Lone AFib – Exercise Cool Down and Swallowing as Trigger?

webmd_rf_photo_of_atrial_fibrillationI’m in my mid 40s and exercise very regularly. And when I say regularly, I mean very regularly… (see Working out 7 Days a Week?!). About 7 years ago (years before I started my more intense exercise routine), I had my first episode of atrial fibrillation (AFib), which feels somewhere between weird and scary. At the time, I started going through all kinds of EKGs, ultrasounds and other tests (you name it). The end result: my heart is healthy, I have no other risk factors and I don’t abuse drugs or alcohol. The official term for this is “Lone AFib” (LAF), which basically means nobody knows where it comes from or what causes it.

Since then, I’ve now had a total 4 episodes:

  • I ended up in the ER every time.
  • Gaps in between were 4 years, and roughly 21 months thereafter.
  • The first time I was admitted and converted back to normal sinus rhythm due to drugs overnight. The 2nd time I enjoyed a cardioversion (read: defibrillator & electroshock). The 3rd and 4th time I spontaneously converted while already in the ER but without clear reason – maybe it was the stress of the ER experience or that the Flecainide ended up working after all. (After the first incident, my doctor advised me to take Flecainide only in case I go into AFib, not as permanent treatment.)
  • I stayed in AFib between 8 and 23 hours during those episodes.

Coming back to the mysterious trigger, there seems to be a common pattern that emerges from the various circumstances when my AFib episodes started:

  • Walking off the mat after a Tae Kwon Do class on a Saturday morning and taking a swig from my water bottle (2 occasions, exact same situation and day and time of day!).
  • Coming home from a jog and getting something to drink.
  • Sitting down after a hike up a mountain and starting to sip water.

It seems obvious: the 2 factors that always appear to come together are 1) finishing cardio-intensive exercise (the heart going into recovery from high BPMs) and 2) swallowing liquid. I’m wondering if the nerves controlling the swallowing reflex/process (vagus nerve?) intersect with or related to the part of the nervous system controlling the heart rate or if there is another way these two bodily processes relate?

From what I’ve read and the doctors I’ve talked to, there is no clearly documented connection. And yet at least for me this pattern is obviously way too consistent to be coincidental.

I’d love to hear from others who’ve been diagnosed with “Lone AFib” as to whether they’ve experienced the same or similar patterns?


On a sidenote: has anyone found that Flecainide affects the blood sugar level (a maybe undocumented side effect)?

Please respond with comments.

3 thoughts on “Lone AFib – Exercise Cool Down and Swallowing as Trigger?”

  1. I too have the lone AFIB – cool down and cold liquids triggered my first episode. Like you, I exercise a lot – look young, feel young. I have had two what I consider to be major AFIB events with smaller ones, exercise induced that I seem to pull out of in the first few minutes after some harrowing coughing, bending over, pleading with the forces of the universe. I had my first when I turned 40 and had my second just two days ago where I was admitted to the hospital and electroconverted (15 years later). The first time I converted on my own with he help of drugs to slow my heart down after a night’s stay in the hospital. The heart doc who treated me in the hospital wants me to go on a beta blocker – I’m pretty suspect o that after reading some literature. At any rate, might be cool to compare notes off line oto see what you/we’ve learned

  2. Pretty much same with me. My wife is always trying to get me to drink right after exercising or hiking but I know better. I usually don’t drink anything until well after I’ve cooled down, or just take very small sips. I can probably point to maybe 50% of my afib episodes where it was directly triggered by drinking water. I can also go into afib by drinking cold water even when not exercising. I’m pretty sure it’s related to the vagal nerve for me. I just had a treadmill stress test which went fine and I got up to my max heart rate but then they had me sit down without cooling down enough and drink water and sure enough, the afib started and kind of freaked the nurse out. Incidentally, I’ve probably had 15-20 AFIB episodes over 12 years and every one of them converted back to normal rhythm by me going for a run – usually just a few run/walk cycles will convert it back for me.

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