Atrial Fib/Activity Level High Blood Pressure

[Kymom]

My 16 year old son is being treated for AF and has had this issue now for 1 1/2 years. He is currently on Flecainide and is working.

About 6 mths ago through a stress test it was discovered he had high bp (top # only) during intense exercise. He was on Sotalol during this time. 3 months later (30lbs lighter and on Enalapril) he took another stress test and tested normal (still on Sotalol). Recently came off of Sotalol onto Flec. My flag went up in my head since he was now off Sotalol, what would his activity level bp be now without the beta blocker factor Sot. provided? Took another stress test and result was high bp (top # only) during activity (not as high as 1st test), also went into AF (converted on his own after 15 min.) right after test.  Activity seemed never to be a factor in his AF because he never had an episode during or immediately after activity (many Holters).

My gut instinct is he has had this activity bp for a few years. Add bp issue to the amount of weightlifting (highschool football player preparing for college) he was doing and I think (doc too) that you have the reason he has AF issues. He is 5' 10" and at the time 265lbs (under 10% body fat), now 235, working on 20 more. Thought is to get bp issue under control and then AF issue will be no more.

My question is, if for some reason bp can't be controlled with meds and continued lifestyle changes and this is still the cause of his AF, would he still be a candidate for PVI Ablation? HBP in family. Was buying time on meds until PVI around longer but perhaps not an option now or is it?

Thanks!

[CCF-M.D.-RCJ]

kymom,

Thanks for the question.

First, it is normal for the blood pressure to rise during exercise.  I have never given a patient the diagnosis of hypertension based on exercise blood pressure alone.  We use a systolic blood pressure of 180 mmHg to say that someone had excessive exercise-induced blood pressure here at the CCF.

Second, I think the continued weight loss with a mind for avoiding high blood pressure is a fine goal.

Third, PV ablation is a relatively new procedure.  Thus, the future complications (such as pulmonary vein stenosis) are not fully known.  I would not recommend this procedure to a young person unless they had severe atrial fibrillation -- ie, severe symptoms or very frequent occurences.

Hope that helps.

[Kymom]

The 1st test the top bp number was 268, the 2nd test the top bp number was 212 and the 3rd test, the top number was 224.

[hbp702]

Weight loss is advised even with less than 10% body fat?

I thought percent body fat was the risk factor, not weight per se.

High weight and low body fat would be a lot of muscle - I thought that was supposed to be good.

I'm confused.

[Kymom]

I always knew that my son's weight exceeded where he should be for his height. But, he was an athlete who was a pretty solid kid, so I thought that was alright.

Some people's body perhaps can handle the additional muscle weight and I think other people's can't. My son stopped building muscle and lost some weight and there has been a change in his bp. That tells me he's one that can't handle the additional muscle weight, his body doesn't like it. The blood pressure issue could be his weight and it could be genes or a combination of both. The blood pressure issue contributes to his AF, so no more muscle building for him.

Don't know if that helps or not.

[Firehawk734]

5 10 and 265 at under 10% body fat?? Sounds like a steroid case to me.  No offense or anything, but at that size, thats well over what the body would typically develop muscle even if you worked out every day.

I am a weightlifter so I know.  If he doesnt do steroids then he must have one hell of a big wide frame, or he takes alot of supplements or SOMETHING.

But losing muscle in an attempt to get "lighter" just does not seem like the proper way to go about this.  If a doctor told you to burn off muscle, then Id get another doctor.