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  • Weight Loss and AFIB

    Losing weight substantially reduces Atrial Fibrillation

    Obese patients with atrial fibrillation who lost at least 10 percent of their body weight were six times more likely to achieve long-term freedom from this common heart rhythm disorder compared to those who did not lose weight, according to a study presented at the American College of Cardiology’s 64th …

  • #2
    I just confirmed my own case. I suspect it is a preload or afterload thing. I haven't researched the literature. But it's just a guess from my own experience. For the first time, I'm doing lots of squats and dead lifts. When I do a lot of those, I get an a fib episode for a few days. When I do a prolonged low intensity thing, it goes away for a few days. Again, n of 1. And no comments about starting lifting at age 60. You know what they say - Growing Old is Not for Sissies. ( I had an old coffee table book on this. It had things like 80 yo powerlifting women - who started in their 60s. So, I am self aware of some aspect of weird. But I'm not the only one. )

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    • #3
      It keeps coming back. And pushing a ventricular response rate of 100. I’m now in the heart center of the hospital. I’m guessing I’ll get an echo and a beta blocker. Just FYI- if you have to go on one, get Toprol or Coreg (if you have IR or T2D). These do not worsen Insulin Resistance. A

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      • Pete W
        Pete W commented
        Editing a comment
        Thinking of you and hoping all goes well Dr. Brewer.

    • #4
      It's good to get an echo to rule out valve issues as they are a common cause for AFIB. I had a resting echo and a stress echo done when I got my AFIB workup last year.

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      • #5
        Thanks, Pete. I appreciate it! And John, my echo came ojt normal. I took a 30 day monitor home. I had a couple of day-lomg episodes. But it seems to have calmed down. It’s interesting - low intensity, long duration exercise seems to slow down the episodes.

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        • #6
          And taking Eliquis worries me, just like it would most of us. But you get ised to these things.

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          • #7
            It's great you had a complete workup and that your echo didn't show that you have a valve issue.

            When I had my Holter monitor done, I had trouble keeping the electrode sensor pads adhered to my chest, particularly when I was sweating during a workout or sleeping at night. Some would fall off for a few minutes but it didn't ruin the results. I called the electrophysiogist's office and they gave me a kit with four different types of replacement adhesive pads, one type which wouldn't fall off at all during exercise or sleep.

            I read the EP report weeks later and found it a bit disconcerting; AFIB 30% of the day and night, plus periods of supraventricular tachycardia (SVT), bradycardia, tachycardia and some ectopic beats like premature ventricular contractions (PVC) too. Sort of a mish-mash of results. He said it's important not to over-analyze the results as many errant beats and rhythms are often common and benign when they only occur occasionally.

            I don't mind taking Eliquis anymore than when I took Xarelto. It's a sensible piece of mind if nothing else, as is the medical ID bracelet. Watch out shaving!

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            • #8
              The Haywire Heart - Too Much Exercise Can Kill You. This is a book I plan to buy and it might address some of your concerns, Dr. Brewer, on endurance exercise and AFIB. It is written by one of my favorite bloggers, Dr. John Mandrola, an electrophysiologist. http://www.drjohnm.org/

              https://www.velopress.com/category/the-haywire-heart/

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              • #9
                Thanks for these, John. These are very helpful. I’ve reading some of Mamdrola’s information recently. Over a one month period, I was having a lot of episodes. And the episodes were causing a rapid response and all the problems assoywith that (farigue, brain fog, knowledge of increasing risk, etc). I read Mandrola talking about one of the advantages of ablation (less likely to get remodeling- and permanent dysthymia). I was leaning more toward a potential ablation.

                Meanwhile I noticed I’d gained a few oounds (almost 10. And this was on low-carb. Who says you cen eat countless calories on low carb? To my credit, I didn’t appear to be gaining fat. I use the Schwargenegger test in addition to a weight scale. Arnold said once to assess body fat, strip to underwear and jump while looking in the mirror. I did, and appeared to be dropping fat,not gaining it. I had, in fact, ramped up squats and deadlifts significantly. Anyway, I’ve gotten a new bathroom scale, dropping some pounds, and increasing long, low-intensity exercise. )

                I haven’t noticed an episode in at least 5 days. I will not have an ablation as long as I feel comfortable and have few episodes with a reasonable response rate. And, even if those do happen, I’ll think twice about having a procedure. And twice again. I’ve always recommended multiple opinions and strong considerations prior to any procedure. Other cardiologists with whom I’ve discussed ablation do not seem to be in a rush to recommend it. (Except for a couple of interventionists. You know the type; “when you’re a hammer, everything looks like a nail.”)

                I hope this personal thought process helps others that need to think through this.

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                • #10
                  Originally posted by Ford Brewer View Post
                  Meanwhile I noticed I’d gained a few oounds (almost 10. And this was on low-carb. Who says you cen eat countless calories on low carb? To my credit, I didn’t appear to be gaining fat. I use the Schwargenegger test in addition to a weight scale. Arnold said once to assess body fat, strip to underwear and jump while looking in the mirror. I did, and appeared to be dropping fat,not gaining it. I had, in fact, ramped up squats and deadlifts significantly. Anyway, I’ve gotten a new bathroom scale, dropping some pounds, and increasing long, low-intensity exercise.
                  Thanks for sharing those experiences. Maintaining and gaining muscle mass during weight loss is important. I have to work on that. I have lost 28 pounds on low-carb/Metformin/HIIT regimen so far but I have noticed I've lost some muscle mass too. I must rethink my program to work on large muscle groups.

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                  • #11
                    I also thank you Dr. Brewer for sharing. Your comments will definitely help others, including me! John, I bought "The Haywire Heart" some time ago for my wife. I think you know she's a serious age-grouper triathlete and she loves the "long-course" events, which are the Half and the Full Ironmans. She was about to do her 7th Ironman last month but broke a bone in her foot so couldn't. I've often worried about her endurance training regimen going on for several years now (she's also 62, like me). Anyway, the book was the first thing that has really made her take a hard look at what she's putting her body (including her heart!) through. She either personally knows, or knows of, some of the athletes highlighted in the case studies in the book; that seemed to drive it home even more.

                    Gotta go jump in front of the mirror now.

                    Pete

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                    • #12
                      It was good of you to buy your wife the book, Pete. There is likely a fine line between dedicated training and exercise addiction. These are the signs that Mandrola states that people need to be aware of during exercise.

                      "Sensations that are not normal include"

                      Racing heart: any sustained racing of the heart that won’t go away. 

                      Chest pressure or pain, especially pressure or pain that worsens during exertion. 

                      Labored breathing: difficult breathing that is out of proportion to effort (everyone breathes hard when climbing hills or sprinting). 

                      Fainting or near-fainting: anything more serious than the everyday lightheadedness you might feel after a hard effort.

                      These symptoms are serious warning signs that should alert you to possible trouble. Sustained chest pressure or chest pain warrants a call to 911. All others warrant an appointment with your doctor, sooner rather than later. If you experience these symptoms, you should stop training until you can be evaluated by a professional. Secondary warning signs include sensations that are not normal but usually less worrisome, including  Palpitations: skips, jumps, or flutters of the heart rhythm. 

                      Consistently low power: A decrease in sustainable power is the real warning sign here. There are lots of reasons for low power output, including natural variability, overtraining, and medical conditions. Usually it’s the first two. But if your sustainable power drops, take note. 

                      Excess fatigue: Like low power, generalized fatigue can be caused by many factors. In fact, fatigue may be one of medicine’s most nonspecific symptoms. Causes range from poor sleep or overtraining to a host of specific medical conditions. 

                      Excess irritability: Irritability is often a sign of overtraining or inadequate nutrition, but patients with arrhythmia or other medical conditions often say they are irritable. Spouses sometimes notice this symptom first."

                      Pages 127-128 of The Haywire Heart - Kindle Edition

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                      • #13
                        Good, practical advice John. I find myself getting impatient and grumpy when I go into an episode of A Fib. That's common - and that feeling like there's a fish in your chest.

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