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Persistent Afib and treatment
I am in early 50s and diagnosed with lone AFib and persistent. An active runner, run 3 miles per day and keeping heart rate below 155. Generally don't feel the symptom except intense exercise. Nurse Practitioner suggested to consider Catheter Ablation (CA) due to my young age and persistent.
Options presented to me are: 1) Do nothing, 2) Cardioversion then medication, 3) Medication only 4) CA 5) Maze Surgical
I am scheduled for 1st Cardioversion + med but thinking long term between Med only or CA or even Maze but like to hear experiences from others who are in similar situation.
AFIBLifter, May 27, 2019 7:48am EST
Can't really advise on treatment except to start with as little as possible -you can add heavier stuff later - to me cardioversion seems very mild, i went running the day after when I had my succesful cardioversion and i felt great (afib came back after 1 week though so now I'm waiting for stronger measures)...
Are you completely unaffected in daily life? (I get tired and slightly dizzy, feel light pressure/palpatations) get wrose when I run, usually i run slowly adn ai also lift a lot of weights, running feels like crap compared to when not in afib and i'm 20% weaker in all lfits but i still feel good lifting.
also: DO you have paroxysmal episodes or in constant afib? (i'm in constant- that's why i'm weaker when running or lifting, when I was paroxysmal I was unaffected unless i triggered it)
Good Luck with whatever procedure you chose. I've done re "restarts"= cardioversions. All felt super safe and felt really good
ken37712, August 20, 2019 1:30am EST
I am diagnosed with persistent AFib. I had cardiversion but AFib came back 3 days later when I started running.
I can only do speed walk around 4.2 mph and if I try to run, my heart rate shoots up to 180 bpm or above and stays there until I slow down.
Thumper2, August 20, 2019 8:48am EST
Ken37712, based on the experiences of so many on this forum, having one or more ablations seems a more likely road to success in staying in NSR. I'm glad you do not seem to be content with just "living with" AFib. As I've said many times here, your heart may be quietly remodeling itself in negative ways. Before you have an ablation, it might be advisable to see if you have sleep apnea -- as Mellanie has said (May 25, 2019),
"If there is any likelihood of sleep apnea (less likely in athletes, but can still happen), then getting that treated BEFORE the ablation is highly recommended."
Please keep us posted! All the best,
MellanieSAF, August 20, 2019 9:08am EST
Judy is right about getting tested for sleep apnea. Since 85% of cardioversion failures are due to untreated sleep apnea, getting tested for sleep apnea would be the next step for me if I were in your shoes.
And, for many people, detraining is necessary until your afib is under control, so running may be out for a while. So, since the cardioversion failed after running, another cardioversion may be in order. However, if you can get a sleep study quickly, and treat sleep apnea if you have it, that may lead to much greater success from the cardioversion.
ken37712, August 29, 2019 4:43am EST
Thanks Judy and Mellanie for the feedback! I scheduled a sleep apnea study and will keep you guys posted.
Meanwhile, I will be getting cardioversion next week and starting flecainide + metoprolol afterwards to keep my heart in rhythm.
And I agree with your suggestion, I stopped running for now, just speed walking. I am only on Eliquis now and I pace speed so that my HR is under 120 during the walk, no more crazy jump to 180 bpm!
MellanieSAF, August 30, 2019 2:04am EST
Good luck. Sounds like you are doing all the right things.
ken37712, October 13, 2019 1:43am EST
An update on my treatment. I had cardioversion + flecainide + metoprolol. Ziopatch shows heart stayed in NSR for 3 days and then went into Atrial Flutter (AFL) and I think I am currently AFL 100%. It is interesting Ziopatch (single contact) is able to recognize the AFL pattern while AliveCor (also single contact) shows normal sinus even for the monitoring period that Ziopatch registered AFL.
NP said it is possible flecainide turns the AFib into AFL.
Next treatment options according to the NP are:
- A different kind of drug which I will have to stay in hosiptal for 3 days or
- Ablation (50% success rate) which will fix the AFib and AFL
I will be doing a Sleep study soon and so I will definitely wait until after the study to make a decision on ablation.
Just one interesting note I like to share on Metoprolol. I know this drug slows down heart rate and I think this drug has the effect of keeping my HR consistent at 123 bpm during run. I can actually do a mild run and feel ok which was not possible before with the previous drug. Metoprolol is able to keep my HR at 123 bpm up to certain run pace and if I run faster than this "max" pace, HR actually will go down from 123 bpm to 118 bpm first before shooting up to 145 bpm which I took it as indication that the heart cannot keep a normal ryhthm *even" with Metoprolol. This is counter intutive because for such a scenario, I would expect HR to go up a little from 123 bpm and then shoots up to 145 bpm. This pattern is quite consistent (down and then spike high and I tested this three times already) and so now I use the 118 bpm (and the downward trend from 123 bpm) as a indicator that I need to slow down my run so I don't overload my heart ..... that seems to work for me.
Neanderthal, January 8, 2020 5:26pm EST
I would like to hear an update on your progress since your symptoms and drugs are the same as mine.
ken37712, January 9, 2020 3:40am EST
Flecainide turns my AFib into AFL very consistently. I use AliveCor daily to measure HR and most of the time it reports normal sinus and of course I know it means AFL because AliveCor does not identify AFL. AFL was confirmed multiple times over several months with ECG machine and echo test. Lately I have been observing lower rHR (resting HR), like 47 bpm, and after discussing with my care provider, we agree to cut down the Metoprolo dosage by 1/2 to reduce the effect on my HR. So far, rHR is around 52 bpm and I feel better with this change because I feel less tired and have more energy. The change does not seem to negatively impact my run and I am still running at same speed on Treadmill as before. I use Polar chest strap to measure my HR, it is very accurate and I monitor my HR throughtout the run and pace my run spped to keep HR below 130 bpm so heart is not over-stressed.
Sleep apena test result is negative and this means it is not the trigger for AF.
I feel better with Flecainide because I am able to exercise (run) more than the previous drug or no drug but I know AFL is not NSR (even though AliveCor reports normal ryhthm) and so I need to do something to bring my heart rhythm back to normal to avoid long term negative effects like atria remodeling or dilation.
I am in PeAF (Persistent AF). I will be discussing with my EP and NP about ablation (AFL or AFL + PVI). I understand the success rate is somewhere between 50-60% for PeAF but want to understand the complication risks. I know my exercise capacity will be limited for as long as I am on ryhthm or rate control drugs. My primary goal for ablation is to increase exercise capacity by eliminating the need to take the AAD or beta blocker or to reduce the dependency of those.