Atrial Fibrillation and Diving - Is this the end ?

[mukey]

Part of my plans since selling up Inspiration/Trojan Diving a couple of months ago is to get Dive fit and start 'proper' diving again (as opposed to the odd dip when I go abroad on holiday). The fitness part is (or WAS) starting to come and I'm getting my kit back together, but on Friday, I had a bit of an 'episode'.

I was working over at the marina preparing for the weekends 'Boat show' when I started experiencing Chest pains, lightheadedness and neck pains. At first I tried to shrug it off but it kept going. I managed to get a lift to the local hospital and before I could say 'How many people in that waiting room ?' found myself in the acute coronary card unit with as many wires coming off me as a BT switchroom.

Following stacks of ECG's and heart monitoring I was told I had an irregular heartbeat at 170bpm which needed to be slowed with drugs and Cardioverted (?). Don't know the technical details but they gave me Saltanol, a Magnesium infusion. This was followed by a large dose of Valium and they then Defib'ed my heart to get it back into sinus rythm (Scarey stuff). They let me out of hospital yesterday morning with BP and heart rate back to normal and now I have to go back for tests to see if there is an underlying cause.

Notwithstanding any such underlying cause, does anybody know if having had the AF episode in itself can cause a problem with diving ?

Should I put my plans to get back in the water on hold ? Is there anybody on the boards that has experience of either one off or regular episodes of AF ?

I'd really appreciate any diving related information.

[nigelH]

Sorry but that's a complete stop.
You diving will probably come back but you aren't going to risk traumatising some poor buddy who has to haul you out cold if that happens in the water.

Chase up your doctor and then take yourself to a full diving doctor who can do an exercise ECG, or send you off for one, and write you up to dive again.

That comes with the proviso that 'I am not a Medical Doctor' just a physicist who has had a heart attack and read it up from his wife's text books.
I got my dive medical back and I lost heart muscle so I think I was worse than you.

Good luck.

Oh and remember the pain. That's Angina. It's heart pain. It's different for different people but it is the stop-sit down, you're overdoing it flag. Some people mistake it for indigestion and just keep going. My father in law did. Took some rennies and dropped dead after dinner.

[Gene_Hobbs]

Originally Posted by mukey

I'd really appreciate any diving related information.

As much as I hate quoting standard DAN answers without much additional info added, Jim Caruso is one guy I don't ever mind quoting.

Originally Posted by Caruso

Also, in select cases, some people with stable atrial dysrhythmias (e.g., uncomplicated atrial fibrillation) may dive safely if a cardiologist determines that there are no other significant health problems.

-from DAN Divers Alert Network : Cardiovascular Fitness and Diving

I can only think of one other paper right now.

Originally Posted by Bove

There are some young people, with no evidence of cardiac disease, who have atrial fibrillation. They are well controlled and have excellent exercise tolerance. They may need to be on anti-coagulation because of the risk of embolisation, but they can dive. The problems of anti-coagulation need to be carefully explained.

-from Bove. Cardiovascular problems and diving. SPUMS 1996 Volume 26 Number 3.
RRR ID: 6306

Your cardiologist should be able to help you through this process. If they have any questions about the implications with diving, have them call DAN.

[David Tombs]

Nigels advice is correct,do NOT dive untill your cardiologist says that you can. There are many causes of AF,dont worry but do talk to the Doc..
I am a Doc,and certainly would not go back in the water for the reasons that are given,untill given the all clear. It is likley that you will be diving soon,but no too soon.

[w650peter]

Hi there,

I went into AF a few years ago and had to be cardioverted as well. I was seen by a cadiologist up in Liverpool ( in the unit I used to work in!) and given the all clear after lots of tests, and so am still able to dive.

I can only repeat what others have said: do not dive untill you have seen a cardiologist. The fact that you had pain in your neck and arm while in AF is a bit of a worry. Going into AF is a bit scarry, but like the episode I had, it could be just a one off thing.Take care of yourself .

Peter

[Captain Calamity]

Several issues here:

Atrial fibrillation of itself doesn't necessarily mean an end to diving. Some people walk around completely unaware that they have atrial fibrillation. Others do not tolerate the abnormal rhythm so well, and as the heart races away it is unable to pump blood efficiently to the brain (causing dizziness or blackout), the lungs (causing breathlessness) or even to the heart itself (causing angina). Not a situation you would want to find yourself in underwater really. Atrial fibrillation often starts and stops abruptly and without warning, so you wouldn't necessarily have time to surface before you were in trouble. Finally, atrial fibrillation may leave you at increased risk of forming blood clots within the heart which can pass into the circulation and cause a stroke. This risk can be reduced with the use of an anticoagulant such as warfarin, but this comes with it's own risks - for example you can haemorrage into your brain or spinal cord if you get DCS.

Having said all that, some cases of atrial fibrillation are due to treatable causes e.g. thyroid problems, alcohol excess or binge drinking, chemical abnormalities in the blood etc. If one of these causes was responsibe for your episode then, once treated, you may be fit to return to diving if it is felt that the risk of another episode is low. There are people diving on anticoagulation medication, often diving nitrox on air tables and staying well away from no stop limits to reduce the DCS risk.

Bear in mind that it may be impossible to predict the risk of future attacks. If so (and assuming you can find a doctor willing to declare you dive fit) you have to weigh up the risks of diving with a condition that could easily kill you if it occured underwater or at a remote dive site against your love of diving. I had an ex- with a similar problem who was declared dive fit by a cardiologist on the grounds that she knew the risks and still considered diving worth it. We stuck to no-decompression stop diving and both lived with the reality that if she had an attack underwater she'd have to take her chances with a CBL.

Whatever you do, good luck, and make sure you see a cardiologist with a special interest in diving to make sure you get balanced advice. The HSE hold a list of such doctors, and i'm sure the UK sport diving medical comittee would also be able to point you in the right direction.

Take care,

CC

[mukey]

Thanks all for the very informative (and sobering) responses on this. I think I probably had already guessed the basic answer that I need to get it thoroughly checked out before doing any more diving. I'll get the standard stuff checked out first and once everything settles down start looking for a specialist diving doc.

They ruled out a number of likely causes with blood tests and lifestyle questions (And yes I was honest !) so they will carry out further investigations over the coming weeks.

Saw my own doc yesterday and she mentioned that the real concern would have been the additional 'VT / SVT with abberancy' . (Whatever that is !!!!)

Oh well, anybody want to buy some dive kit ??

Thanks again for all the advice.