Anticoagulants and Diving

[inquis]

I have a close friend who is in AFib (constantly) and has been cleared to dive. IOW, it's not an automatic disqualification. As others have said, a physician (or two) should weigh in on your particular case. However, it's likely you'll not get that sorted before your deposit refund window closes. Best of luck towards a happy verdict.

 

[FishWatcher747]

I have a close friend who is in AFib (constantly) and has been cleared to dive. IOW, it's not an automatic disqualification. As others have said, a physician (or two) should weigh in on your particular case. However, it's likely you'll not get that sorted before your deposit refund window closes. Best of luck towards a happy verdict.

The OP should note @inquisit friend with constant AFIB with rate controlled by medication is in a completely different situation as you are. The friend is not going to have the potential to have a sudden rapid acceleration of heart rate at rest as someone with intermittent AFIB.

Unfortunately for someone with Intermittent AFIB one can continue to do a lot of different forms of exercise but if it comes on and stays exercise is over at least as long as it stays. And if it stays for hours at 130 one can feel like one has just ran a marathon and will be very tired.

Exercise like finning against current, climbing a ladder with gear, exiting a shore exit with gear, surface swim, or having to assist someone else would be very difficult.

Again not giving advice just discussing risks.

 

[Buadhai]

Unfortunately for someone with Intermittent AFIB one can continue to do a lot of different forms of exercise but if it comes on and stays exercise is over at least as long as it stays. And if it stays for hours at 130 one can feel like one has just ran a marathon and will be very tired.

Hence my hesitancy to continue diving; at least until I learn more about the condition and what’s going on with my body.

 

[Centrals]

@Buadhai
I am really sorry to hear your predicament on future diving. You have my utmost sympathy but I cannot offer you anything other than moral support.
You are the only one who can make the ultimate decision.

Good luck and all the best.

 

[Duke Dive Medicine]

I live in Thailand. I am 73 years old. I've been diving for just over 50 years.

Last December I had an atrial fibrillation event for the first and, so far, only time. It lasted about ten minutes. Other than the rapid, irregular heartbeat I had no other symptoms and felt completely normal. I was wearing an Apple Watch so I did a single lead ECG which the watch diagnosed as atrial fibrillation. This was later confirmed by a cardiologist who looked at the ECG.

The cardiologist has prescribed Edoxaban (anticoagulant - 60mg daily) and Losartan (for hypertension - 25mg daily).

There's not a lot of information out there about diving on anticoagulants except that it's not advised. (This thread indicates that there's not much data on this: Have you dived while taking the newer anticoagulant medications?)

I hate to give up diving, but I'm having difficulty evaluating the risks.

Any advice or links to better data would be appreciated.

(BTW, the Losartan has had zero effect on my blood pressure. Since starting the medication the average is 138/76. For all of last year, the average was 134/78.)

From personal and professional experience, one episode of atrial fibrillation is not an automatic disqualifier for diving. Did your doctor say what he/she thinks caused it and what the likelihood of it reoccurring is?

Typically if a physician is concerned about persistent a-fib or repeated episodes, he or she would prescribe something for heart rate control. Losartan does not do that, it's an angiotensin receptor blocker so acts on the smooth muscle of the blood vessels. This makes me wonder whether the physician may believe this was a one-off event. If your blood pressure continues to be high, your physician may increase the dose or prescribe a different medication. I would note that if this is causing you anxiety, your current blood pressure readings might be reflecting that.

Also, as you age you could become more prone to atrial fibrillation and, as @FishWatcher747 noted above, if your heart rate is elevated to the point that it decreases your cardiac output, that could be dangerous when diving.

Anticoagulants are prescribed because blood can pool in fibrillating (quivering) atria (the upper chambers of the heart) and coagulate. Once a normal rhythm returns, those clots can be ejected and cause major symptoms, including stroke as @bletso noted above. The rationale for the recommendation not to dive on anticoagulants is the risk for bleeding with a serious mechanical injury or a fall with a head strike.

I would recommend that you gain an understanding of the source of the a-fib before moving forward. If you decide to dive while taking anticoagulants, you should do so fully mindful of the risks involved.

Best regards,
DDM

 

[Buadhai]

From personal and professional experience, one episode of atrial fibrillation is not an automatic disqualifier for diving. Did your doctor say what he/she thinks caused it and what the likelihood of it reoccurring is?

Thank you so much for your clear, comprehensive and reassuring reply. I will meet with he cardiologist this week and ask about the issues you raised.

I have wondered what could have caused this one episode of atrial fibrillation. It happened about an hour after I finished a long-ish cycling workout of about 37K. As a former endurance athlete (marathons and triathlons) I am always quite cognizant of my heart rate; especially recovery time. I had no symptoms other than feeling the rapid and irregular heartbeat. Recovery time after the workout was normal. My resting heart rate is usually in the low 50s and my maximum at this age seems to be about 180. Heart rate variability is about 27ms. So, no red flags as far as I can see.

Thanks again for your thorough reply.

 

[FishWatcher747]

@Buadhai You may be interested in this summary article on AFIB.

From the article. "The incidence of atrial fibrillation is 2-10 times higher in athletes participating in extreme endurance sports". Unfortunately common in cyclists.

Guide to Atrial Fibrillation (A-Fib) for Cyclists

incidence of atrial fibrillation is 2-10 times higher in athletes participating in extreme endurance sports, and this increases as they age. The possible

www.roadbikerider.com

 

[Buadhai]

@Buadhai You may be interested in this summary article on AFIB.

From the article. "The incidence of atrial fibrillation is 2-10 times higher in athletes participating in extreme endurance sports". Unfortunately common in cyclists.

Guide to Atrial Fibrillation (A-Fib) for Cyclists

incidence of atrial fibrillation is 2-10 times higher in athletes participating in extreme endurance sports, and this increases as they age. The possible

www.roadbikerider.com

Thank you for that. Explains a lot. And, I always thought that a low resting heart rate was a good thing.

 

[FishWatcher747]

Thank you for that. Explains a lot. And, I always thought that a low resting heart rate was a good thing.

Ironic isn't it? Turns out for whatever reason that significant cycling, running, and triathalons are a risk factor for Afib.

The vast majority of patients presenting with new onset Afib other than needing to take anticoagulants to lower stroke risk and a rate control drug to limit tachycardia hardly notice any difference in their health because they are non exercisers.

But if you are an exerciser it can be a real kick in the teeth.

Now scuba diving is not usually a high aerobic activity. But it can be in the situations I outlined in a previous post. I would think minimizing the opportunities for someone with Afib to go anaerobic during scuba diving would be a good idea.

 

[FishWatcher747]

To illustrate the point of the magnitude of lost exercise ability from someone without Afib to someone with chronic Afib a study was done where cardiac output was measured in a group of people with Afib. They were then cardioverted to sinus rhythm which was maintained for 3 months and cardiac output was measured again. The cardiac output went up 30%.

So for nonexercisers this is not that noticeable. There is plenty of reserve for sedentary activities. But for someone that is a high level aerobic athlete it is a big deal.

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