AF and exercise.

In yesterdays Daily Mail a reader asked if it is safe to exercise with AF.

This was the doctors reply.

Your condition - atrial fibrillation - is the most common abnormality of heart rhythm, affecting up to 800,000 people in the UK and one in ten of the over-75s. It creates an irregular or fast heart rate and is caused by a malfunction in the natural pacemaker of the heart.  This malfunction has a wide range of potential triggers, though high blood pressure and furred-up arteries are thought to be the most common.  The irregular heartbeat may or may not cause symptoms, but when they do occur, they are usually palpitations, fatigue, light-headedness, breathlessness and perhaps a reduced capacity for exercise.  The biggest risk of the condition is not, as many would assume, a cardiac event such as a heart attack, but a stroke.   Atrial fibrillation increases the risk of stroke by four or five times because the irregular or fast rhythm can lead to blood pooling in the chambers of the heart. It can then form a clot, and this clot can then be pumped up to the brain, blocking blood supply and causing a stroke. When you were first diagnosed, your cardiologist will have made a decision about whether to attempt to convert your heart back to a regular rhythm. This is achieved most efficiently by an electric shock applied to the chest. This sounds alarming, but it is safe, quick and performed under general anaesthetic. 

If this cannot be achieved, or the improvement is only temporary, then medication such as beta blockers may be given to control the heart rhythm.  Drugs must also be given to protect you from stroke. One of the drugs you are taking, rivaroxaban, does exactly this by thinning the blood and making a clot less likely.   Your heart output may not be as good as it would be in a regular rhythm, but it will be adequate for most normal activities and for the pursuits you enjoy.  So when it comes to exercise, I am entirely happy that you should attend an exercise class, do any amount of gardening (wear gloves when pruning - even small injuries from thorns will bleed profusely due to the blood-thinner you are taking) or go hiking or cycling.   None of these activities can make your heart rhythm any worse, trigger a stroke, or lead to a heart attack. Most of us would agree that, if anything, a regular regimen of exercise such as you describe can only be helpful to your health, rather than the reverse.

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