 Poster: A snowHead
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@buchanan101, I've given up trying to work out my triggers, doesn't seem any rhyme or reason to them! Would they do both ablations at the same time?? My first one he did work in both chambers, one for flutter, one for AF.
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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| kitenski wrote: |
| @buchanan101, I've given up trying to work out my triggers, doesn't seem any rhyme or reason to them! Would they do both ablations at the same time?? My first one he did work in both chambers, one for flutter, one for AF. |
No - he says he'd go in the second time to check the first one... but one is flutter one is fib. I mean this guy is Papworth** so there must be a reason why he wouldn't do both at once...
Triggers are physical + mental stress together I think (I couldn't get the ticket machines to work - they asked for US zip code*)
(*if you are ever in NY and buying metrocards, use 00000 as Zip Code)
(**they've moved to the Addenbrookes site, but still it's probably one of the best parts of the country to have heart issues)
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Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
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| buchanan101 wrote: |
this guy is Papworth** so there must be a reason why he wouldn't do both at once...
(**they've moved to the Addenbrookes site, but still it's probably one of the best parts of the country to have heart issues) |
Best have the op done in May or November then, when the junior docs are near the end of their rota and know where the heart is 
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You need to Login to know who's really who.
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| snowdave wrote: |
| buchanan101 wrote: |
this guy is Papworth** so there must be a reason why he wouldn't do both at once...
(**they've moved to the Addenbrookes site, but still it's probably one of the best parts of the country to have heart issues) |
Best have the op done in May or November then, when the junior docs are near the end of their rota and know where the heart is |
If you're having a trainee do something best have it done at the beginning of the rotation when the consultant is demonstrating rather than the end when they are flying solo. Though I rather suspect things like ablations are pretty heavily supervised.
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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@tarrantd - Hi, I think it is lucky that @mountainsurfer popped up. I think I had a long discussion with him about AF in the gondola at la Grave (I think there can't be that many electrophisiology consultant cardiologists who ski as much as him). As well as my querying his assertion that all blue whales are permanently in AF (I asked if every blue whale had had an ECG? He went and re-read his source and changed his slides) we also discussed AF in racehorses with a racehorse vet who was also on the same trip. Apparently racehorses quite often flip into AF and respond to a dose of flecanide. The commonality between blue whales, racehorses and human athletes being that they all have big hearts- which are more prone to go into AF.
But I think the main point of my posting is to caution against asking about the risk (or otherwise) of skiing with AF here (apart from the expertly informed but generic advice given by @mountainsurfer).
I had AF about 13-14 years ago a couple of times and I'm a doctor, I've obviously refreshed my knowledge from medical school - 1986-1992. But I'd not think that any of this is sufficient to advise you about the specific query you made. Sorry for sounding so sanctimonious.
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@ed123, I think it's worthwhile hearing how others deal with risk. I am fascinated by the whole topic of risk. You don't need to be a doctor, let alone a cardiologist, to respond to the question of "how do you decide whether to ski with AF?" I enjoy hearing how other people assess risk, and the decisions they make. I would give up skiing for a day rather than ski on the horribly crowded pistes people were encountering at New Year. My risk of a major cardiac incident would be no different than on any other day's skiing (or possibly any other day dashing round Tesco) but my risk of a collision like the one which broke my pelvis would be far higher. And my next injury might be far more problematical. But other people will ski anyway, rather than lose a day. No amount of medical training can inform those sort of decisions.
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I was diagnosed with A-fib Jan 2022. It was pretty close to 100% of the time. I couldn't really tell when it was happening and when it wasn't after a while, but every little thing was exhausting. Continued skiing anyway. Was put on metoprolol and Eliquis, and scheduled for a cardioversion which did exactly zip. Then put on amiodarone and another cardioversion was scheduled. During this period had a fairly disastrous trip to Lech where just hoofing it with equipment from point A to point B would take me forever, and was so exhausted all the time that my skiing regressed to the beginner level. 2nd cardioversion didn't happen because AT THAT MOMENT my heart decided not to be in A-FIB. After 2 hours they sent me home then scheduled me for an ablation. Went off amiodarone, had ablation, it apparently worked.
Meanwhile, they also sent me to a sleep study and diagnosed me as having obstructive sleep apnea and blamed THAT for the A-fib. Put me on a CPAP in August. I hate it, but am using it religiously.
I also started taking weight off beginning April 2022. Now down 30 lbs. and skiing abilities have been revived. Am still on metoprolol, but for ski season stopped the Eliquis and am having just an aspirin each day. After ski season, will resume the Eliquis, but did not like the odds of making it to a hospital with an undiagnosed brain bleed while taking a blood thinner. Fortunately, my cardiologist is a skier, who "gets it' although I think he would prefer I stayed on it. But apparently I'm "right on the cusp" at the moment to take it, so he's going along for now.
71 years old.
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Don't know why I missed this thread when it was new. It's really fascinating.
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You'll get to see more forums and be part of the best ski club on the net.
You'll get to see more forums and be part of the best ski club on the net.
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Once my heart is in AF it stays in AF. But twice so far Cardioversion has worked on first shot (they do a max of 3, upping volts a bit each time), and seems to stick quite well.
First time in AF heart rate also went to 140 resting, but the stupid machine they had monitoring rate overnight in hospital obviously averages rate over too short a time and kept off setting alarms for “low”.. or “none”
On 5mg Bisoprolol constantly which seemed to make second AF episode less dramatic in how I felt with it - I think I could’ve skied ok-ish.
Someone asked about Bisoprolol and altitude; whilst on it, but not in AF, I was fine at 3000m in Obergurgl and Solden last April.
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@buchanan101, do you take Bisoprolol once? One of my triggers for atrial tachycardia is definitely adrenaline and harder exercise. So I started taking 2.5mg in the morning and the same in the evening.
What’s quite interesting is that the various consultants seem ok with my tweaking of amounts and timings within some high level boundaries
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snowHeads are a friendly bunch.
snowHeads are a friendly bunch.
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| kitenski wrote: |
@buchanan101, do you take Bisoprolol once? One of my triggers for atrial tachycardia is definitely adrenaline and harder exercise. So I started taking 2.5mg in the morning and the same in the evening.
What’s quite interesting is that the various consultants seem ok with my tweaking of amounts and timings within some high level boundaries |
Yours could well be more sensible - I take one 5mg in the morning. There again I’m 105kg so quite a lot for the 5mg to go in to (vets titrate but doctors don’t..which is a little strange if it’s the same dose for humans who may differ 2:1 in weight). AF did get me to lose 10kg though.
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And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
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| buchanan101 wrote: |
| kitenski wrote: |
@buchanan101, do you take Bisoprolol once? One of my triggers for atrial tachycardia is definitely adrenaline and harder exercise. So I started taking 2.5mg in the morning and the same in the evening.
What’s quite interesting is that the various consultants seem ok with my tweaking of amounts and timings within some high level boundaries |
Yours could well be more sensible - I take one 5mg in the morning though NHS website says usually taken once a day in the morning. I’m 105kg so quite a lot for the 5mg to go in to (vets titrate but doctors don’t..which is a little strange if it’s the same dose for humans who may differ 2:1 in weight). AF did get me to lose 10kg though. |
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| Quote: |
vets titrate but doctors don’t..which is a little strange if it’s the same dose for humans who may differ 2:1 in weight
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When I went to the surgery for the presentation on blood thinners on Saturday the pharmacist weighed us all to determine the dose but I'm not aware that weight was ever a consideration before. Perhaps the prescribing doctor, in the past, has just "eyeballed". My Entresto was titrated up to the max dose, over several months, because they were worried about my low blood pressure - falling downstairs and breaking my neck being a more immediate danger.
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You know it makes sense.
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| pam w wrote: |
| @ed123, I think it's worthwhile hearing how others deal with risk. I am fascinated by the whole topic of risk. You don't need to be a doctor, let alone a cardiologist, to respond to the question of "how do you decide whether to ski with AF?" I enjoy hearing how other people assess risk, and the decisions they make. I would give up skiing for a day rather than ski on the horribly crowded pistes people were encountering at New Year. My risk of a major cardiac incident would be no different than on any other day's skiing (or possibly any other day dashing round Tesco) but my risk of a collision like the one which broke my pelvis would be far higher. And my next injury might be far more problematical. But other people will ski anyway, rather than lose a day. No amount of medical training can inform those sort of decisions. |
Hi pam, I've almost always agreed with everything I've seen you post. But unfortunately not today.
As you have pointed out AF is (usually) not in itself the primary problem and treatments for the primary problem, the AF and the effects of AF and then from the treatments wildly vary. So whilst many people here have AF the severity of it, causes, treatments, treatment risks etc are all different. So individual's anecdotal accounts are just that and potentially misleading.
The question 'how do you decide whether to ski with AF?' isn't really a question! It's more like 'how do you decide to ski with AF (of severity s, frequency f, duration t with associated features xyz, due to conditions c, c1 etc, treated with t, t1, etc with side effects / risks of treatment r, r1 with severity etc etc etc' Followed by- 'My cardiologists advice is abc and my insurance company will / will not cover this preexisting condition.'
I'm afraid health advice on internet forums is a disaster. COVID, vaccinations, dietary advice are all good examples. THh expertise required being a. an internet connection and b. the ability to typeThat said this thread has had the excellent- but generic, post by mountainsurfer (who I think I know). There is also the knee surgeon who posts but again generically.
For AF the risks of exercise / altitude will vary enormously between individuals because of their individual circumstances. I think you are also mistaken about the risk decision making. There will be three parties involved. Someone to give expert medical advice on an individual basis, then the risk appetite / pros and cons as assessed by the patient and then the insurer.
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Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
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If I've given anybody any advice about skiing with AF, then I shouldn't have. What I have tried to do is describe my own experience and thought processes. Which is perfectly legitimate - and I've greatly appreciated reading about those of others. My reference to risk was by no means focussed on AF or even on medical issues. We all make risk assessments, all the time, usually unconsciously. And in my experience the medical "experts" are generally unwilling to give advice on which risks to take. My cardiologist says I should do as much exercise as I feel comfortable with (not that I've seen him since before Covid) which is tautological. The only thing he's said I shouldn't do is lift heavy weights "But carrying your suitcase going on holiday is fine". Like most people who have historically done a fair bit of exercise I was quite accustomed to feeling very knackered and out of breath (e.g. after walking fast up hills or grinding a headsail sheet back in the day when the boats I sailed didn't have powered winches). So my tolerance of exercise-induced temporary discomfort is probably a lot greater than some people's.
I got him to refer me to cardiac rehab (it was not routinely available for heart failure victims) and was struck by how fearful many people in the class were.
Take half a dozen people in that class, give them the advice that they should do what exercise they are comfortable with, and you'll get half a dozen quite different outcomes.
Some people boast of their ridiculously fast drives down to the Alps and then fret about whether an out of control skier might injure one of their kids. Go figure.
IME medical advice about the risks of skiing depend largely on whether the advice-giver is a skier or not. Same with sailing. I am regular crew/second in command on a boat with an 88 year old skipper who has had cardiac surgery and has a pacemaker. His chances of dropping dead, or being taken very ill, at the wheel are quite high. Years ago he was out with a very old friend who dropped dead sitting on the gunwhale and toppled backwards into the water. So he knows the risks. Should he stop sailing (his wife thinks so)? Should I (at a mere 76 in a couple of weeks) refuse to sail with him? I am a competent crew and could get the boat somewhere safe without him - but then I probably stand at least as high a chance of dropping dead myself.
At least in a boat we are less likely to take innocent parties with us than we are when we drive our cars - a risk which scarcely anybody thinks about.
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Poster: A snowHead
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@ed123 my AF is relatively straightforward - if I have it I have it all the time...doesn't kick in and out like some. I know what I feel like; I couldn't have skied first time with it, I could have second time. I'm not sure why I didn't feel as bad second time (still tired with exertion but much less so, even though ECGs on my watch were just as erratic), though I was on Bisoprolol when it kicked in, so maybe that reduces effect (cardiologist says - guesses? - it might)
My travel insurer is fine I think... they paid up for my day in New York ER with the second (most recent) relapse I had, and have insured me for the coming year - in both cases I took out insurance with underlying condition (is AF once treated with Cardioversion and heart back to normal rhythm an "underlying condition"...?)
Staysure is my insurer if anyone is interested; Amex insurance on my Credit Card is no good for AF underlying. Only £85 for me for this year even with condition and the form asked for number of unplanned hospital visits in the last year with the condition (one - in New York). Interestingly European cover goes up if Spain included...
I don't think Pam was giving advice - people on here are just relaying their own experiences. Only the person themselves really knows, and only advice from their cardiologist should be relevant. If I had "active" AF but didn't feel too bad, i think I'd ski, but would be sticking to the blues and only ski if the conditions were good; I'm good enough a skier for that to be low exertion - after all what is the slope for
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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@pam w, anyone on DOACs (apixaban) etc, needs a yearly weight and height to calculate the proper dose for the medication. It should have been done every year, not just this one. You should also be having at least annual blood tests to determine your kidney function, and blood count to make sure you aren't having any un-noticed internal bleeds. As you get older blood tests may become more frequent. Eyeballing a weight is useless for calculating the correct dose, as it has to be recorded and coded in your GP record annually.
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Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
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@Hells Bells, I think that's only one of the ways my care (like that of lots of people) has been sub-optimal! I had to ask for a full blood count last year after two years without! My GP also mis-interpreted an ECG, which had been done after a routine check by a nurse had found an erratic pulse. It was only when I went back because I felt really quite unwell that a different (locum) GP found I was tachycardic, had AF and a good deal of fluid on my lungs - he prescribed immediate beta blockers and DOAC and then went into hospital and diagnosed with heart failure. Now "discharged" to GP care but I have recourse to the heart failure nurse team (who are very good) if I feel the need. I am contemplating a private echo, which isn't very expensive. Wouldn't make any difference - it is what it is - but I am curious as to whether my ejection fraction has improved. I am a lot less "ill" than people with my dismal number usually are. Thankfully.
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You need to Login to know who's really who.
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Hi pam, I may well have misrepresented you as having given advice rather than talk about your own experience. Which I'm always at risk of doing. Damn and sorry. I suppose I'm generally concerned about medical advice on the internet.
I think you are correct though about medics who are / are not skiers (or generally fit) and a propensity to give / not give advice about skiing per se.
A tip for anyone with any condition asking medics about things like skiing would be to explain a little about the degree of exertion or otherwise. Cardiologists will be regularly giving advice about the limits of exertion and will also know about the risks greater or smaller of the anticoagulants they prescribe. FWIW Mrs Ed had some nasty heart problems a few years ago with pericarditis- she went from ultraruns / triathlons and 100 mile cycles to breathless walking down the stairs. The cardiologist she saw a year later about exercise was very enthusiastic about it- although he had been in the SAS before going into medicine and obviously climbs / skis extensively (Prof Rod Stables- he is like a superperson).
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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I was recently diagnosed with Afib. I had an episode 4 months ago and another on Monday.
It happened while I was packing for a ski trip.
I canceled the trip until I figure this out. My PCP was 110% against my going skiing due to the altitude and level of exercise. An EKG was normal.
It sounds like I didn't really need to cancel. But I think I will wait until I consult a cardiologist in early February. I am 70 yo.
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Yes, sensible to see your cardiologist. You might need medication. But don't panic. I am in permanent AF and it doesn't interfere with my everyday life. I'm 77 now and was diagnosed with cardiomyopathy induced heart failure over 5 years ago,. With the medication I feel much than I did then, when I had fluid on the lungs.
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I should say that AF is common. I was relieved, in hospital, when the husband of one of my ward mates, obviously an active and energetic chap, said he'd had AF for 30 years.
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It's very helpful to have a cardiologist who skis! As an aside, I persuaded the non-skiing anaesthetist on my two lots of open-heart surgery to give skiing a go and he's now completely hooked.
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You'll get to see more forums and be part of the best ski club on the net.
You'll get to see more forums and be part of the best ski club on the net.
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| Quote: |
I persuaded the non-skiing anaesthetist on my two lots of open-heart surgery to give skiing a go and he's now completely hooked.
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I don't know whether my cardiologist skis or not, but at no point have I been advised to avoid anything other than "heavy lifting" andf he stressed that by that, he didn't mean carrying a suitcase when going on holiday. He said that was fine but advised me not to break up concrete with a sledge hammer. I was disappointed, as I do a lot of that, but promised I wouldn't.  If you have a serious heart condition then you are at risk of a sudden cardiac incident - even a catastrophic cardiac incident! However, that is not more of a risk when you are skiing than when you are dashing round Tesco or walking the dog (though that wouldn't happen to me as I don't have a dog.....).
However, it IS likely to push up the cost of insurance and I pay a substantial premium because of my list of medications. It's not more likely that you have a cardiac incident when skiing, but if that happens in a foreign country it could prove expensive for you, or your heirs......
Hope you get good news about your condition and can go off skiing soon. Just remember to tell your insurance company.
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snowHeads are a friendly bunch.
snowHeads are a friendly bunch.
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Interesting to find this thread again! I am now 2 years and 2 months free of AF ( not that I’m counting!), following my 3rd big ablation in France. At a recent consultation my wonderful cardiologist told me to eat cheese, drink wine, and enjoy my life! He said it was likely to return at some future point, and if that happened, I should ping him an ecg and he will sort it out  .
I’ve decided not to ski again - due to Apixaban and such a good result from my ACL reconstruction 9 years ago (thank you Jonathan Bell), that for me, being rather accident prone at the best of times, it isn’t worth the risk. I will continue snowshoeing and walking in the mountains, which I love.
So that means I have some skis with good knee bindings on if anyone is interested ??
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And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
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Good news, @genepi, 
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@genepi, interesting thanks, I've had two ablations and keep wondering about a third as I get occasional issues and am on beta blockers to calm everything down....
How come you need to stay on a blood thinner if you are 2 years free of AF?
Do you know what he did differently on the third go?
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You know it makes sense.
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@kitenski, I’m on them forever as I have a CHADSVASC risk of 2 and a terrible family history of strokes!
The Ist ablation was a Farapulse one with radio waves, 2nd was a cryoablation, and because neither of these worked - in fact the second added atrial flutter to the mix- they decided on the 3rd. This involved 2 of them and it took over 3 hours. It involved complicated mapping of the electrical impulses and burning lines they couldn’t cross. My vein of Marshall (apparently a source of unwanted electrical activity) was injected with alcohol. Certainly 2 years ago this was something that wasn’t done in the UK. They told me it was a particularly recalcitrant AF! Very happy to be free of it for now 
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Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
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The standard view is that whilst ablation can be helpful in treating symptomatic AF the successful restoration of sinus rhythm does not reduce risk of stroke and enhanced mortality rates.
So the argument for continued medication - particularly anticoagulants - is very strong.
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Poster: A snowHead
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@Origen, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7486083/
"The most important factor implicated in the reduction of stroke and mortality is maintenance of sinus rhythm, which is better achieved by ablation therapy compared to anti-arrhythmic medications."
That's not to say (continued) OAC therapy isn't also important, as this review makes clear.
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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The article in that link also says "Multiple trials have highlighted the benefit of catheter ablation over medical therapy in restoring sinus rhythm and improving quality of life. Whether it reduces long-term risk of stroke and mortality is still unclear."
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Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
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The quote compares ablation vs medication, not ablation vs nothing, as you did in your earlier statement.
Ablation vs no ablation improves outcomes.
"Ablation + OAC" vs "no ablation + OAC" also improves outcomes.
What is unclear is whether Ablation vs "no ablation + OAC" improves outcomes.
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You need to Login to know who's really who.
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Interesting paper. Regarding ablation vs no ablation + OAC, it would be good to see the results. Personally, it was a quality of life thing too, which should never be underestimated. Pre-ablation, despite beta blockers and Flecainide, I spent more time in fast and erratic AF than not, and it was quite scary.
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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| genepi wrote: |
| Personally, it was a quality of life thing too, which should never be underestimated. |
Agreed - I'm due an ablation soon (hence reading up on the topic) and quality of life is the main driver. There are alternatives for me, but all of them result in a much lower quality of life, particularly when it comes to sport.
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You'll need to Register first of course.
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@snowdave, Best of luck with it and I hope you get a good result!
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@genepi, thanks, hopefully I'll be a one-hit wonder At least my CHADS score is very low, so I can stay off those drugs for a while.
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@genepi, sounds like they've really nailed it, fingers crossed! I'm a bit nervous about a third operation so will see how I go. I think both mine were farapulse at the same hospital.
@Origen, the argument for anticoagulants is based heavily on the CHADSVASC score according to my cardilogist.
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You'll get to see more forums and be part of the best ski club on the net.
You'll get to see more forums and be part of the best ski club on the net.
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Yes, I imagine you wouldn't need OACs if you have a good left ventricular "ejection fraction". I don't, mine is disastrously low, which means I qualify for a very expensive drug, but fortunately my functional ability is much higher than that indicates! I can walk on the flat for a couple of hours at a good pace, and have no problems with the stairs in my three-storey house but walking uphill at any pace makes me breathless quite quickly. I'd like to think that's partly the result of the beta-blockers but I'm kidding myself. My blood pressure is very low - the optimum dose of sacubitril/valsartan (the expensive one) had to be titrated over several months as they were afraid I'd be falling down the stairs when tottering out to the loo in the middle of the night. I count myself fortunate - yes, I do have a serious heart condition but it interferes very little with my life, I'm fine with all the meds and lots of my friends have much worse things to put up with - things like arthritic hips and knees, and polymyalgia rheumatica which are more difficult to live with.
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FAQ
