Atrial Fibrillation

[emoreira]

Hi, I'm male, 53 years old. I'm healthy and fit, though I'm not athletic. I'm far from the CardioVascular Risk Factors. No obesity, no smoke, no alcohol, no drugs, no Viagra, no high blood pressure, no high Cholesterol, no diabetes, no sedentary, no family history.
I've got my SSI DCS certification last year. I was planning to start OWDI next year.
I've been helping in my dive school for the last two years while I did my MSD, Dive Guide and Dive Master certs.
Year 2014 has been, so far, really bad. I was fired from work, though I could find a new job, and this obliged me to let go a 10 days dive live-a-board to Bahamas fully paid, my wife had to be operated to replace a Hip, my daughter destroyed my car though she suffered almost no harm. Social situation here in my country has become critical, inflation, criminality, corruption, unemployment and several pests of the kind. People is becoming crazy.
All this finally took its toll. Friday Nov 07th, at lunch I suffered palpitations. After several hours instead of going home, I went to the local hospital and they discovered that I had Atrial Fibrillation. After several hours in the Emergency Room in the hospital and with some medications (Atenolol 25 mg x 12 hs) I was released with orders for an Echo Cardiogram and 24 hs Holter. Besides, the advice to visit urgently a cardiologist. Visits and check times were planned.
Last Wednesday 12th, at work in the middle of the morning, palpitations, which didn't dissipate in the previous days, made me feel bad, a press in the chest and dyspnoea, besides of the fear I had been gathering. I took a taxi and went to a famous Cardiologist hospital (Fundación Favaloro).
I was received in the Emergency Service. They did to me all the analysis. Blood test and chest RX were OK, Electro cardiogram showed AFib. TNUS negative, CHA2DS2 VASc 0, HASBLED 0. Atrial Fibrillation was the diagnose, and with the antecedent of 4 days with AFib they told me I will receive an Electro Cardioversion to reestablish sinus pulse.
Echo Cardiogram and Transesophageal echocardiography were done with no news (no blood clots were found) and finally on Thursday 13th the ECV was done to reestablish regular rhythm. After this a SPECT Dipiridamol with load and rest were done to confirm normal situation. Several 30 secs Electro cardiograms showed no more AFib.
Last Friday 14th I was sent back home to my normal life with the advise to be careful as I'm under anticoagulants. This means no high impact nor extreme sports. Now I'm with preventative medications : Bisoprolol 5 mg, Propafenona 150 mg and Rivaroxaban 20 mg (for the next 4 weeks) once a day each, in the morning, plus a gastric protector.
Next Wednesday 19th I will have my first post-incident check in the cardiology service and on Wednesday 26th I will have my first visit to the Electrofisiologist to define the next steps regarding the AFib. No one of the doctors I met and will meet have any clue about diving.
Well, these are the events, now I would like to know if any one could tell me how my dive future looks like.
Thanks in advance.

 

[Dr. Doug Ebersole]

I am a cardiologist as well as an avid technical diver and instructor. With a CHADS2 VAS score of 0 you should not require long term anticoagulation. I imagine they plan to continue the riveroxaban for approximately four weeks after the cardioversion and then discontinue it. They may elect to put you on aspirin indefinitely.

There is no absolute contraindication to diving just because you have had atrial fibrillation. The issues to consider in a risk vs. benefit evaluation include how incapacitated you were during the episode to decide how much of a problem a recurrent episode would be underwater and the issue of increased risk of bleeding with trauma should you be on long term anticoagulation. A final concern is access to medical care should the problem recur. In other words, you may not want to take that long trip out to Cocos, Socorro, Galapagos, etc.

Just my 2 cents.

Doug

 

[emoreira]

I am a cardiologist as well as an avid technical diver and instructor. With a CHADS2 VAS score of 0 you should not require long term anticoagulation. I imagine they plan to continue the riveroxaban for approximately four weeks after the cardioversion and then discontinue it. They may elect to put you on aspirin indefinitely.

There is no absolute contraindication to diving just because you have had atrial fibrillation. The issues to consider in a risk vs. benefit evaluation include how incapacitated you were during the episode to decide how much of a problem a recurrent episode would be underwater and the issue of increased risk of bleeding with trauma should you be on long term anticoagulation. A final concern is access to medical care should the problem recur. In other words, you may not want to take that long trip out to Cocos, Socorro, Galapagos, etc.

Just my 2 cents.

Doug

Thanks Doug.
I had today my first post ECV review. Everything seems to be ok. A new Computerized Axial Tomography was ordered to discard heart damage. Bisoprolol was reduced to 2,5 mg. I have been with low blood pressure and low beat rate, plus headache. Aerobic low impact exercise was also suggested (fixed bike and swimming).

 

[emoreira]

5 months after the AF episode, was my last visit to the cardiologist and electrofisiologist. The next visit will be on 6 months just for control if no new event appears. Anticoagulant was suppressed 4 weeks after the episode and no aspirin prescribed.
Propafenona 150 mg was also suppressed and now I'm only with Bisoprolol 2,5 mg/day. This will be indefinitely. No restriction to any activity and aerobic exercise was strongly suggested.
Since this episode I dived 3 times, up to 20 meters depth with no difference from my previous experience.

 

[TSandM]

Great news! As debersole said, with essentially normal cardiac function, you should be fine. If you have multiple recurrent episodes, consider asking them to do some electrophysiologic studies and possibly an ablation.

 

[emoreira]

Great news! As debersole said, with essentially normal cardiac function, you should be fine. If you have multiple recurrent episodes, consider asking them to do some electrophysiologic studies and possibly an ablation.

We discussed this with the electrophysiologist. Though the risk now is so low, as I'm with Beta blocker, he told me that in the event of a new episode of AF, ablation is the way to go.

 

[kwinter]

We discussed this with the electrophysiologist. Though the risk now is so low, as I'm with Beta blocker, he told me that in the event of a new episode of AF, ablation is the way to go.

Perhaps Doug can also elaborate on the issue of beta blockers and diving. I seem to recall that they can reduce exercise tolerance and that the ability to achieve 13 mets without fatigue was necessary to be approved for diving. But this could all be old info since I do not take a beta blocker anymore.

 

[boulderjohn]

I strongly suggest that both of the above questions be rewritten into new threads. Not only will Doug be more likely to see them there than at the end of a 5 month old thread, the questions will be in the titles and will attract other readers with similar questions.

 

[kwinter]

I notified him about the new posts.


iPhone. iTypo. iApologize.

 

[boulderjohn]

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A ScubaBoard Staff Message...

Explanation of the multiple new posts references: one of them was a mistake by the poster, and he requested that it be deleted.

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