From the Guidelines
Scuba diving is not recommended for individuals with atrial fibrillation (AFib) without proper medical clearance, as it may increase the risk of thromboembolism, decompression sickness, and worsening of AFib symptoms. Before diving, it is essential to consult with both a cardiologist and a physician trained in dive medicine to assess your specific risk, taking into account factors such as ejection fraction, exercise tolerance, and anticoagulant therapy 1. The 2024 ESC guidelines for the management of atrial fibrillation emphasize the importance of optimal treatment, including comorbidity and risk factor management, to reduce the risk of stroke and thromboembolism 1.
When considering scuba diving, it is crucial to evaluate the risk of thromboembolism using locally validated risk tools or the CHA2DS2-VA score, and to assess other risk factors, such as hypertension, heart failure, and diabetes mellitus 1. If anticoagulant therapy is required, the choice of anticoagulant and dose should be carefully considered, with a preference for direct oral anticoagulants (DOACs) over vitamin K antagonists (VKAs) 1.
Some key points to consider when evaluating the risk of scuba diving in individuals with AFib include:
- The risk of decompression sickness may be higher in AFib patients due to altered blood flow patterns
- The physiological stresses of diving, including immersion effects, pressure changes, and cold water, can trigger AFib episodes or worsen existing ones
- Anticoagulant therapy may increase the risk of bleeding if barotrauma occurs
- The importance of having a dive buddy aware of the individual's condition and being able to respond in case of an emergency
Overall, the decision to allow scuba diving in individuals with AFib should be made on a case-by-case basis, taking into account the individual's specific risk factors and medical condition, and with careful consideration of the potential risks and benefits 1.
From the Research
Scuba Diving in Atrial Fibrillation
There are no research papers to assist in answering this question about scuba diving in atrial fibrillation. The provided studies focus on the effectiveness and safety of various anticoagulants for stroke prevention in patients with atrial fibrillation, including:
- Comparison of apixaban, dabigatran, rivaroxaban, and warfarin 2, 3
- Guidelines for stroke prevention in patients with atrial fibrillation 4
- Stroke prevention strategies in high-risk patients with atrial fibrillation 5
- Prevention of stroke in patients with atrial fibrillation: anticoagulant and antiplatelet options 6 These studies do not address the topic of scuba diving in atrial fibrillation.
Key Findings
Some key findings from the studies include:
- The effectiveness and safety of non-vitamin K antagonist oral anticoagulants (NOACs) compared to warfarin for stroke prevention in atrial fibrillation 2, 3
- The importance of antithrombotic therapy for preventing stroke in patients with atrial fibrillation 4, 6
- The need for caution when using NOACs in certain high-risk groups of patients with atrial fibrillation 5