Exercising at high altitude with afib

I would be interested in hearing how it goes for you. I want to climb Kilamanjaro soon and wonder how the heart would take it: ie would it increase the risk of Afib. Thanks.

Hi @riverpark,

I have PAF and other arrhythmias. I grew up in the SF Bay Area where I led an active lifestyle, including hiking and skiing at Tahoe. I retired 6 years ago and moved to a higher elevation of 4500 ft. A sleep study 1 year ago diagnosed me with hypoxia (low blood oxygen) at this elevation and it gets worse when I travel to higher elevations. I am on oxygen during the day off and on, and I need to use oxygen overnight. I am generally fine when I return to the California coast to visit friends without oxygen with light activity. However, the oxygen always helps when I get AFib, chest tightness, or another arrhythmia. I always travel with a portable oxygen concentrator, including travel on airplanes.

My suggestion is to do some test rides at different elevations and monitor your heart with an Apple Watch or similar device, and an oximeter to see how you do. Sounds like an exciting ride!

High intensity exercise triggers my AFib and so does low oxygen. I have to be careful. I am on 50 mg of Flecainide and 5 mg Eliquis twice a day.

Mayo Cardiologist, Dr Barry Borlaug, recently diagnosed me with HFpEF the most common type of heart failure. I am a little more cautious about the activities I do and intensity. Currently, there is no cure for HFpEF, it is a progressive, complex, systemic disease. AFib is a risk factor in Mayo’s H2FPEF score.

I have tried many oximeters to keep track of my blood oxygen level. I use two FDA approved continuous oximeters - LookeeTech Sleep Pro and Nonin Connect. Both will upload data to your phone through an App or email. The LookeeTech Sleep Pro has an alarm which will alert you when your SpO2% is too low. I use them both them at times during the day, overnight, and during exercise. They are the only ones I found that actually work consistently and will maintain their blue tooth connection during exercise. Their readings match my hospital visit monitors, although, my EP doc told me that oximeters are not accurate for your heart rate when you have an arrhythmia. It is best to use an ECG device.

All the Cardiologists I have seen encourage exercise. I was told I need to be on a blood thinner with AFib to prevent a stroke, some have said I could try carrying Eliquis, Flecainide, and Metoperol Tartrate as a pill in the pocket meds for use if I get an AFib episode. I have decided to try and decrease my dose over time since I have asymptomatic AFib episodes.

Good luck with your exercise program, enjoy life, and stay well.

Hi Janet,

Enormous thanks to you for your excellent, informative reply. Everything you mention gives me something to consider, and I truly appreciate your sharing your experiences. As far as I know, I have no oxygen problems. Last summer, before I was diagnosed with AFib, I had no problems hiking at higher elevations such as to Lake Winnemucca and higher above 9000 feet out of Carson Pass. I have done fine slowly but surely increasing my exercising back to pre-AFib levels of moderate intensity here in Sacramento, but riding a bike at Tahoe elevation slightly worries me about a breakthrough AFib episode, though I have had none since January, before I began Flecainide. Anyhow, I do agree with your advice about doing test rides at different elevations and plan on doing that or at least hiking up hill at different elevations. Thank you for your kind well wishes, and the same to you! I’ll let you know how my Tahoe ride goes later in July.

(Sorry for accidental duplication. I had intended to direct this only to @riverpark. Site won't let me delete this printing.)

I too have Afib at 76, and was told it was OK to continue with my ~hr/day of aerobic exercise + weight lifting a few times/week.

I haven't had any trouble with the exercising apart from a few times when my pulse rose (to ~ 150 - 160) and didn't drop afterwards as it should.

On that account (rare continuous tachycardia, which eventually went away), I was prescribed Metoprolol to be taken PRN, 12.5 mg (have only taken it three times). I also take daily Xarelto.

I'm nowhere near as active as you (orthopedic problems preclude it) but still I think I exercise enough to keep my heart reasonably fit. (I do HIIT gym exercise almost once/day - that is "high intensity interval training", supposed to be most useful to condition ones heart). Unlike you, I have Afib several times/week for a matter of hours, usually when asleep. No symptoms.

However, my heart tests have been fairly healthy (EF of 65 shown on echocardiogram) and only slight valve regurgitation, normal size heart. The last time I saw my PCP a week ago, my Oximeter read 100% (!) and I don't have high blood pressure.

All this is just to compare the two of us at least as far as the stats you provided allow.

I am astonished, however, that even though your AFib is far more infrequent you haven't prescribed a blood thinner to reduce your stroke risk! I wonder too, how you know when you're in Afib. I have no symptoms - perhaps yours alert you. Do you have a wearable device showing when you're in Afib? (I have an Apple Watch with a cardiac function I can read out on an iPhone - I check my sleeping BPM when I awaken. I intend to get the newest watch when it comes out as it will allow me to keep track of my blood oxygen.)

Of course, none of us can really compare our relative Afib situations online, but I have never heard of anyone avoiding a blood thinner even with a lower Afib frequency. AFAIK the stroke risk is the greatest danger from Afib, apart from the wear and tear it apparently causes the heart especially when accompanied by tachycardia. That to me would be the greatest risk for you.

@riverpark

I too have Afib at 76, and was told it was OK to continue with my ~hr/day of aerobic exercise + weight lifting a few times/week.

I haven't had any trouble with the exercising apart from a few times when my pulse rose (to ~ 150 – 160) and didn't drop afterwards as it should.

On that account (rare continuous tachycardia, which eventually went away), I was prescribed Metoprolol to be taken PRN, 12.5 mg (have only taken it three times). I also take Xarelto (blood thinner) for the Afib itself.

I'm nowhere near as active as you (orthopedic problems preclude it) but still I think I exercise enough to keep my heart reasonably fit. (I do HIIT gym exercise almost once/day – that is "high intensity interval training", supposed to be most useful to condition ones heart). Unlike you, I have Afib several times/week for a matter of hours, usually when asleep. No symptoms.

However, my heart tests have been fairly healthy (EF of 65 shown on echocardiogram) and only slight valve regurgitation, normal size heart. The last time I saw my PCP a week ago, my Oximeter read 100% (!) and I don't have high blood pressure.

All this is just to compare the two of us at least as far as the stats you provided allow.

I am astonished, however, that even though your AFib is far more infrequent you haven't prescribed a blood thinner to reduce your stroke risk! I wonder too, how you know when you're in Afib. I have no symptoms – perhaps yours alert you. Do you have a wearable device showing when you're in Afib? (I have an Apple Watch with a cardiac function I can read out on an iPhone – I check my sleeping BPM when I awaken. I intend to get the newest watch when it comes out as it will allow me to keep track of my blood oxygen.)

Of course, none of us can really compare our relative Afib situations online, but I have never heard of anyone avoiding a blood thinner even with a lower Afib frequency. AFAIK the stroke risk is the greatest danger from Afib, apart from the wear and tear it apparently causes the heart especially when accompanied by tachycardia. That to me would be the greatest risk for you.

Sorry this duplication occurred. Site won't let me delete the first one.

Hi @reality test,

Thank you for your reply! It is great to hear from somebody my age so that we can share our symptoms and experiences while we are at the same stage in life. I have always had palpitations since age 19, had several Holter monitors over the years that always diagnosed them as benign. However, last October, my heart went into crazy-wild arrhythmia at a pace of about 120 bpm. It lasted about five hours. After the same thing happened some weeks later for 8 hours (my longest one), I was prescribed 25 mg metoprolol once a day. After it happened again despite the metoprolol, I had a 2-week Holter monitor and the same thing happened just once for two hours while on the monitor. That was the only episode of AFib during those two weeks, although other benign arrhythmias did occur. So I have had just a few of those wild AFib events that ended in late January after I added 50 mg Flecainide twice daily to my meds. Metoprolol and Flecainide are the only meds I take for anything except for finasteride for enlarged prostate. My AFib is definitely not asymptomatic, and I know the instant it begins and ends. After a echocardiogram and treadmill stress test, which revealed no structural or organic heart irregularities, and considering my overall pretty good health with only my age a strike against me for stroke risk, my cardiologist firmly recommended that I do not take an anticoagulant, stating that the risk of that would outweigh my risk of stroke, even though I have no condition that would predispose me to higher than normal risk of bleeding if I did take a blood thinner. My primary care physician agrees with the cardiologist regarding the blood thinner, so go figure. You are definitely not the first to question why I don’t take the anticoagulant, but I am perfectly pleased with not taking it for now, and I don’t feel at a great risk of stroke at present. If I begin having AFib episodes more frequently or have one that lasts, say, 12 hours or more, then I think my docs and I would probably revisit the blood thinner idea. Thanks again for your reply!