AF Association
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Is it possible that resting is a trigger for aFib?

Hello again! So, last week my cardiologist put me on a 48 hour monitor to double check that I have aFib before possibly pursuing an ablation. So this is the last step before having that serious discussion. Just to review, I am 53-years-old and normal weight with no other conditions. They think I am a viable candidate for a successful ablation.

While on the monitor, I had to record my activity every two hours plus any events I had. In that time, I had several episodes of aFib and they always occur at rest. If I am exercising or on the go, I don't have any symptoms. But when I sit down and recline in my easy chair in the evening or sometimes at my desk after lunch (sitting, not reclining), I feel the flutters coming on.

Is it possible that while I am active, my heart rate is slightly or moderately elevated but then when I rest and it goes back to 50-60 (I am on metoprolol to control my heart rate), that the decrease in my heart rate to a lower level is an actual TRIGGER?

Keep in mind, I haven't had this revelation from the doctor since I haven't seen him yet since the 48 hour monitor, but this is my own observation.

Thanks for any thoughts on this as a possibility.

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Hi Teecee - This is a thought provoking post. I can only speak as I find and I am 100% sure that resting triggers my AF. I too never ever have an attack while I'm active, only when I'm sat or in bed. I do wonder whether sitting slouched, or curled up in bed and compressing the stomach area could be a trigger too. The other thing I suspect may be a cause is holding tension in the heart area. I sometimes find I am doing this.

It will be interesting to see what others on this site have to say on this topic.

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We sound the same, jean. I often go to sleep having an episode because it starts either while I am downstairs reclining watching TV or in bed.

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Sometimes my AF comes on overnight whilst asleep and I think that this is vagal. Also I have Bradycardia and this seems very linked to my episodes so it might be that the slower rate whilst resting is a factor for you. I sort of feel that if I have a period of hours with a very slow heart rate it 'lets the AF' in - sounds mad but that what seems to happen.

Jo

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This sounds like classic vagally mediated AF. The vagus nerve is the main neural superhighway between brain. stomach heart and a number of other organs and often acts as a trigger for AF "when the vagal tone is low" i e when resting. sleeping or after a large meal when the stomach is working hard. My phrase in inverted commas was spoken once by one of the top EPs in UK . Note this is only a trigger, not the cause of AF which is a whole other bag of worms. (Pun intended)

Bob

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Good information Bob. I am going to google it.

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...yes, and after a heavy meal. That's also when the AF seems to assert itself, not just when resting. Greatly appreciate the "when the vagal tone is low" comment, too.

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There seems to be 3 types of vagally induced AF, triggered by exercise, triggered by rest or triggered by either. Unfortunately I fell into the latter category! If I did too much, if I got stressed and very often just start when I was asleep. I couldn't win any which way!

Thankfully ablation sorted it out and have been AF free since March 2014.

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I really want an ablation. I know I shouldn't want something like that, but I want to put this AF behind me so I can live a happy, active life. I feel for everyone who has this problem. It is not fair (but I guess nothing is). :-(

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Hi can I ask how bad your Afib was and where you Audi the ablation done, I'm considering it as I get Afib happening more now at 51

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Hi Ian - just arrived home from hols hence delay in replying.

My AFib in 2012-2013 was pretty bad - 2-3 episodes a week which were very symptomatic with Autonomic dysfunctions such as POTS & low blood pressure which meant I couldn't even sit up, never mind stand a lot of the time when I was in AFib.

The first ablation was done privately in London by a member of the Barts team and ended up making things worse, partly my own fault I think as I did far too much, far too soon after the procedure as I couldn't believe how much better I felt. I ended up in Acute Cardiac. Second ablation wasn't as straight forward as I had hoped but it did improve things dramatically and I was more sensible 2nd time around. I was AF free for 2.5 years.

Unfortunately it has recently returned but I am not nearly as symptomatic and episodes don't last nearly as long - 3-4 hours on average whereas they had been 3-4 days sometimes.

I am considering another ablation but I have been advised that Pace & Ablate may be a better long term treatment for me as I have complications of another serious chronic illness.

At your age I wouldn't hesitate if ablation was offered but do your own research and be clear in your own mind, complications are rare but recovery requires time and if you have a physical job think months rather than weeks and graduated return, you can feel very tired for up to 12 months afterwards.

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Think so yes, I seem to trigger at night usually 1am or so, never had a trigger while working or moving around or doing anything through the day.

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Where and who carried out your ablation cd?

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I had to go privately as I couldn't get a referral in 2014 so went to London - an EP consultant from Barts who was one of Prof Schilling's team.

Thankfully things have now improved drastically in my area & we now have 2 EPs in RD&E Exeter.

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I have lots of triggers Teecee, but thanks to the Alicecor app I can more or less predict to a few hours when an episode is due. When fresh out of an episode my HR is about 65 - 70, as the week progresses it comes down to 60, then prior to an episode it's around 50 - 55. When in AF it doesn't go any higher that 80, just erratic.

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If I am physically working, or exercising, I do not get arrhythmia, or I can't feel it. Also, just standing does it for me. Last year I had been ill with arrhythmia nearly all day, every day, so I couldn't work normally. Got a young man in to do the heavy stuff with my sheep, and I just stood there all day handing him stuff, giving him my unwanted opinion and hardly moving. Went the whole day without a blip.

Koll

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Hi Teece

I sometimes find that while exercising it is fine,but as soon as I stop i get palpitations, af or svt.

However adrenalin is a trigger for me....

I'm on a waiting list for svt ablation, and then af should I require it-during the same procedure.

I have also been seeing a osteopath recently who believes I have lots of tension in the chest/heart area, and thinks he can improve symptoms.

I had reassurance from my EP that af is NOT always progressive , so wanted to research all other options before ablation.

However should ablation be the best option I am ready to go for it, to get my life back

All the best

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Good luck Rich. Please keep me posted on your ablation or any other alternative you select. I am very interested.

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Thanks, just wanted to add that there is a great website drjohnm.org which has a lot of interesting views on alternative treatments. He is an E.P himself

Cheer

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I've been trying to think of an AFib episode in the past seven and a half years I've had that didn't come on when I was sat down, lying down or sleeping and I can't.

On the other hand, I can recall once going to sleep in AFib and it had gone when I woke up and there have been a few times when it has stopped when I was sat down. However, on the vast majority of occasions when I come out of AFib, I have been doing things like pushing a trolley around the supermarket, out walking the dog or, most commonly, just climbed one of the hills close to my home - based on these experiences, I'm likely to go into AFib if my heart rate is low (it can go as low as 44bpm because of the rate control medication I'm on) and come out of it when my heart rate rises.

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Thanks to Bob, CDreamer and Rich who clearly state my vagally induced triggers for AF episodes i.e. when resting in the evening/bedtime, when overexercising and after vigourous exercise stops (i.e. when there is too bigger change in heart activity.

The cure for me so far (8 months) has been Flecainide and 'levelling out' of my activities during the day i.e. no running, no tennis instead walking and table tennis.

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The worst ever episodes I have had have been when I have first woken up in the morning or have been standing preparing food.

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I make sure that my head does not 'slump' towards my chest when sitting or resting in a chair in upright position. If I am likely to go to sleep in that position I wedge a cushion under my chin. If I don't do that I am pretty sure the Afib increases.

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I have posted many times that your best bet first is a chiropractor who is understands how the neck and back influence the parasympathetic and sympathetic nerves. Look at my recent post on Heart Arrhythmias - the Missed Cause. Until you have expounded this option, you will never know if this is a solution for you; and if it is, and you do not do this, you will likely never find a complete long term solution as most people who have posted here have not. I know rather a blatant statement and one not shared by heart doctors, but my experience proves this to me over and over again. Unfortunately, it is not a cookie cutter solution and each person will need more or less treatment with more or less consequences and more or less time to get results. It is amazing how a chiropractic adjustment will affect what my heart does. Unfortunately, for me, as yet, a complete solution is intermittent. Yet, I prefer it against taking dangerous drugs and risking permanently damaging my heart with ablations. To me these are the last options. I tried drugs with bad results. If you do look at drjohn.org, you may come to the same conclusion. Although, even he does not mention chiropractic options. He's a heart doctor after all where his expertise lies.

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I now have what I consider is a competent chiropractor. He has difficulty accepting what I tell him happens to my heart even when I show him EKG charts and heart rate records. I suspect his education keeps him in doubt; and, he has never had a patient like me. But he never gives up; and will, hopefully, fix my spine. He will try different options; and with my feedback, eliminate those that do not work.

So what you want is a competent chiropractor who will check your thoracic and cervical spine for any issues. If there are none, then this is not your heart problem. The chiropractor must be trained to adjust C1 and C2. Ask because not all are. Find another if they are not. It is your body, so run. An untrained person adjusting C1 is not recommended. Then allow this qualified person to correct these issues ( and it may take a while); and along the way gradually tell this person how it affects your heart, if it does. Don't be surprised if you get the deer in the headlights response. Also, remember chiropractors are normally not allowed to say they treat the heart and so many do not know that they really do.

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EXACTLY! Yesterday I worked in the yard most of the day doing light tasks at a steady rate. I noticed zero AF flutters the whole day. I thought, "Gee, the Multaq 400mg. I've been taking for 3 days is finally working!" But then when I settled down in front of the TV last night, the flutters started up again. Then this morning when I got up -- more flutters. I even punched the episode in my heart monitor I'm wearing while I wrote this reply. When I'm active, I don't notice the AF. But when, for example, I'm driving my car I notice flutters. I'm starting to wonder if I'm ALWAYS in AF but just don't notice it as much when I'm active. Kind of a concerning thought. (I think I'm going to tell the cardio doc to forget the Multaq.)

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They just started me on Multaq. It definitely slows the max HR when it AFib which is comforting to me..

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This sounds exactly like what I'm dealing with right now, I'm 59 1/2 years old. Came home from Florida a few weeks back, we ate a large meal at Chipotle, got home started to unpack and do laundry and took a seat to rest on the sofa. A few minutes after sitting down I felt three blips in my stomach and the next minute I go into a 45 min AFIB, HR at 140-150 max before I self invert back to NSR at the ER. It was a stressful two weeks traveling for work and we took some vacation. The day before flying home we went kayaking in Florida and I flipped out of the kayak, twisted and hurt my lower left back. Could barely walk that evening, hunched over but was able to make it home feeling better. Don't think that I pulled a muscle in my stomach but my lower back near the kidney was hurting me. This last for about a week.

I experienced two concurrent AFib incidents going back 5.5 years ago after drink a beer and eating a burger with a buddy of mine at lunch one day, bent down after lunch and pulled a muscle in my stomach and the next thing I know is that my heart is in AFib tachycardia at 200-250 bpm. The next day I was OK but it came back the following day. I was OK without a palpitation for over a year after they prescribed 12.5mg twice daily metoprolol and 80 mg Diovan twice daily and the same lone AFib event occured while having a beer and eating corn chips 4.5 years ago.

After these two events I remember that back in my early 30s, I had a strange vibration in my chest while skiing on a warm sunny mountain in Idaho. It lasted for maybe 8-10 hours. Didn't know that it was AFib. Remembered this after the episode 5.5 years ago.

I've never smoked though I drink a beer with meals or maybe two wines maximum and never hard liquour. Quit drink all caffeinated drinks 5 years ago. Quit drinking any beer or wine for 3.5 years starting back 5 years ago.

4.5 years ago I went for a sleep study and have been wearing a CPAP since then.

I've been palpitation free for 4 years but have been experiencing some lately over the last 6 months when I have a beer (Last October in Switzerland when I was up in the mountains at Kleine Scheidegg at about 9000ft and took three sips of beer at lunch) and the last few months waking up at night with a racing heart; unfortunately didn't check my HR using a cuff to see if I had arrhythmia.

I have a stressful job however the stress lately hasn't been as bad as a few years back.

The last 3 weeks have been awful. 5 AFib events. One triggered vagally-mediated from eating a large dinner before returning home from the Florida trip. One triggered by sending my boss an email explaining why I was off from work. One triggered by learning of a friend's death. And two triggered recently in the early morning hours following a new set of medications. Took my CPAP machine in to be checked today. The pressure checked and matched the machine setpoint.

My observation is that when I'm moving and exercising my HR increases and my BP drops. When I rest, the reverse happens. In the evening, my BP approaches 150 and I starts to feel palpitations. Going to bed with these palps has led to both AFib early morning hour events. The first lasted 35 minutes, today's was 7hrs before I returned to NSR. I've asked the doctor to add back the Diovan to help drop my BP. The dosage level of 160mg appears to be too low and my resting BP still approaches 150 at bedtime.

In the last three weeks I've lost 16lbs, 16 more and I'll be under 200lbs..

My normal resting pulse is 53. I have bradycardia. I was very athletic as a youth and my HR used to be in the high 40s.

Seeking answers and solutions. Will talk to a specialist at Allegheny General Hospital in a few weeks about ablation. Considering a consult with Cleveland Clinic about 2 hrs away as well.

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