Atrial Fibrillation and Exercise

by Paul Teague

A heart arrhythmia is a disorder of the heart rhythm characterized by an irregular heartbeat. Atrial fibrillation [AF] is the most common and complex of all arrhythmias. It occurs in 0.4% to 2.0% of the general population. There is increasing evidence that AF occurs more frequently in those who engage in long-term aerobics exercise. On page 56 of his 1994 book, Antioxidant Revolution, Kenneth H. Cooper, MD, states, "I have become alarmed at the increasing frequency of atrial fibrillation . . . in highly conditioned runners who have been exercising over a period of many years.

After reading Dr. Cooper’s first book, Aerobics in 1967 [when I was 33 years old], I became a dedicated runner. I continued to run regularly until I had to stop in 1995 because of AF. During my years of running I had routine physical examinations that included maximal treadmill stress EKG tests. I even went to the Cooper Clinic in Dallas for some of these annual examinations. All of the tests were normal until 1993.

During my annual stress EKG test in 1993, my heart rhythm changed from normal sinus rhythm to atrial fibrillation as I attained the maximum stress level. My heart rate jumped from 190 to 240. This was my first known episode of AF. I converted back to sinus rhythm in less than an hour. But AF episodes triggered by elevated heart rates during exercise became increasingly frequent.

AF has three detrimental affects that increase morbidity and mortality. These are:

• The irregular heart rate reduces exercise tolerance and causes discomfort and anxiety,

• The loss of synchronous heart atrioventricular contractions reduces the heart output which can cause congestive heart disease.

• Stagnation of blood in the left atrium increasing the possibility of blood clots that cause strokes. Anticoagulant therapy to prevent strokes is standard treatment for AF patients over 60 years of age

I sought the best medical treatment for AF. I was diagnosed as having lone atrial fibrillation, i.e., there was no underlying heart disease or apparent reason for the AF. The standard treatment for AF involves the use of anti-arrhythmic drugs—all of which have potential serious side effects including fatal arrhythmias. I was refractory [i.e., the drugs did not control my AF] to all the standard medications.

In September 1997, my AF changed from paroxysmal [i.e., comes and goes] to chronic [i.e., continually in AF]. The Mayo Clinic in Rochester, Minnesota, is recognized as one of the top diagnostic clinics in the world. In October 1997, 1 went to the Mayo Clinic where I was hospitalized for eight days for a full evaluation of my AF. I was placed on coumadin, a blood anticoagulant, and amiodarone—the anti-arrhythmic drug of last resort because of its many serious side effects.

Amiodarone treatment failed to control my AF. I returned to the Mayo Clinic two times for electrical cardioversions to restore sinus rhythm between December 1997 and May 1998. After each conversion, I quickly reverted to AF. In April 1998, a leading heart arrhythmia specialist at the University of Colorado Medical School bluntly told me, "You are going to have to change your active life style and stay on anticoagulant therapy for the rest of your life. You must accept this because there is no cure for your AF.

I could not accept this discouraging prognosis. So I started an intense web search of the medical literature. My search of the internal medicine field that treats AF only confirmed what the doctor had told me. Then I searched the surgical journals. There I found that one of the top surgeons in the world, James L. Cox, MD, at the Georgetown University Medical Center in Washington, D.C. had developed a highly complex open heart surgical procedure—called the Maze procedure—that could cure AF. None of my many doctors had ever recommended that I consider the Maze procedure.

The electrical currents that trigger heartbeats cannot cross suture lines. With AF, errant and chaotic electrical impulses short circuit on the surface of the upper chambers of the heart causing the atrial fibrillation. For the normal pumping action of the heart to occur, the surface of the atria must be electrically energized. Dr. Cox discovered that a maze made with incisions on the surface of the heart could prevent the errant electrical impulses and short circuits that cause the atria to fibrillate. The scars from the suture line incisions [forming the maze] confine the electrical currents, but still permit the atria to be energized for normal heart rhythm and function.

The heart has to be stopped and the patient placed on a heart bypass machine during the Maze surgery. For the first 300 Maze procedures, Dr. Cox, split the breastbone [the same as in bypass surgery] to gain access to the heart. In late 1997, he started using "minimally invasive" techniques for the Maze procedure. Rather than split the breastbone, he gains access to the heart through a four-inch incision between the ribs on the right side of the chest. This requires the use of the highly sophisticated surgical equipment including a tiny wide-angled video camera that is inserted through the incision. It also requires great surgical skill.

When I first visited with Dr. Cox about the Maze procedure, he told me that almost every AF patient he sees with lone AF has been a long-term aerobics exercise adherent. Dr. Cox could not definitely say that the aerobics caused my AF.

Dr. Cox requires that his Maze Patients have a coronary angiography study [angiogram] before the surgery. This is to assure that there is no blockage of the coronary arteries that would require bypass surgery with the Maze surgery. My angiogram showed I did not have any coronary artery blockage. The radiologist who did the study told me that I had " the arteries of a 9-year-old boy."

On June 26, 1998 [when I was 64 years old], I became Dr.Cox’s fifteenth patient to have the Maze procedure done using the minimally invasive technique. Five days after the surgery, I was discharged from the hospital in sinus rhythm. I have continued to be in sinus rhythm without any AF episodes.

My recovery was unusually quick. Dr. Cox’s office suggested that I follow normal heart surgery rehab with no strength training for at least six weeks. I started strength training using the SuperSlow® Protocol three weeks after the surgery. Eight weeks after the surgery, I was fully recovered. I resumed all normal activities—except running. The normal recovery period for the Maze procedure is 3 months.

The anesthesiologist for my Maze procedure compares the trauma to the heart from bypass surgery to being run over by a Volkswagen®—and the trauma from the Maze procedure to being run over by a Mack® truck. The Maze procedure is much more complicated and traumatic as is the recovery.

I began strength training in 1978 using Nautilus® equipment and the 2/4 protocol. When I learned about the SuperSlow® Protocol from Ken Hutchins in 1988, I became a convert, practitioner, enthusiastic supporter, and a charter member of the SuperSlow® Exercise Guild, INC. I have an ideal in-house exercise facility with 15 Nautilus Next GenerationTM machines.