Coumadin for Afib

[axg9504]

I have had exercise intolerance for about 2 1/2 years now. Recently event  monitor testing showed tachycardia 120-160 beats per min and some burst of atrial fib during running. I have light-headedness only when doing areobic exercise and only after reaching a certain threshold level. I did have a TIA 11 years ago, but had none of these problems at that time. I have 2 Q's. Are there people who have paroxysmal Afib that occur only during exercise and never otherwise ? Would you recommend I take Coumadin when I am possibly experiencing Afib no more than a few minutes a week (on the treadmill)? I am 60, male and have a structurally sound heart and normal BP. Thanks.

[axg9504]

I think Afib can have different effects on the ventricular rate. It can either go up or go down (as in my case). However I have not seen very high (160+) yet before I go the low rates. My bpm picks up quickly at the first sign of exercise. Walking at 4 miles per hour brings it to about 120. Running at 7mt pace for about 1/10 to 2/10 mile will bring it up to 140+.

[axg9504]

Back in August I had 4 event monitor readings taken on the treadmill and sent to my EP. He came back with interpretations for 3 out of which 2 showed "bursts of Afib". All had tach.(according to the EP) of 130-160 bpm (however I was running at the limit of my current meager capacity). That's all I know at this point that has been documented. I'm going to get another event monitor this weekend to monitor runs where I don't progress to dizziness to see whether I can correlate the Afib to my physical symptoms. Yes for 2 1/2 years I have had this very predictable exercise pattern that leads to dizziness. If I run at a certain pace and walk when I get tired, after a certain point I cannot run at the same pace that I started, without getting light headed. I go home light headed and about 15 mts later I am fine. Dquenzer may be right about PAC/PVC's. When this problem first started I notice that the precursor to the dizzy stage was a clutching sensation in the throat which I now recognize as the ectopic beats. I am now having some of these even at rest but they are not bad at all and don't last very long. I will be going to a new EP next year (changed my insurance from the limiting HMO I have this year) so I can pursue ablation if that is recommended. However I am also a person that is averse to taking medicines (turned down the Coumadin recommendation of my EP).Does having an ablation mean sacrificing anything? Does it lead to a pacemaker? I wouldn't want that.

[JCB]

Your symptoms are quite different from mine. When I have had a run of Afib, my rate goes high (greater than 240 bpm), then the rapid, irregular heartbeats start. My rate remains high and irregular gradually returning to normal either within minutes or over several hours (20 hours max with visit to ER). Like you, when my rate returns to normal, I feel fine and ready to continue with whatever activity in which I was involved. However, my events are rare and I do not experience dizziness except for the time mentioned in an earlier note. I have been playing tennis on a few occasions when I have experienced a high rate. I slowed down long enough to swallow hard and convert the rhythm back to normal and continued playing.

The variation in my normal rate as measured by my HRM is also the same at low and high rates when I am exercising (+/- 2). I normally walk and run outside where my rates are noticeably noisy. However, when I exercise on a treadmill, my rates increase in nice plateaus when the intensity is increased. These may be academic observations for you with your recent experience.

Our feelings of dizziness during these events may be the result of the same effect (i.e. inefficient pumping by the heart) but the root cause appears to be different (high rate vs low rate).

I agree with dquenzer's comments and I hope you find the root cause and get well soon.

[axg9504]

Your situation is very much like mine, as I probably have stated before. Meds make me worse as two Beta Blockers have already shown. Got my HRM this weekend and went out on a run with it on. My resting bpm is around 72 with +- 2 bpm as you indicated. My bpm went up quickly to 120 and then to 140 during the run fluctuating about 10 bpm and then after 7/10 mile, very predictably it plummeted to 60, and I had to stop running because resumption resulted in dizziness. In the past event monitor readings taken when I had dizziness has indicated "bursts" of atrial fib (as the EP documented it). However the EP's event monitor has no indication of low bpm. When I have a dizziness episode, the HRM tells me that my bpm stays in the 50-60 range for 5-10 mts and then kicks abruptly up to the 80's and then works its way back to normal. I will be getting an event monitor this week from my cardio to shed more light on this. Except for the light headedness after the run, which goes away in about 10 mts I am fine and have never felt like I needed help. Thanks again for your input.

[dquenzer]

Are you getting AFIB every time you run or most of the time?

Personally I wouldn't tolerate AFIB every time I exercised.  Also if you are getting lots of PAC's they are most likely triggers for your AFIB.  

I think whenever AFIB cannot be controlled by meds (which it seems like you are sensitive to) and it is taking something out of your life that would affect your enjoyment of life (exercise), then you should go to an EP and consider an ablation.

I agree with your cardio about taking a more aggressive approach to that.  In my earlier post I thought these episodes were rare, but they sound like they are exercise induced and occur most of the time.  Is that correct?

[JCB]

My Cardiologist said the same thing to me several years ago when I told him about my HRM and my A-F (i.e. he needs to see rythym). However, I can "feel" the rythym while the HRM displays the (highly variable) rate. I have been told by several people that they are in A-F constantly and I don't understand this since I have never experienced it. Based on my 30+ years with this condition (some years I have had zero episodes), I would be concerned if I were in A-F constantly. My cardio attempted to put me on Meds several ago, and each one we tried caused worse arrythmias than I had experienced. I also met with an EP and concluded that I was not interested in ablations.

I have 5 years of data (4 to 5 episodes a year) and a 100% correlation between my experiencing A-F and the rates recorded by my HRM. I also have confirming data when I have gone to the emergency room (4 times) and the EKG has indicated A-F as read by the doctor after I "told" them that I was in A-F when admitted.

I have never been diagnosed with PAC's or PVC's so I don't know how these would present on a HRM. I do know what my baseline HR looks like and that it also correlates with "official" indications that my A-F has converted. My confidence in the readings from my HRM may be due to the fact that I don't have any other complicating rythyms.

I expect that your HRM will be very revealing to you.

Take care and good luck.