What is Atrial Fibrillation?
Before I explain what atrial fibrillation is, it’s important to understand that normal electrical signals in the heart are timed so that the chambers beat in a coordinated rhythmic fashion (called normal sinus rhythm).
Blood from the top chambers (atria) is transferred down to your lower chambers (ventricles) and then pumped out to your body to meet oxygen and nutrient needs. This short YouTube Video will give you more details on atrial fibrillation.
Atrial fibrillation is an extremely common condition and occurs when there is a “short-circuit” or disruption in the heart’s normal electrical conduction system, causing the atria (upper chambers) to beat in a rapid and irregular manner.
The problem with this is that the normal flow of blood through the heart’s chambers (from top down) is altered and can cause incomplete filling of the ventricle. This, in turn, leads to less oxygen and nutrient-carrying blood pumped out to meet your body’s needs.
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What are the signs and symptoms of atrial fibrillation?
Some people may have no overt symptoms, particularly if their atrial fibrillation is transient and each episode is short-lived.
Symptoms can range from palpitations (the feeling like your heart is fluttering in your chest), shortness of breath, chest pain, dizziness or fainting spells, weakness, or confusion. If you think about it, these symptoms make sense.
With atrial fibrillation, your heart muscle is not pumping out enough blood, and without adequate oxygen getting to your brain, lungs, muscles, and other target organs, it’s only logical that you should feel rotten.
Stroke is also a possible consequence of atrial fibrillation. During atrial fibrillation, it is possible that blood can pool inside the heart, giving rise to a blood clot (thrombus) which, once it breaks off and exits the heart, can operate like a floating clog waiting to find a home.
If it ends up in the brain, then you have a good old-fashioned stroke. This is precisely the reason why blood-thinning medications are so important for the treatment of atrial fibrillation.
What causes atrial fibrillation?
In some cases, the cause of atrial fibrillation is unknown. But in most instances, it occurs in tandem with other health conditions such as hypertension (high blood pressure), previous heart attack, valvular defects, congestive heart failure, or associated comorbidities like obesity.
In my experience working in cardiac rehab, it was also quite common to see patients with atrial fibrillation after open-heart surgery.
What are the treatments for atrial fibrillation?
You should understand that not all cases of atrial fibrillation are the end of the world. Your cardiac specialist will need to run some tests (such as an electrocardiogram or ECG) on you to ascertain how severe (or not severe) your condition is.
In many cases, it can be treated with anti-arrhythmic medication and blood thinners (see stroke risk above). Other approaches entail using cardioversion to “jolt” the heart back into normal rhythm, or catheter ablation to isolate and zap the specific region of the heart that is the source of the atrial fibrillation.
Exercise guidelines for atrial fibrillation
I am often asked for “right-wrong” or “black-and-white” guidelines for safe exercise with atrial fibrillation, but the short answer is always “it depends.”
Atrial fibrillation often presents in concert with other underlying health conditions, so the exercise prescription cannot be a one size fits all approach.
To follow some random exercise program off the internet could leave you face down and unconscious on the pavement while taking your afternoon walk!
Having said that, the good news is that you CAN exercise safely with atrial fibrillation. Have a detailed discussion with your cardiologist and medical management team and find out if there are any specific considerations that would preclude you from doing any certain types of activities.
If you were previously active, then you should let them know what your previous regimen was and what you’d like to achieve now that you have atrial fibrillation. Because the condition can reduce how much blood is ultimately reaching your exercising muscles, you will likely need to start off at a low level and then gradually increase your intensity and duration as tolerated.
A heart rate monitor “may” help you, but the inherent problem is that the numbers might jump around a bit while your heart’s in atrial fibrillation. The most prudent advice is to consult a clinical exercise physiologist with experience in cardiac conditions.
Take home message
Atrial fibrillation can be a scary condition, but your best weapon is a thorough evaluation and diagnosis and education on how best to manage it. I have worked with countless patients with atrial fibrillation and most go on to live completely normal and uneventful lives (no news is good news, right?). In nearly all cases, they were able to exercise quite safely provided their condition was medically managed and well-controlled.