Running with AFIB or After Ablation

Kenyhercz wrote:

How did you fare Ernest? I was in constant afib for over 6 months before I knew it. I have always been fit but not a racer. I ran about 6 miles 5 days per week. I got covid in Dec 2021 and was having trouble breathing when I ran, so bad I couldn’t even run a minute. To condense the story by the time afib was diagnosed I had a blood clot in my heart causing a heart attack. Two months later I had a 3 hour cardiac ablation. Meds metoprolol and blood thinners x 2. Doc said covid can cause a flutter to turn into afib. I was told I could go back to running but 3 months after the Ablation can only run 3 minutes before I am out of breath and HR is 160. I do a run then walk until my HR is 100 then run then walk…seem to be very slowly adding time to my run time over weeks.

Andre Dane wrote:

Hi Guys.
Found your interesting thread after googling. Thanks for sharing.

I got an afib ablation 3 months ago and I noticed a few things that I would like to share. (I am 48 male)

I have run 2 marathons in the past, the latest 18 years ago 3.20. Stopped because of back pain and went more into watersports (rowing, kitesurfing and freediving).

I was drinking maybe 5-10 drinks per month but for the last 77 days I have been alcohol free. After some weeks I got the desire to run from the extra energy and I have steadily increased (last week 55km). It is hard though, but I really like the long slow runs.. Also did my first tempo training yesterday.

When I first got AF I red that drinking alcohol could induce AF. So I did not drink for 4 months. And did not have any episodes at all. Then at one party I completely overdid it and one week after I got afib.. I moderated my drinking to 5-10 drinks per week but still got Afib and got cardio converted several times at the hospital in the following months. Then I tried to meditate (min 12 min per day 5 days per week) and did not experience any AF episodes at all for the last 4 months up to ablation.

After getting my ablation I decided to quit alcoho for good, but I actually wish I had done that before I got the ablation - but I was not ready for that change at that time.

My resting HR went from around 53 to 75 after ablation.. but after starting my running I am now down to resting 63 HR. I hope running long distance can decrease this even further... I have been training freediving and this higher resting hearthrate is an extra challenge..

Since I am "fairly young" in AF terms I was taken off anticoagulation drugs, so I take no medication.

If some of you still experiences AF I would recommend try quitting alcohol completely. It is actually highly rewarding with better mood, less anxiety, better sleep and more energy. And consider meditation, just 12 min 5 days per week is enough. Sit stil and only focus on breathing and once your focus starts to drift just gently pull back your focus.

OLD SMTC SOB wrote:

Andre Dane wrote:

Hi Guys.
Found your interesting thread after googling. Thanks for sharing.

I got an afib ablation 3 months ago and I noticed a few things that I would like to share. (I am 48 male)

I have run 2 marathons in the past, the latest 18 years ago 3.20. Stopped because of back pain and went more into watersports (rowing, kitesurfing and freediving).

I was drinking maybe 5-10 drinks per month but for the last 77 days I have been alcohol free. After some weeks I got the desire to run from the extra energy and I have steadily increased (last week 55km). It is hard though, but I really like the long slow runs.. Also did my first tempo training yesterday.

When I first got AF I red that drinking alcohol could induce AF. So I did not drink for 4 months. And did not have any episodes at all. Then at one party I completely overdid it and one week after I got afib.. I moderated my drinking to 5-10 drinks per week but still got Afib and got cardio converted several times at the hospital in the following months. Then I tried to meditate (min 12 min per day 5 days per week) and did not experience any AF episodes at all for the last 4 months up to ablation.

After getting my ablation I decided to quit alcoho for good, but I actually wish I had done that before I got the ablation - but I was not ready for that change at that time.

My resting HR went from around 53 to 75 after ablation.. but after starting my running I am now down to resting 63 HR. I hope running long distance can decrease this even further... I have been training freediving and this higher resting hearthrate is an extra challenge..

Since I am "fairly young" in AF terms I was taken off anticoagulation drugs, so I take no medication.

If some of you still experiences AF I would recommend try quitting alcohol completely. It is actually highly rewarding with better mood, less anxiety, better sleep and more energy. And consider meditation, just 12 min 5 days per week is enough. Sit stil and only focus on breathing and once your focus starts to drift just gently pull back your focus.

Being "fairly young" will not protect you from some of the side effects of A-Fib. One of the most immediate effects is the tendency for the blood to pool and clot in the atrial appendix. If the A-Fib is persistent over several days to a week and a clot forms, once the rhythm converts back to normal sinus the clot can travel into the brain where it can cause a stroke. Unless you immediately know when you're in A-Fib, and many people don't, you're at high risk. So anticoagulation is prudent unless you know and can anticoagulate to guard against it. And a baby aspirin isn't enough. I'd have another chat with your MD.

glad you know better wrote:

OLD SMTC SOB wrote:

Being "fairly young" will not protect you from some of the side effects of A-Fib. One of the most immediate effects is the tendency for the blood to pool and clot in the atrial appendix. If the A-Fib is persistent over several days to a week and a clot forms, once the rhythm converts back to normal sinus the clot can travel into the brain where it can cause a stroke. Unless you immediately know when you're in A-Fib, and many people don't, you're at high risk. So anticoagulation is prudent unless you know and can anticoagulate to guard against it. And a baby aspirin isn't enough. I'd have another chat with your MD.

Classic LR. Dude's cardiologist is satisfied that the guy's risk of recurrence is low enough that the benefits of AC don't outweigh the risks, but LR knows better and wants to send the guy back to demand Eliquis.

And being fairly young does decrease your risk of A fib related thromboembolic events, which is why age is a factor in CHADS-VASc score.

another afibber in residence wrote:

glad you know better wrote:

Classic LR. Dude's cardiologist is satisfied that the guy's risk of recurrence is low enough that the benefits of AC don't outweigh the risks, but LR knows better and wants to send the guy back to demand Eliquis.

And being fairly young does decrease your risk of A fib related thromboembolic events, which is why age is a factor in CHADS-VASc score.

old smtc sob is a notoriously negative person if you have seen his posts over the years. While there are elements of truth in what he says, tact is not his strong suit.

Yes different cardiologists (as with doctors in other specialist areas of medicine) will have different opinions on treatment - this is not an exact science, as reactions to treatment will differ for a given individual.

But this thread has been informative - as someone in their mid-60's, only recently back in Afib (a month) after 15 years without (with only the rare episode) it looks like running (after a planned hip operation) will now be recreational if at all - mostly just coach these days anyway. Needless to say I can't run with my young athletes anymore and that is something I miss.

Andre Dane wrote:

Thank you for your concern.

My cardiologist explained to me that in my "relative young" age the long term side effects of anticoagulants on the vessels in the brain are as severe as the increased risk of stroke (if I live long). So even before I got my ablation I could choose if I wanted medication or not. Only caveat was that if I got Afib and needed a DC conversion, then I had to wait 3 weeks while taking my meds (unless I could get a DC within 3 days of AFib onset)

And now after my ablation I am Afib free, so I am allowed to not take my anticoagulant. This is also due to good health score (smoking, overweight, diabetes etc).

These are the European guidelines, but might differ in other regions.

But everyone should first speak with their cardiologist to not take any unnecessary risk as you point out.

OLD SMTC SOB wrote:

another afibber in residence wrote:

old smtc sob is a notoriously negative person if you have seen his posts over the years. While there are elements of truth in what he says, tact is not his strong suit.

Yes different cardiologists (as with doctors in other specialist areas of medicine) will have different opinions on treatment - this is not an exact science, as reactions to treatment will differ for a given individual.

But this thread has been informative - as someone in their mid-60's, only recently back in Afib (a month) after 15 years without (with only the rare episode) it looks like running (after a planned hip operation) will now be recreational if at all - mostly just coach these days anyway. Needless to say I can't run with my young athletes anymore and that is something I miss.

So how have my posts been any more or less negative than anyone else on this message board? And while there are always differences of opinion between MD’s the data on A-Fib and the risk of thromboembolic events is clear. Unless one knows they are in A-Fib and can anticoagulate within sever hours the risk of CVA is very real. And can be deadly. And most people don’t realize they are in it. Isn’t worth the risk.

glad you know better wrote:

OLD SMTC SOB wrote:

So how have my posts been any more or less negative than anyone else on this message board? And while there are always differences of opinion between MD’s the data on A-Fib and the risk of thromboembolic events is clear. Unless one knows they are in A-Fib and can anticoagulate within sever hours the risk of CVA is very real. And can be deadly. And most people don’t realize they are in it. Isn’t worth the risk.

The risk of bleeding on AC is also very real. So when you reduce the risk of embolic stroke with AC, you are increasing the risk of hemorrhagic stroke. You have to consider both the benefits and risks of the medication.

Risk of thromboembolic event in the setting of Afib depends on a number of other factors. If the patient doesn't have any other risk factors (i.e. CHADS-VASc of 0), their stroke risk is about the same as someone who is not in Afib. A CHADS-VASc of 1 (if you have hypertension or diabetes or you're over the age of 65, for example), gives you about a 1.3% annual risk of stroke. A score of 2 (i.e. two risk factors, or previous stroke, or over the age of 75) gives you a stroke risk of 2.2%. So real risk, but not these are annual risks and the idea that someone is going to flip into Afib and stroke in a matter of hours is a little dramatic.

Ablation has a very high success rate in young patients who are early in the progression of disease. 92% of patients who have Afib ablation at my hospital remain in sinus rhythm going forward. The number is lower for older people who have been in Afib for years, and higher for people who are younger and early in the course of Afib progression.

So let's imagine we have a young, otherwise healthy guy with a CHADS-VASc of 1 who has just undergone ablation and is now in sinus rhythm. Guy has a <10% chance of ever going into Afib again, and if he does go into Afib again his risk of stroke is 1.3% per year that he remains in Afib, all while he is seeing his cardiologist regularly to assess for recurrence. Is there a non-zero risk of embolic stroke? Sure. Is it worth putting him on AC and creating the risk that he'll have a brain bleed if he slips and falls during a run? Probably not.

All this is to say that I trust the other poster's cardiologist, who has a firm understanding of all of the patient's risk factors, to make a more informed decision about anticoagulation than some guy on the internet who went to Google College of Medicine.

OLD SMTC SOB wrote:

glad you know better wrote:

The risk of bleeding on AC is also very real. So when you reduce the risk of embolic stroke with AC, you are increasing the risk of hemorrhagic stroke. You have to consider both the benefits and risks of the medication.

Risk of thromboembolic event in the setting of Afib depends on a number of other factors. If the patient doesn't have any other risk factors (i.e. CHADS-VASc of 0), their stroke risk is about the same as someone who is not in Afib. A CHADS-VASc of 1 (if you have hypertension or diabetes or you're over the age of 65, for example), gives you about a 1.3% annual risk of stroke. A score of 2 (i.e. two risk factors, or previous stroke, or over the age of 75) gives you a stroke risk of 2.2%. So real risk, but not these are annual risks and the idea that someone is going to flip into Afib and stroke in a matter of hours is a little dramatic.

Ablation has a very high success rate in young patients who are early in the progression of disease. 92% of patients who have Afib ablation at my hospital remain in sinus rhythm going forward. The number is lower for older people who have been in Afib for years, and higher for people who are younger and early in the course of Afib progression.

So let's imagine we have a young, otherwise healthy guy with a CHADS-VASc of 1 who has just undergone ablation and is now in sinus rhythm. Guy has a <10% chance of ever going into Afib again, and if he does go into Afib again his risk of stroke is 1.3% per year that he remains in Afib, all while he is seeing his cardiologist regularly to assess for recurrence. Is there a non-zero risk of embolic stroke? Sure. Is it worth putting him on AC and creating the risk that he'll have a brain bleed if he slips and falls during a run? Probably not.

All this is to say that I trust the other poster's cardiologist, who has a firm understanding of all of the patient's risk factors, to make a more informed decision about anticoagulation than some guy on the internet who went to Google College of Medicine.

"Google College of Medicine". You're quite the comedian. I'm sure you also know that the risk of brain bleed is low, depending on the medication used. Everything is subject to a risk/benefit analysis. Again, I'm talking about someone who does not know they are in A-Fib, where the risk of a thromboembolic event increases over time should they spontaneously covert to NSR, again without realizing it. Do you dispute that? I'm not talking about someone in persistent A-Fib. Ever wonder why a TEE is done pre-cardioversion??? My recommendation was to go back and chat with the Cardiologist, not unilaterally start one's self on an anticoagulant they may still have stockpiled.

glad you know better wrote:

OLD SMTC SOB wrote:

"Google College of Medicine". You're quite the comedian. I'm sure you also know that the risk of brain bleed is low, depending on the medication used. Everything is subject to a risk/benefit analysis. Again, I'm talking about someone who does not know they are in A-Fib, where the risk of a thromboembolic event increases over time should they spontaneously covert to NSR, again without realizing it. Do you dispute that? I'm not talking about someone in persistent A-Fib. Ever wonder why a TEE is done pre-cardioversion??? My recommendation was to go back and chat with the Cardiologist, not unilaterally start one's self on an anticoagulant they may still have stockpiled.

To be clear, the reason I found your post funny and called it "classic LR" was your apparent Dunning-Krugeresque assumption that the patient and physician hadn't already considered the risks and benefits of AC before making the decision. As if they'd just stopped medication by a coin flip and are now just waiting for a deep thinker like you to to remind them to go through a clinical reasoning process that every EP doc and general cardiologist goes through with a dozen patients every clinic day.

And now here you are on cue, back and ready to teach me about why I order a TEE before non-emergent cardioversion, something that any random second year med student understands.

You're the kind of guy who explains what childbirth is like to a room full of women. Even if the little sliver of knowledge you possess about the topic is mostly accurate, the assumption that the world needs your input on the topic is what's really comical.