Blood Thinners
Heart rate change on Coumadin (after catheter ablation, too) 12/27/2009 9:11AM Reply | Return to Index | Report Post
Have any of you been on Coumadin or other blood thinners, and noticed any effects on your heart rate range? I am taking this drug because I had a catheter ablation done on my heart for Afib about 6 weeks ago.

Now I'm finding that my resting heart rate is about 90, and the max I have been able to get it to is ~160 (although I need to check this again today). Before the surgery, I always had a high resting rate of somewhere in the 70-80 range even when I was very fit (ran low 14's for 5k, etc...). However, my max HR was at least in the high 180s if not 190s.

I'm fit now, and have no problem working out at low to medium intensity levels, but can't tell how much this is holding me back when I try to go hard. Also, no lectures necessary on not worrying about this and just staying healthy. I don't really care if I can't compete at a high level anymore. I only want to know if this heart rate limitation is somehow related to the coumadin, or maybe the surgery.

any input would be appreciated.
Pharmacy Student
RE: Heart rate change on Coumadin (after catheter ablation, too) 12/27/2009 11:39AM - in reply to Blood Thinners Reply | Return to Index | Report Post
Coumadin (Warfarin) should have no effect on your heart rate, all it does is prevent your blood from clotting to the same extent as normal. I have no knowledge of ablation effects.
Blood Thinners
RE: Heart rate change on Coumadin (after catheter ablation, too) 12/27/2009 9:35PM - in reply to Reply | Return to Index | Report Post
I had a lot of afib episodes before the ablation. Started pretty sporadic about three years ago, but ended up happening to me every 7-10 days within a year. The episodes generally lasted close to 24 hours, and my irregular heart rate was very high, so I could always feel it. Plus, i would get winded just walking up stairs, for instance, when the next day I could go run a hard 20 miler without any problem (after the episode ended that is).

if you have it, doctors will tell you to try a drug or two or three before you have the procedure done. I tried diltiazem and flecainide. Both helped with what they were supposed to, but their benefits wore off after time.

I was 26 when this problem started and had no other health problems or structural problems with my heart, so it's pretty unusual.
Blood Thinners
RE: Heart rate change on Coumadin (after catheter ablation, too) 12/27/2009 9:37PM - in reply to Pharmacy Student Reply | Return to Index | Report Post
thanks. I haven't found anything linking coumadin to heart rate limitations, so I figured as much. I guess whatever was done to my heart changed how it functions. Hopefully it will get back to normal over time.
transplant
RE: Heart rate change on Coumadin (after catheter ablation, too) 12/27/2009 9:41PM - in reply to Blood Thinners Reply | Return to Index | Report Post
This is interesting, and I'm sorry to hear you had to have an ablation. I have to wonder if it somehow reset your normal sinus rhythm or damaged your sinus node somehow. If it's damaged, your natural atrial rhythm kicks in to keep tempo and would be higher than your old resting rate, and may limit your high-end rate as well. Ask your cardiologist - hopefully he/she is an electrophysiologist to be doing that procedure on you.
M3
RE: Heart rate change on Coumadin (after catheter ablation, too) 12/27/2009 10:25PM - in reply to transplant Reply | Return to Index | Report Post

transplant wrote:

This is interesting, and I'm sorry to hear you had to have an ablation. I have to wonder if it somehow reset your normal sinus rhythm or damaged your sinus node somehow. If it's damaged, your natural atrial rhythm kicks in to keep tempo and would be higher than your old resting rate, and may limit your high-end rate as well. Ask your cardiologist - hopefully he/she is an electrophysiologist to be doing that procedure on you.



What "atrial rate" are you talking about? Your atrial myocytes have no intrinsic pacemaker, and your AV node conducts at a SLOWER rate than the SA node (this is referred to as Junctional Rhythm when the AV node takes over due to a problem with the SA node impulses). It would not conduct faster unless you had a supraventricular tachycardia going on.
M3
RE: Heart rate change on Coumadin (after catheter ablation, too) 12/27/2009 10:28PM - in reply to M3 Reply | Return to Index | Report Post
By the way, coumadin shouldn't "reset" anything. All it does is reduce clotting ability (neither I nor pharmacy student will delve into the nitty gritty details unless you really want them). It should have absolutely no effects on the electrophysical properties of your heart's conduction system. It's given to a-fib patients to avoid clots that can occur with "stagnant" blood that fails to get transported from the atrium to the ventricle because your atrium is not undergoing standard full contractions like in normal sinus rhythm.
Blood Thinners
RE: Heart rate change on Coumadin (after catheter ablation, too) 12/27/2009 10:39PM - in reply to M3 Reply | Return to Index | Report Post
thanks. like i said, i could not find anything linking coumadin to an altered heart rate, so I figured that was not the problem.

I am now seeing a couple studies linking ablation procedures to higher resting heart rates for at least a few months after the procedure. I didn't try to read carefully yet.

At this point, I'm more concerned with the limitation of my max rate. Again today I didn't work out too hard, but still thought my rate should be at least in the 160s according to what I have seen from myself before the procedure. However, I could not get above 159. Tomorrow I'm going to do intervals and see what happens. if I don't go above 160 or 165 then, then I'll know there is a real issue.

of course i'll talk to my cardiologists about this as well.

one final thing about coumadin since there are a couple pharmacists/med students/doctors on the boards: how do blood thinners affect athletic performance? I know this is a dumb question that I could probably look up, but feel free to answer if you need to kill some time. Of course you may not know of specific studies about athletes on thinners, but do they do something that obviously limits the amount of oxygen your blood carries, etc...?
M3
RE: Heart rate change on Coumadin (after catheter ablation, too) 12/27/2009 10:57PM - in reply to Blood Thinners Reply | Return to Index | Report Post

Blood Thinners wrote:


one final thing about coumadin since there are a couple pharmacists/med students/doctors on the boards: how do blood thinners affect athletic performance? I know this is a dumb question that I could probably look up, but feel free to answer if you need to kill some time. Of course you may not know of specific studies about athletes on thinners, but do they do something that obviously limits the amount of oxygen your blood carries, etc...?




To the best of my knowledge it should not have any direct effects on your oxygen carrying capacity or anything of that nature. Here's the very much dumbed down version of how it works (and I apologize if I insult your intelligence in the process, I just figure the info could be used by more people in that manner):

Your body has a bunch of different circulating proteins in your blood called "clotting factors" that work together in a cascade (well, two cascades, sort of) to ultimately lead to a clot. Four of these factors require Vitamin K to "pre-activate" them so that they can take part in the clotting cascades. Coumadin inhibits the process of Vitamin K activating these factors, limiting your blood's ability to clot (i.e. it takes longer to clot than usual).

So really, its direct actions are to prevent Vitamin K from existing in the form it needs to in order to activate these factors. To my knowledge it should not noticeably affect your exercise capacity directly, but if someone knows better please chime in.
mez
RE: Heart rate change on Coumadin (after catheter ablation, too) 12/28/2009 9:34AM - in reply to Blood Thinners Reply | Return to Index | Report Post
Curious as to whether you self-cardioverted after these 24hr episodes. I, like Runs Hot, have had 5 bouts in the last 6 years (master runner), with chemical and electro-cardioversion on 3 occasions. My rate gets high too, and I can't imagine staying like that for too long, It's a horrible feeling, and I count every moment waiting to convert back. Within 3 years you went from occasional to weekly? How long did you stay on drug therapy before getting ablated?
Blood Thinners
RE: Heart rate change on Coumadin (after catheter ablation, too) 12/28/2009 10:14AM - in reply to mez Reply | Return to Index | Report Post
i always self converted. I imagine if i did not they would have had to ablate much sooner. yes, within one or two years i went from barely having this problem to having it almost weekly. the flecainide i took helped spread out the episodes to once every two or three weeks, but only for awhile. After a couple months i was back to a regular 7-10 day schedule.

i took diltiazem for about 1.3 years and flecainide for 1 year before doing the ablation. by the way, neither of those drugs seemed to have an impact on my athletic capacity.

i'm not sure if the procedure it worth it for people who only have an episode or a few per year. the success rate is ~70% at best for the first ablation I think, and there can be complications. For example, the surgeons accidentally damaged my phrenic nerve, so my diaphragm is partially paralyzed right now and I can't run because of the bouncing. They think it will heal, but there are no guarantees.

on the other hand, i haven't had an afib episode since the procedure in mid-november, so that's a good sign.
ceg
RE: Heart rate change on Coumadin (after catheter ablation, too) 12/28/2009 10:29AM - in reply to M3 Reply | Return to Index | Report Post
I've wondered the same thing about coumadin and athletic performance. From personal experience, I was on coumadin for a year and a half after a clotting episode (and finding out I have Factor V Leiden mutation) and think that it may have helped my running in some way. Prior to the clotting episode, for several months I was getting easily fatigued from training and had a harder time than normal recovering from workouts and races. Once I got back to training and was on the coumadin I found that my recovery was much better than before and I could push myself a lot more. I realize that how I was feeling before being put on coumadin could have been a result of the clotting event, but I still wonder if the coumadin helped due to the FVL mutation. I've been off coumadin for four years now and have had trouble with recovery and injury...more so than I used to. The best I've felt running in the past few years has been that stretch I was on coumadin. I've asked the docs if there's a correlation between being on the blood thinner while having FVL and having a greater ability to exert yourself. They don't seem to think so, but I don't think there's a whole lot of information out there on athletes and coumadin and clotting disorders, at least from the searches I've done.
mez
RE: Heart rate change on Coumadin (after catheter ablation, too) 12/28/2009 10:35AM - in reply to Blood Thinners Reply | Return to Index | Report Post
Yeah, I'm just hoping to keep at bay so that "re-modeling" doesn't occur and lead to more frequent or constant afib. It's been 2 1/2 years since the last one (always cold food or drink....vagal?),and the next step would be drug therapy. Either "pill in pocket" or something more. My hope is that I can prevent it totally or hold off as long as possible so that treatment methods continue to improve. I'm always curious to hear people's stories and how they came through vaious procedures. Good luck, happy running and stay afib free!