IslandLuvr - I started back swimming laps 3 days after my ablation without problems. Before my ablation, I often swam laps while in AFIB. I would feel dizzy before getting in the water, but once in I was all right. I believe the reason is that it is not a weight bearing exercise. 3 months post ablation, I still cannot run hills without shortness of breath. It also takes longer to return to regular breathing afterward. I am slowly getting my wind back for weight bearing exercises, but it is a slow process. Good luck on your exercise and keep swimming.

Jim

Thanks Jim. I'm now up to 22 laps without resting in between. I'm determined! Are you on any medication post ablation?

I just put a pool in my backyard... now I guess I'll have to start swimming laps to keep up with you guys... no more floating on the raft. petey

Handing Petey floaties, nose plug, and Donald Duck ring... oh, and Petey.. I'll be right over!

IslandLubr - I am currently only taking baby aspirins, but after reading jrapchuk's post about aspirin, I may have to go back to pradaxa.

Jim

Personally, I wouldn't touch Pradaxa with a ten foot pole... but it's your decision. Just be sure you're fully informed about Pradaxa. For me, I don't think the risks are worth it... but we all need to make our own decisions because it's our own bodies.

Uh oh... do I have to do my "defend Pradaxa" talking points?
petey

Petey, please do! I am taking pradaxa and would love to learn something positive about it.

Petey- My personal favorite is the scenario about bending over to pick up a penny while stepping out of your smart car story :) I actually printed out the post some time ago and read it when I want to laugh :) I bust up every time I read it!

" Petey, please do! I am taking pradaxa and would love to learn something positive about it. "

The biggest risk with afib is stroke. Otherwise (other than symptoms), it is rather benign. The best drug for stroke reduction is Pradaxa. Xarelto may prove as good or almost as good. All the fuss about Pradaxa was mostly very old, fragile people with other medical problems and they even think the people might have double dosed themselves. I'll have to look up some old posts where I got the exact information. Pradaxa has been getting reported for adverse because it is a new drug and there is money in lawsuits. Coumadin has the longest history of adverse effects and was the #1 reported drug for problems based on hospital admissions. I posted on that also months ago.

But I don't want to get into that debate. Here's what Dr Mandrola says:

Dabigatran and rivaroxaban are blood thinners. They lower the risk of stroke, but increase the risk of bleeding. Its the same for warfarin. When these two agents were compared to warfarin in huge randomized controlled clinical trials, they both looked favorable.

For my entire career, I have heard the downsides of warfarin. Now, we have two drugs that prevent more strokes than warfarin, dont require blood checks, have no dietary interactions, minimal drug-drug interactions and are not used to poison rats. Do they worsen bleeding when one falls? Yes. So does warfarin.

Folks, of course it is better to not have a disease that increases the risk of stroke. Thats what I have been saying since I started this blog. Prevention is better. Go to bed on time, exercise every day that you eat, eat less, drink fewer irritants, dont sweat getting a B+ and smile at your neighbor. I know; these are hard therapies with which to comply adhere.

But blood thinners are not bad medicines. They are medicines. They have risks and they have benefits. And the alternative: a patient can have the disease and its inherent risks.

Now the facts: Warfarin causes more brain bleeds, Pradaxa causes more stomach bleeds. Pradaxa reduces stroke 90%, Warfarin 67%. Pradaxa works differently. It is taken twice a day and wears off quicker than Coumadin. The type of traumatic event (in the words of Dr Mandrola) that would cause a person to have concern about reversing Pradaxa would probably kill the person anyway. And there are techniques and protocols to deal with Pradaxa bleeding... and Warfarin is not as reversible as people think... it takes hours.

Bottom line... I want to lower my risk of stroke to the minimum. I don't want a brain bleed. I do not want to deal with getting calcification of the heart and arteries due to vitamin K depletion from taking Warfarin. I am not giving up healthy foods. I'll take Pradaxa anytime. Xarelto (Rivaroxiban) is not out of the question. I have to find my smart car post.

petey

Smart Car Post:

There's more to the story than that and more to weigh... believe me I know...
1) Pradaxa is 35% more effective than Coumadin for preventing strokes. Coumadin claims 67% reduction in strokes. And Pradaxa is 35% more effective so that means cumulatively Pradaxa prevents about 91% of strokes. These are just numbers and higher stroke risks are borne by those over 75 and who had previous strokes or other medical problems (Google CHA2DS2VaSC stroke risk scoring for more information). If your stroke risk using the CHA2DS2VaSC Scoring System is 4% per year with AFIB, if you use Coumadin (Warfarin), your risk is now 1.32 % per year. And thats if your INR (how thin your blood is) is correctly maintained and that has been very problematic for people and did I mention you have to have it monitored using Coumadin? Oh no! I forgot to mention that all healthy greens mess up your INR if you vary your intake (Vitamin K effect). If you use Pradaxa, your stroke risk, assuming the same original risk, would now be .36 %. THATS A BIG DEAL!!! The idea is to reduce stroke. You take Pradaxa twice a day. You dont have to get checked. The effects wear off in 12-17 hours.
2) Coumadin has far greater amounts of BRAIN BLEEDS!!!! THATS ANOTHER BIG DEAL!!! Pradaxa is harder on the gastric system for some people and the bleeds with Pradaxa are more likely to be stomach bleeds. Most people dont have a problem. Brain bleed or stomach bleed? THATS A NO BRAINER!!!
3) Oh no! I forgot to mention that all healthy greens mess up your INR if you vary your intake (Vitamin K effect). OK so you say you will cut out your greens sounds easy enough Oh no! Vitamin K prevents calcification of the arteries and people on longterm Coumadin (Warfarin) have been shown to have more calcified arteries.
4) So far, the first 3 have gotten my vote to go to Pradaxa but theres more. The bleeds with Pradaxa were with elderly patients with fragile bodies AND they dont know if they double dosed themselves or triple dosed themselves. Who knows? Further, doctors indiscriminately prescribed Pradaxa to patients with bad kidney function (Pradaxa is cleared by the kidneys).
5) The emergency room trauma scenario: You are hit by an 18 wheeler while getting out of your Smart Car to pick up a penny (Good thing you got out) you start bleeding. First of all, you will probably die anywaybut foregoing that, the idea that Coumadin (Warfarin) can quickly be reversed is simply not true. It takes hours. Pradaxa does not have an antidote yet, but they can clear it with charcoal and dialysis while they are sewing your butt back on. Solution get out of your Smart Car on the sidewalk side or get a Hummer and send someone else out to get the penny.
6) Lets review: My analysis is to be careful and take Pradaxa as a stroke is very bad as are brain bleeds and calcified arteries. INR testing and getting it right is a pain. So isnot eating healthy. Coumadin used to be used to kill mice by having them bleed out. D-Con was the product. Not sure how many mice had afib or strokes. Sounds primitive.
7) One last thing: Coumadin (Warfarin) is the number one medication for adverse effects resulting in emergency room visits. Class over.

:-)

petey

Another Dr Mandrola blog (btw, he is an EP, an athlete AND he has afib.

The best tool for treating atrial fibrillation
March 20, 2011

in AF ablation, Atrial fibrillation, General Cardiology

Today, I would like to tell you about the most effective way to treat the most common heart ailment, atrial fibrillation (AF).

Its not the novel new blood-thinner, dabigatran (Pradaxa). Though its obvious that preventing stroke without using a rat poison represents a huge advance.

Its not burning the left atrium with an ablation catheter. Though its clearly true that we can ablate AF much more safely and efficiently than we did in past years.

Its not freezing the atria with cryo-balloons. Though I look forward to learning this new technique.

You know its definitely not Multaq.

By far, the most effective way to treat AF patients is to provide them information. Knowledge is king. AF patients need to know stuff about their crazy new disease.

AF is nuts. It can cause heart failure and stroke, or it can cause nothing. It can disable some, and others dont know they have it. Its incidence increases with age, degree of inflammation and general wear-and-tear, but it can also afflict the athletic and nimble. (Though there is little doubt that doctors, lawyers and engineers have more AF than yoga instructors.)

Heres a sampling of twelve things that I often tell AF patients.

I am sorry that you have AF. Welcome to the club, there are many members.
I know how it feels.
Your fatigue, shortness of breath and uneasiness in the chest are most likely related to your AF.
AF may pass without treatment.
AF isnt immediately life-threatening, though it feels so.
Worrying about AF is like worrying about getting gray hair and wrinkles. Plus, excessive worry makes AF more likely to occur.
Emergency rooms treat all AF in the same way.
There is no cure for AF.
The treatment of AF can be worse than the disease.
The worst (and most non-reversible) thing that can happen with AF is a stroke. For AF patients with more than one of these conditions: Age> 75, high blood pressure, diabetes, heart failure, or previous stroke, the only means of lowering stroke risk is to take a blood thinner. Sorry about the skin bruises; a stroke is worse.
The treasure of AF ablation includes eliminating AF episodes without taking medicines. But AF ablation is not like squishing a blockage or doing a stress test. It will be hard on you. It works 60-80% of the time, has to be repeated one-third of the time and has a list of very serious complications.
If your AF heart rate is not excessive, its unlikely that you will develop heart failure. Likewise, if you have none of the 5 risks for stroke, or you take blood-thinning drugs, AF is unlikely to cause a stroke. In these cases, you dont have to take an AF-rhythm drug(s) or have an ablation. You can live with AF. You might not be as good as you were, but you will continue to be.
Theres obviously more than twelve things to say about AF. Its a complicated disease with many different ways to the same end. We need adequate time with our patients to give them this kind of powerful knowledge. They need time to digest all the possible treatments, or perhaps no treatment. Patients need to weigh the disease against the treatments.

All this is why AF treatment shouldnt be rushed.

JMM

peteycap glad you posted about Pradaxa and Coumadin. I was unaware that Coumadin depleted Vitamin K. Now I know why my pharmacist had an ablation telling me he did not want to take Coumadin for the rest of his life. He knew it depleted Vitamin K.

Jim, I like your spelling error "IslandLubr" - sounds like landlubber - funny (to me) when we're talking about swimming.

IslandLuvr, I'm in awe at your efforts - you go, girl! I like Petey's quote, tho - "You can live with AF. You might not be as good as you were, but you will continue to be." You're doing the best you can and your best IS good enough.

Petey, thanks so much for Dr Mandrola's 12 points. The more I read, the more I think I can put up with my afib, at least for the time being. I really appreciated KatyWhite's recent post.