Just to get it out of the way first - I have a follow up appointment with a cardiologist 2 Nov, so I’m not expecting personalised medical advice. My gut feeling is I might be looking at a 2nd ablation which I understand is relatively common and has a high success rate.
I just spent the night in hospital with 12 hours of AF which started after my second set of DB split squats on BB program. Wasn’t expecting AF at all. It wasn’t a crazy difficult set, and my last (known) episodes were Feb 2019 for 5-10 min each. Prior to the ablation, AF made life unbearable for 18 months with easily 10+ episodes a week with 2-3 of them 12-15hrs long. Training was impossible and I put on a lot of weight.
After surgery I started BBM programming and went from 111kg to 83kg, 116cm to 91cm waist. Lost focus throughout lockdowns this year and now back to 85kg and 94cm waist. Recently re-focussed, hitting calorie goals and not missing sessions.
I’m 50, male. The hospital cardiologist gave me a CHADS score 0 and put me back on sotalol 80mg/day which did not help at all prior to surgery, but I’m not discounting it maybe helping now.
I understand from much of your content that being sedentary has its own risks to consider. My main focus is to continue waist reduction comfortably below minimum guidelines.
My main question for you here is what should I do training-wise between now and my appointment? (And perhaps beyond, until my possible surgery which could be a 6-9 months wait)
Given what a nightmare life was before PVI surgery, I’m a little freaked out at the moment and stuck deciding how to proceed: continue everything as normal with BB program, assuming this episode was a 1 off. Sort of pretend it didn’t happen, but avoid catastrophising if it triggers again. Or be more cautious, change things up. Perhaps a lower volume like beginner program. Maybe reduce RPEs. Risk there is that I might hypersensitise myself and ramp up the anxiety again.
I don’t know how much we’ll realistically be able to alter your risk of recurrent symptoms by altering these programming parameters, to be honest – especially if you felt the onset during a set that wasn’t particularly difficult. You can certainly experiment with adjustments to volume/intensity/RPE, but again – we have no way of knowing the extent that any of these variables were even involved in your most recent episode. I do think that continued physical activity would be wise, however.
In general, there are several modifiable risk factors for atrial fibrillation that I look at as potential targets to address:
-Excess bodyfat / elevated waist circumference – this is a big one, and it sounds like you’re already aware of it / working to address it
-Alcohol use – there is an increase in risk of AF with every drink someone consumes per week.
-Obstructive sleep apnea – this is something that you should be screened for and treated, if you haven’t already
-Fish oil supplements – these are associated with an INCREASED risk of atrial fibrillation, so if you are taking these I would talk to your doctor about potentially stopping them (unless there is a clear indication for them – which sounds unlikely from your story here).
-Thyroid function – which I assume has been checked for you at some point
Outside of these, for atrial fibrillation that causes severe symptoms, rhythm control (using antiarrhythmic medications, like sotalol) can be a good option. If that medication doesn’t work well for you, there are certainly other options as well to be discussed with your cardiologist.
“we have no way of knowing the extent that any of these variables were even involved in your most recent episode.”
I really needed this reminder, thanks! Prior to surgery when episodes were relatively short/infrequent, the search for “triggers” seemed worthwhile (but probably was not, in my case at least). By the time I was going in and out of AF every day, I realised it was effectively just applying a post hoc fallacy which only served to increase anxiety that anything and everything might trigger the next episode.
Overall, I think I’m generally on the right track:
Yeah I’m definitely working on getting the waist down.
I don’t drink alcohol at all. Drank when I was younger then slowed down a lot from my mid 20s. Stopped completely somewhere around 2005
Was on the fish oil megadosing bandwagon several years ago but stopped entirely maybe 2013 thanks to Jordan’s advice on the old forums
TSH test results pending on my discharge papers. Found an old blood test which showed normal ranges: Jan 2018 (1.3 mIU/L) and Sep 2019 (2.4 mIU/L)
haven’t looked into OSA so I’ll definitely bring that up with my GP and cardiologist.
Moving forward, I’ll continue training and try to avoid expectations. With this recent episode I was fearful that I’ll suddenly be back to where I was immediately before surgery - but there’s no evidence that will be the case.
Just a couple of follow up questions if I may:
Any suggestions on a waist goal in the context of maximising benefits for AF? I understand the general messaging on the key 40" and 37" thresholds, but I would assume that 36 is better than 37, 35 better than 36 and so on until some point at which it levels off.
-Any general thoughts of lifting through an episode? When AF was infrequent, I managed to lift through it without too much discomfort and it would often stop within a few sets anyway. I talked to my cardiologist about it in our first consult 2015 and best I can recall his only concern was syncope.
I don’t think we have evidence to support such granular thresholds for waist circumference. Let’s first aim for getting below 37" and re-assess things at that point.
This is a bit trickier, depending on the severity of your symptoms. If minimally symptomatic, you can carry on – but I agree that if you’re having significant lightheadedness or symptoms concerning for syncope … that’d be a reason to stop and probably go to an ER. If I were in this situation with frequent symptomatic episodes, I would probably be pushing more for a rhythm-control strategy (i.e., antiarrhythmic medications) in the short term, until you get your surgery done.
It can cause atrial fibrillation, which may or may not be symptomatic. We’d recommend staying at or below current guidelines for alcohol intake, if you choose to consume it. This is discussed further in our alcohol podcast.