Atrial Fibrillation...Should We Worry

yeatesbY
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Re: Atrial Fibrillation...Should We Worry

Post by yeatesbY »

Thanks Jonathan for the Apple survey link. Unfortunately it doesn't get me much further.
My original enquiry was about what the Smartwatch is actually telling me, and if its dangerous.
So yes, I have been diagnosed with AF. Been to hospital for a reset that didn't work. Resumed cycling with doctor's approval, sometimes getting AF notifications, sometimes elevated heart rate, and sometimes nothing. A month ago I fainted in the middle of the peleton without warning, managing to break my collar bone.
So...no more group rides, just the home trainer.
I'm no nearer to knowing if elevated heartrate is dangerous, or how quickly AF is detected by the watch, or if its sampling interval is regular or confused by AF, or if fainting is my bods way of saying,"thats enough".
Jdsk
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Re: Atrial Fibrillation...Should We Worry

Post by Jdsk »

The systematic review of AF in athletes quoted upthread was from 2009. A couple that are more recent:

https://bjsm.bmj.com/content/55/21/1233
https://journals.lww.com/md-journal/Ful ... al.51.aspx

And a recent review including discussion of mechanisms:
https://www.heartlungcirc.org/article/S ... 6/fulltext
(paywalled).

Jonathan
Jdsk
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Re: Atrial Fibrillation...Should We Worry

Post by Jdsk »

I think that both of those systematic reviews describe the levels of exercise in the Methods...

... please let me know if you can't find them.

Jonathan
re_cycler
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Re: Atrial Fibrillation...Should We Worry

Post by re_cycler »

Jdsk wrote: 25 Jan 2023, 4:56pm I think that both of those systematic reviews describe the levels of exercise in the Methods...

... please let me know if you can't find them.

Jonathan
Just had another skim and can't see anything other than general descriptions, even tried the crossref for the selection criteria on the BMJ printed review.

Edit - I did finally find a definition in this referenced document.
https://academic.oup.com/eurheartj/arti ... 17/5898937

4.1.1 Definition and characteristics of exercise interventions
axel_knutt
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Re: Atrial Fibrillation...Should We Worry

Post by axel_knutt »

re_cycler wrote: 25 Jan 2023, 5:26pm
Jdsk wrote: 25 Jan 2023, 4:56pm I think that both of those systematic reviews describe the levels of exercise in the Methods...

... please let me know if you can't find them.

Jonathan
Just had another skim and can't see anything other than general descriptions, even tried the crossref for the selection criteria on the BMJ printed review.
They're in each of the papers being reviewed.
re_cycler wrote: 25 Jan 2023, 5:26pm Edit - I did finally find a definition in this referenced document.
https://academic.oup.com/eurheartj/arti ... 17/5898937

4.1.1 Definition and characteristics of exercise interventions
It mostly seems to be a lot of woolly handwaving about exercise being beneficial.

What are you looking for? If it's the levels of exercise that patients diagnosed with AF have been doing you need to read each of the papers studying it, if you want to know what's safe after being diagnosed Heidbuchel and Zipes are full of specific detail:

Heidbuchel: Recommendations for participation in physical activity
Zipes: Eligibility recommendations for competing in sport
Jdsk wrote: 19 Nov 2020, 3:52pm
axel_knutt wrote:
Jdsk wrote:The possibility of AF being caused by intense exercise is fascinating.
Possibility? Since 2016 the European Society of Cardiology have acknowledged chronic endurance training as an arrhythmogen, and advise that “athletes should be counselled that long-lasting intense sports participation can promote AF”. This is categorised as Class 1: “Evidence and/or general agreement that a given treatment or procedure is beneficial, useful, effective”, and Level A: “Data derived from multiple randomized clinical trials or meta-analyses”. The degree of risk remains an open question, there are numerous studies finding an increase in the incidence of AF ranging from 20% to 20 fold.
Thanks. I've read a fair number of original studies but I wasn't aware of that. I've got:

"2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS"
https://academic.oup.com/eurheartj/arti ... 93/2334964

but I can't find that bit. Where should I be looking?

Jonathan
Arrhythmogen.png
Bonefishblues wrote: 19 Nov 2020, 2:56pm I take it you are medically qualified AK?
The 17 authors of the 2016 ESC Guidelines for the management of atrial fibrillation are, that's why I read them and not internet forums:

"The bleeding risk on aspirin is not different to the bleeding risk on VKA or NOAC therapy, while VKA and NOACs, but not aspirin, effectively prevent strokes in AF patients."

"VKA therapy reduces the risk of stroke by two-thirds and mortality by one-quarter compared with control (aspirin or no therapy)"

"VKA therapy prevents stroke, systemic embolism, myocardial infarction, and vascular death better than single or dual antiplatelet therapy with aspirin and clopidogrel (annual risk of 5.6% for aspirin and clopidogrel vs. 3.9% with VKA therapy)....Antiplatelet therapy increases bleeding risk, especially dual antiplatelet therapy (2.0% vs. 1.3% with antiplatelet monotherapy; P , 0.001), with bleeding rates that are similar to those on OAC. Thus, antiplatelet therapy cannot be recommended for stroke prevention in AF patients."
“I'm not upset that you lied to me, I'm upset that from now on I can't believe you.”
― Friedrich Nietzsche
Bonefishblues
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Re: Atrial Fibrillation...Should We Worry

Post by Bonefishblues »

axel_knutt wrote: 25 Jan 2023, 10:14pm
Bonefishblues wrote: 19 Nov 2020, 2:56pm I take it you are medically qualified AK?
The 17 authors of the 2016 ESC Guidelines for the management of atrial fibrillation are, that's why I read them and not internet forums:

"The bleeding risk on aspirin is not different to the bleeding risk on VKA or NOAC therapy, while VKA and NOACs, but not aspirin, effectively prevent strokes in AF patients."

"VKA therapy reduces the risk of stroke by two-thirds and mortality by one-quarter compared with control (aspirin or no therapy)"

"VKA therapy prevents stroke, systemic embolism, myocardial infarction, and vascular death better than single or dual antiplatelet therapy with aspirin and clopidogrel (annual risk of 5.6% for aspirin and clopidogrel vs. 3.9% with VKA therapy)....Antiplatelet therapy increases bleeding risk, especially dual antiplatelet therapy (2.0% vs. 1.3% with antiplatelet monotherapy; P , 0.001), with bleeding rates that are similar to those on OAC. Thus, antiplatelet therapy cannot be recommended for stroke prevention in AF patients."
No then.
re_cycler
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Re: Atrial Fibrillation...Should We Worry

Post by re_cycler »

axel_knutt wrote: 25 Jan 2023, 10:14pm
re_cycler wrote: 25 Jan 2023, 5:26pm Edit - I did finally find a definition in this referenced document.
https://academic.oup.com/eurheartj/arti ... 17/5898937

4.1.1 Definition and characteristics of exercise interventions
It mostly seems to be a lot of woolly handwaving about exercise being beneficial.
The linked document didn't seem as woolly as some of the other documents at least it defined it's terms for endurance.
2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease: The Task Force on sports cardiology and exercise in patients with cardiovascular disease of the European Society of Cardiology (ESC)

Thank you for taking the time to reply, your posts are very informative on a subject I knew nothing about.
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francovendee
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Re: Atrial Fibrillation...Should We Worry

Post by francovendee »

My son, when he was in his early teens had a regular problem with his heart beating very fast during sports.
He went for tests that involved being monitored while riding a bike. The strange thing he never had the problem cycling. At the time he raced every weekend. They increased the load on the bike and eventually he did get the problem.
He had a day in hospital and they burnt some nerves in his heart. He's never had the problem again.
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simonineaston
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Re: Atrial Fibrillation...Should We Worry

Post by simonineaston »

It's so cool to hear of really successful treatments :-)
S
(on the look out for Armageddon, on board a Brompton nano & ever-changing Moultons)
brianleach
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Re: Atrial Fibrillation...Should We Worry

Post by brianleach »

He had a day in hospital and they burnt some nerves in his heart. He's never had the problem again.
After 2 cardioversions I had this as well. Its an ablation. The cardioversions lasted no more than a couple of hours. The ablation lasted a couple of years. Now back in af and my cardiologist, who is a keen cyclist, was surprised I had stayed in sinus rhythym for so long. He has not suggested another as it is a fairly expensive and invasive operation.

He encourages me to continue cycling sensibly so the largest display on my Wahoo is my heart rate! I keep an eye on it and at 73 nearly 4 if it gets to 145 I get off and walk or rest. Usually the heart rate is pretty stable but can be irregular.
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simonineaston
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Re: Atrial Fibrillation...Should We Worry

Post by simonineaston »

continue cycling sensibly
It's great that you've been able to do so. I'm full of admiration - as a worrier, I would find it difficult.
S
(on the look out for Armageddon, on board a Brompton nano & ever-changing Moultons)
Jdsk
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Re: Atrial Fibrillation...Should We Worry

Post by Jdsk »

brianleach wrote: 14 Feb 2023, 4:24pm
He had a day in hospital and they burnt some nerves in his heart. He's never had the problem again.
After 2 cardioversions I had this as well. Its an ablation. The cardioversions lasted no more than a couple of hours. The ablation lasted a couple of years. Now back in af and my cardiologist, who is a keen cyclist, was surprised I had stayed in sinus rhythym for so long. He has not suggested another as it is a fairly expensive and invasive operation.

He encourages me to continue cycling sensibly so the largest display on my Wahoo is my heart rate! I keep an eye on it and at 73 nearly 4 if it gets to 145 I get off and walk or rest. Usually the heart rate is pretty stable but can be irregular.
That is good to hear.

When it's irregular now is it AF?

Thanks

Jonathan
brianleach
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Re: Atrial Fibrillation...Should We Worry

Post by brianleach »

When it's irregular now is it AF?
Apparently AF doesn't have to involve high variations of heart rate, just an irregular heartbeat qualifies I think.

I have another small heart issue which probably complicates things but again I assume the cardiologist will tell me if I need to stop.

I have an annual check up and he and I then spend the rest of the consultation talking bikes. He had just done the KAW this year. I had tentatively thought of doing it but felt it was now probably too tough for an old man and he agreed!!!
softlips
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Re: Atrial Fibrillation...Should We Worry

Post by softlips »

brianleach wrote: 14 Feb 2023, 4:53pm
When it's irregular now is it AF?
Apparently AF doesn't have to involve high variations of heart rate, just an irregular heartbeat qualifies I think.

I have another small heart issue which probably complicates things but again I assume the cardiologist will tell me if I need to stop.

I have an annual check up and he and I then spend the rest of the consultation talking bikes. He had just done the KAW this year. I had tentatively thought of doing it but felt it was now probably too tough for an old man and he agreed!!!
Yup, AF tends to just be irregular. In some patients the rhythm can be rapidly conducted to the ventricles. You would most probably be aware should this be the case.

Ablation procedures often fail and have to be redone in quite a high percentage of patients.
axel_knutt
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Re: Atrial Fibrillation...Should We Worry

Post by axel_knutt »

brianleach wrote: 14 Feb 2023, 4:24pmAfter 2 cardioversions I had this as well. Its an ablation. The cardioversions lasted no more than a couple of hours. The ablation lasted a couple of years. Now back in af and my cardiologist, who is a keen cyclist, was surprised I had stayed in sinus rhythym for so long. He has not suggested another as it is a fairly expensive and invasive operation.
I was offered a pulmonary vein isolation for my AF nearly ten years ago but I never got it, when I accepted their offer they withdrew it.
“I'm not upset that you lied to me, I'm upset that from now on I can't believe you.”
― Friedrich Nietzsche
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