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Atrial Fibrillation conversion with exercise
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by sotckas, Jul 05, 2005
I am 57 years old and have had chronic AF since I was around 50.  Years ago I used to jog 5 miles a day and do 10K races.  I jogged regularly for about 15 years and occassionally noticed irregular heartbeats while exercising or shortly afterwards.  My resting heart rate back then was 42 to 45.  When I got to around 50 I started having severe episodes of AF and had to have 3 cartioversions initially, and have been taking Sotalol(160mg 3x day)for 5 years to try to control the AF.  Most(95%) of my AF episodes occur at night, after supper, when I am sitting or after going to bed.  Often AF will trigger when I get up from sitting, walk upstairs and lie down in the bed.  Sometimes it will trigger during night while I am sleeping.  I have also noticed that overeating, alcohol consumption and stress will also will trigger my AF.  Lately, the frequency of my bouts of AF has been gradually increasing to once or twice a week and lasting one to three days. I feel really lousy while I am in AF.
  
  I play tennis twice a week and walk/jog vigorously 2 -3 times a week.  I need to lose about 40lbs., but am otherwise in good shape physically.  My resting pulse rate is around 43, probably due to the Sotalol and residual effect of years of running.
  
  A few years ago I found that sustained(50 - 60 min.), vigorous exercise would almost always(90%) convert me back into sinus rhythm.  In fact, I did this yesterday to get back in rhythm.  My question is: Is this ability to convert through exercise unusual and is it possible that my AF may be Vagally Mediated.
Answer:
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by Cleveland ClinicBlank, Jul 05, 2005
sotckas,

Vagal tone as well as heart rate may both play a role in your ability to convert yourself back as both change with exercise.

If your symptoms are debilitating, other antiarrythmics or pehaps an ablation may be the next step.

good luck
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Member Comments (14)
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by Erik36, Jul 05, 2005
How long do you stay in Normal Sinus Rhythm once you covert during exercise? Is this a temporary conversion or do you stay in Normal Sinus Rhythm for an appreciable time?
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by dquenzer, Jul 05, 2005
Sounds exactly like me.  Only I didn't need to be cardioverted.

Actually it is not unusual that exercise sometimes converts AFIB.  That sometimes was my case, but generally not.

If I were you I would really look into a pulmonary vein isolation ablation.  The fact that you have been a runner might have caused your pulmonary veins to stretch out and become the source of your problem.  

I was a track athlete in college and into my 30's would run half marathons etc.  When I hit 40 I started having ectopics, and continued to run but less because the ectopics really bothered me.  Finally got over the psychological aspect of them and only to one day wake up with AFIB at 46.

I tried meds for 3 years, but they didn't keep me in rythmn.  My cardiologist was pretty aggressive and sent me to Mayo.  When the doctor at May found out that I was a runner he was almost positive I could be cured with a pulmonary vein ablation.  And he told me about the studies being done at Mayo.

Sure enough, it worked.  I still have some ectopics, but not near as many (just a half dozen a day it seems that I can feel).

I think some cardiologists simply try to control the amount of AFIB without keeping you in rythmn all the time.  My cardiologist felt that if one is symptomatic there was only one way and that was to stay in rythmn.  

Good luck.

I think you should try going to an EP at a large university or research hospital and get checked out for an ablation.  It might work and it might not.  But it would be worth the try.
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by sotckas, Jul 05, 2005
Thanks for the reponses to my questions and comments.  It is great to have a place to talk to others who are truly interested in helping all of us get healthy.

To erikwithoutthedoctor:  The length of time that I am able to stay in rhythm after coversion with exercise varies from one or two days, up to a week and sometimes longer.  The frequency of my AF episodes has been gradually increasing over the last year.  I used to be able to stay converted for 2 - 4 weeks, but that seems to be a thing of the past.
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by axg9504, Jul 07, 2005
Hi again. So you had a PVA. My first set of heart monitor (4 of them) events on the treadmill showed, according to the EP who read them some "bursts" of AFib. Another EP at the same facility concluded that it was due to the PV but he did not think that the state of the art had progressed to the point where he would recommend it. My second EP did not concur that the same heart monitor charts showed Afib. I had a second set of event monitoring on the treadmill and it showed no Afib. I'm bringing this up to highlight that EP's (at least in my case) don't all seem to agree on how to read the rhythm. Two more questions of you if I may: 1. Did you ever have a documented case (ECG monitoring) of Afib when you were not feeling any symptoms. 2.Looks like you were(are still) an accomplished runner. Would you mind telling me what would have been an easy run for you in your early 40's (distance and time)before you started having your problems and what that would compare to now ? Thanks
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by arthur, Jul 07, 2005
Exercise induces a higher level of activity in focal signalling and subsequent rest, which slows the heart rate down, opens the door to these signals, resulting in arrhythmias.  That was my problem with PV foci responsible for PAF generally brought on by exercise...a bit different than yours, but more or less the same.  Ablation a few years ago got rid of the problem.  I am now 57, and still playing competitive soccer in the over 40 bracket.  I highly recommend seeing an EP about a possible ablation.

-Arthur
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by axg9504, Jul 07, 2005
Tell me how your situation compared with mine. I started having exercise induced dizziness (after running-walking for about 12-20 minutes) three years ago. Heart rate appears to go down immediately after terminating exercise. Had an EP study with ablation in the left atrium for an atrial flutter but had no effect. Have no problems at rest. Did you have Afib at rest?
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by dquenzer, Jul 07, 2005
1. Did you ever have a documented case (ECG monitoring) of Afib when you were not feeling any symptoms.

I could always tell when I was in AFIB.  I never had a ECG monitoring of AFIB when I didn't feel it.  Although I know some people have.

2.Looks like you were(are still) an accomplished runner. Would you mind telling me what would have been an easy run for you in your early 40's (distance and time)before you started having your problems and what that would compare to now ? Thanks

Actually distance running wasn't my forte.  I was a sprinter in high school and college (primarily quarter mile).  I ran distance because I enjoyed running and being in shape.

Actually in my early 40's I wasn't in that good of shape because I developed PAC's that kind of hampered me (at least psychologically), but I could run 4 to 5 miles and average 8 minute miles pretty easily.  But in my late 30's I could easily run minute miles for 4 to 5 miles.  Actually ran 12 minutes for 2 miles when I was 36 and in the military.  

When I developed AFIB I just didn't feel like running very far.  The meds really made me sluggish.  And I had a lot of irregular heart beats.  So I lost some conditioning, and gained about 25 pounds.  Also after my ablation I didn't do anything for 3 months, and when I started back I never worked very hard.  Just enough to get a sweat up and my heart rate at a comfortable rate.  Plus I only worked out 3 times a week.

Right now I'm going at about a 10 minute pace for two miles, and then kick back and go at 12 minute pace for the next mile.  I really don't try to push too hard.  Just enough to get a sweat up and my heart rate at a comfortable rate.  Plus I only worked out 3 times a week.

But I am slowly starting to feel better running and I'm starting to slowly increase my work load. But I'm 50 and feeling the age a bit.  My goal is to run 8 to 9 minute miles for 3 miles and feel comfortable.  I'm not ever going to run half marathons again because it takes too much time to train, and I don't think my knees can handle it anymore.