinking enough water before, during, and after playing. Yesterday, I was playing pickleball and started to feel some palpitations. Obviously, got concerned since this is how a-fib episode #8 started. So, I stopped playing, drank some water, and went home. I didn’t go into a-fib, but felt I would have if I continued playing.

When playing pickleball, it’s a lot of quick stop-and-go footwork, reaching up/down and side-to-side arm movements. It definitely gets my heart rate up. When I first started playing, I felt great as it was a good workout.

I'll add, I walk 2 miles 4-5x/week on a hilly road and never have an issue with palpitations or a-fib.

Has anyone else experienced a-fib while exercising, or soon after? Was exercise the cause of the a-fib or was there some other factor? Any suggestions aside from not playing? I do enjoy it.

Sorry for the long post. Thank you.

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douellette17289
Has anyone else experienced a-fib while exercising, or soon after? Was exercise the cause of the a-fib or was there some other factor? Any suggestions aside from not playing? I do enjoy it.

Short answer is yes. Chronic fitness was my path to afib over 19 years ago (I'm now 68). There is a subset of afibbers where exercise is the trigger. If it happens after, it is usually a "vagal" or parasympathetic trigger. If while you are exerting hard, then an "adrenergic" or sympathetic trigger. See here. Some people can have both, called mixed.

There is a fair amount on the exercise topic in this thread. The book talked about "The Haywire Heart" is more from a bicyclist perspective, however the issue is the same no matter what the activity. More on exercise & afib here.

I empirically figured out that, for me, the trigger was the product of duration times intensity. That is long duration, high intensity could be a trigger; long duration low intensity was OK and short duration, high intensity was OK (i.e. 4 minutes of 8 x 20:10 second tabatas as hard as I can on a fan bike preceded and followed by a 3 minute warm up and cool down). I also learned that what the cyclists call "Zone 2" was an exertion limit that I could do for a long duration without it being a trigger. Above Zone 2 is technically where lactate starts to accumulate and energy generation is anaerobic. If you were walking fast/jogging and talking on the phone, the other person would know you were exercising, but you wouldn't be out of breath. Also you could easily be nasal breathing. For heart rate, the quick answer is Phil Maffetone's MAF heart rate, nominally 180-age (he has modifiers that decrement if you are on meds). In great detail see the interviews with Dr. Iñigo San Millán linked in the second paragraph here.

As to how to not have exercise be a trigger & play pickleball with the effort you want to, that is a good question. I love alpine skiing, but I know what my limits are, in terms of long duration intensity. If I honor those limits, I'm OK, if I don't, I commonly get afib.



Edited 1 time(s). Last edit at 09/15/2023 07:57PM by GeorgeN.

If your docs think it is right for you, they could prescribe a med on demand to convert you without having to go through ECV. Generally known as PIP or pill in pocket. Here is the original 2004 article on the topic from 2004. The two choices for meds in this article are flecainide & propafenone. I've used flec in this way since 2004. For others reading this, the max dose depends on weight. 200 mg/day for those under 154#/70kg and 300 mg/day for those over. You generally take it as soon as you know you are in afib. I chew my dose (foul tasting) so as to get it into my system as fast as possible. It has worked 100% of the time for me, including a 2 1/2 month episode in 2004 (I was the one that suggested the script from the EP then). That took 20 hours to convert, but most take a few hours.

I am 71 now but for the last 15 plus years had afib from playing competitive tennis (meaning, local leagues but with younger players, state championships, etc.). Clearly adrenalin was the culprit because anxiety about wanting to win (versus "fun" tennis with friends) made a difference. Also, serious heat (I live in North Carolina) upped my chances. But still, I only had 2-4 known afib events of 2-12 hours max for that period of time. I self converted but the trick for me was taking liquid magnesium from Cardiovascular Solutions (in OJ) which made my heart feel calm amazingly quickly and I would convert to sinus without ever being cardioverted. I also take 4 Magnesium tablets a day from Pure for 1000 mg which I tolerate well. I have been taking 2 potassium tabs before playing and now am drinking electrolytes as well which seems to help immensely. From being on this forum for 20 years, I think it is understood afibbers blow through magnesium faster than most folks. Finally, the game was up and I had an ablation in 8/22 after falling hard playing tennis and breaking my ankle. That adrenalin burst just blew up those tenuous electrical connections and I started Multaq (which I LOVE and am still on since I think I will need a wee touch up ablation at some point) which has held me in rhythm through 3 hour matches in 100 degree heat! No way I could do that without the Multaq.

Wishing you the best of luck. There are many solutions to try so don't give up something you love! PIP is certainly one as George suggested. Most importantly is finding a very good electrical physiologist and getting evaluated and a plan of action to consider. Not a cardiologist. We all are learning this is a life long condition that will require different strategies at each stage. I was glad to have the ablation when the thought of not playing tennis or constantly wondering if I was having PACs or afib was a far worse option, physically or socially! You might want to get a Kardia machine to get 6 lead readings to give to whatever physician you are seeing as well.

Some physical activities cause more Atrial Stretch than others. Atrial Stretch is one of the factors that contributes to the occurrence of an AFIB episode. In addition to the adrenal impact on the heart from intense competition, the Pickleball is probably causing more atrial stretch than the walking or other activities you might do. Constantly raising your arms up and around is why. We know for example that lifting weight (pushing) above the head puts alot more strain on the Atria and valves, than compared to other weight training, even if alot more muscle mass is put under load, as with the lower body leg exercises. I suggest you either suspend the Pickleball for awhile, and then try it later, or somehow temporarily engage in it at a lower intensity.

There is a saying than AFIB begets AFIB", and likewise NSR begets NSR. Momentum is important is the struggle against AFIB, so why continue with a known triggering activity, when there are alternative forms of exercise and sport that probably won't trigger your AFIB.

This is coming from someone fighting AFIB for 18 years having over 100 episodes, and participating in a wide variety of physical activities the whole time.

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The Anti-Fib
There is a saying than AFIB begets AFIB", and likewise NSR begets NSR. Momentum is important is the struggle against AFIB, so why continue with a known triggering activity, when there are alternative forms of exercise and sport that probably won't trigger your AFIB.

Thanks for reminding me this. I just bought the pickleball set

During my first round of afib before my first successful ablation - 1996 to 2006 (11 years, I was very active. At least a 1,000 to 1,500 days doing weights, jogging, windsurfing, skiing, golfing & hiking. During the last 5 years of the afib, I documented over 200 episodes. As I recall, physical activity rarely if ever caused an afib episode.

Point being, there are few universal truths regarding what can initiate an episode of afib.

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Ken


Point being, there are few universal truths regarding what can initiate an episode of afib.

Indeed.