Exercise After AFib Ablation

A goal of catheter ablation for atrial fibrillation (AF) is to help patients return to a normal, active life. For many, this means resuming something that they enjoy- exercise. AF can diminish a person's confidence and ability to engage in physical activities. Regaining the freedom to enjoy exercise can strongly motivate people to pursue rhythm control.

In the long term, exercise after AF ablation is not only safe but beneficial. It promotes cardiovascular health, may lower AF recurrence risk, and enhances overall wellbeing. Avoiding movement altogether can lead to stiffness, deconditioning, and fatigue. Rebuilding strength and routine after ablation is therefore crucial.

And so, a common question patients ask immediately after ablation is:

When can I return to exercise?

There’s no universal answer. But this post offers a practical framework based on current practice and available guidance.

Note: Always prioritise the specific guidance from your cardiologist or ablation operator.

General (common sense) Principles

Rest fully for the first 24 hours; minimise any prolonged walking in the first 72 hours.
Avoid swimming or submerging your groin puncture site until completely healed (usually one week). Visually confirm that the site has healed without bleeding or signs of infection.
Gradually return to exercise. Begin with low-intensity, brief sessions, increasing intensity and duration progressively only if you feel well.
Immediately stop exercising if you experience chest pain, unexpected breathlessness, palpitations, or groin discomfort.

Factors Influencing Your Return

1. Type and Intensity of Exercise

In 2020, The European Society of Cardiology published a related guideline on sports cardiology and exercise in patients with cardiovascular disease. It nicely categorises different sports and activities based on their intensity from a cardiac perspective.

This figure is taken from the 2020 European Guideline. Professor Sanjay Sharma, the Chairman of this Consensus paper, provided a lot of teaching on my Sports Cardiology Masters degree- he told us this figure was fiercely debated(!) and there was a lot of disagreement on several sports as to whether they are low vs medium vs high intesity.

It goes one step further and provides sensor-based parameters to help a person understand if they are performing the activity at the prescribed intensity.

This table is taken from the 2020 European Guideline. It provides a number of different parameters that a person can use to gauge the intensity of their activity. HRmax = maximum heart rate; HRR = heart rate reserve; RPE = rate of perceived exertion (a scale from 0-20); VO2max = maximum oxygen consumption on a cardiopulmonary exercise test. HRmax (%) and RPE are the most user-friendly parameters with the latter being a subjective assessment by the individual.

Specifically, the guideline also make a recommendation for exercise after procedures similar to AF ablation:

“Leisure-time and low- to medium-intensity exercise programmes can generally be resumed 1 week after [SVT] ablation if there is no particular risk of arrhythmia recurrence.”

Although referring to SVT ablations (an ablation procedure performed to different parts of the heart), these guidelines still offer relevant insights for AF ablation recovery:

Walking: is an accessible, low-intensity starting point. When performed at Zone 2 intensity (<55% max HR), walking boosts VO₂ max, supports recovery, and prepares you for more intense activities.
Enjoyable, non-contact sports: Golf, bowling, and swimming (after wound healing) offer gentle physical and social benefits without excessive cardiovascular stress.
High-endurance training: Avoid heavy endurance exercise, especially involving dehydration risk or significant cardiovascular strain, for at least 8 weeks post-ablation.
Contact/high-risk sports: Should be deferred for at least 3 months due to anticoagulant-related bleeding risks.
Long-term goal (3–6 months post-ablation): Aim for up to five 30-minute exercise sessions weekly. Individual sessions can range from 30–90 minutes, performed 2–5 times weekly, based on comfort and tolerance.

2. Outcome of Your Ablation Procedure

Complications after AF ablation are uncommon and usually identified early. However, caution remains essential. Patients who experienced vascular complications or pericardial effusion may require extended rest. Always adhere strictly to your cardiologist’s advice if you encounter complications.

Resuming exercise may triggers palpitations or ectopic beats, which may not be indicative of AF recurrence. Isolated extra heart beats or short runs of AF during the healing period are common. Consider wearable ECG or heart-rate monitors if concerned, and consult your healthcare team if symptoms are reproducible or persist.

The Sports Cardiology 2020 ESC guideline also notes uncertainty regarding the effect of sports on AF recurrence after AF ablation:

“It is unknown whether continuation of sports after successful PVI might progress the disease process and lead to recurrence of non-pulmonary vein dependent AF. Thus, no firm recommendation can be made about the ‘safe’ dose of sports after ablation.”

Suggested Return-to-Exercise Timeline

This timeline is an adaptable guide based on everything we've reviewed above. It is not a rigid prescription. You should modify it based on personal comfort and your cardiologist’s advice.

Week 1: Rest and recovery. Limit activities to daily essentials only.
Week 2: Introduce gentle walking or stationary cycling (Zone 1–2).
Week 3: Gradually extend Zone 2 exercise durations. Begin light practice in sports (no strenuous exertion).
Week 4: Return to regular exercise frequency, continuing to avoid maximum intensity.

Long-Term Outlook

Many patients eventually surpass their pre-ablation fitness levels within 6–12 months. Ablation frequently restores energy and motivation. Gradual progression, consistency, and patience are key to long-term recovery.

Four weeks of careful recovery is minimal compared to lifelong benefits of improved heart rhythm, enhanced fitness, and renewed health confidence.