AF Association
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Vagal atrial fibrilation

There are not many cardiologists who are well acquainted with a vagal character of AF. They always mention that they heard about it and suggest that I

google it. I do get a mild AF always in the evening after a small supper and when I am resting after evening meal. I never get it before 5:00 pm , and I never get it when I physically work or exercise during the day. It has nothing to do with the selection of food. I could feel great after the food eating for the breakfast and if I would eat the same food in the evening I would get AF.

For those who have vagal AF I would like to know how you cope with it and what kind of medications you taking. I am not taking currently any anticoagulants.

29 Replies

Hiya Choroba,

My take on your post, at the risk of being told I'm being pedantic, is that I was officially diagnosed with Paroxysmal AF (PAF). It was some 4 months after this diagnosis that I became aware that my PAF was triggered by food. But not all food. At this point I became aware that my PAF seemed to be Vagal or Vagus Nerve in origin. To cut a long story short and to keep to your post - I consulted a Nutritionist who prescribed a particular brand of Probiotic powder, suggested I go Gluten Free and who also suggested I look at the FODMAPS diet. After a lot of hard work over the last, almost 6 years now, I can tell you my PAF events now range from zero to 2 a year - and only short bursts at that. My medication is unchanged from that originally prescribed by the Cardiologist who treated me at the time of diagnosis, i.e. Warfarin and Bisoprolol. However, against all that I have to say my PAF was diagnosed within 9 hours of onset and treatment started straight away. Mercifully, I was not one of those people who spend months and months with GP's and Cardios before getting a diagnosis and an appropriate treatment.



It can also be the case that AF itself affects the vagal nerve (ie the reverse of the above) and this proved to be the situation in my case. I was and am in persistent AF.

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I have often wondered about this. My A.F. is not the usual vagally stimulated A.F. but when i have it , my stomach is often affected. I feel full and bloated. Actually when it became almost persistent ( 70% time in A.F. ) these symptoms seemed to go. X


I had read on the forum about the vagal nerve setting off people's AF.

In case you don't remember I was / am in persistent AF. I then had my ablation at the end of last March and the report said 3 out of 4 pulmonary veins isolated. Before my ablation I used to get diahorrea typically five or so days a week and suffered with a lot of wind and got bloated. Also my INR was all over the place. Following my ablation I reverted into persistent AF less than 72 hours later but now only get diahorrea once or twice a fortnight, much less bloatedness and much less wind. My diet has remained unchanged. Believe / conclusion is that the AF was affecting vagal nerve which then triggered the stomach issues so to speak. A few other minor bits omitted.


I just eat small and often, doesn't matter what so much as size. I suppose mostimportant is that i never fill myself up. If i still get it,which i do a bit, i just ignore it, not a problem it just goes away 🙂


Ive looked at this for a while now and even before i was officially diagnosed with af realised that episodes were related to my stomach. At one point i convinced myself that when being sick i was holding my breath which caused my blackouts. Now i don.t eat a meal after 7pm. That helps. Try not to over stuff esp on sweets etc . But to be honest understanding it all has helped me more than the medication.

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The same as Koll. Stodginess and hotness of the meal are factors. I sit down and

concentrate on breathing techniques while touching my fingers together in a certain pattern and rhythm and rate return to normal within 10 minutes. I hope this helps.


I agree with Kill. I do not like eating big meals and find smaller and often suits better. My AF is thought to be probably vagally triggered and I take the drug Disopyramide which does help and is known to for vagal AF

I also tried going gluten free for a few months but still ended up in fast AF and DCCV.



Increased Vagal tone (and following "vagal" Afib) can result from different causes, such as resting after physical activity, (over)eating (foods, habits, GERD), drinking (Alcohol), lack of sleep etc.

If you are sure your Afib has no other cause than the eating habits, than work from there.

Please note my Afib always occured when the vagal tone was highest (this means 24-36hrs AFTER long exhausitng physical activity) combined with poor sleep and alcohol the day before.

High vagal tone always lead to Afib in my case.

I recently found an App (Elite HRV) that can measure parasymphatic activity based on HRV and estimate HF/LF ratio.

Clear judgement for vagal Afib is HF/LF ratio of HRV and "low" HR during Afib.

My suggestion would be to check all possible triggers, measure HRV and see if there is a correlation between your vagal tone and Afib.

Please keep in mind when talking to doctors, in vagal afibbers, chemical (Amiodarone etc) cardioversions have lower success rates. Beta Blockers (Bisoprolol) are contra-indicated because they may increase the vagal tone.

What always helps to end vagal Afib episodes (if no underlying heart disease) is physical activity. Running up a flight of stairs will switch on the symphaticus nerve and let the sinus node take over again.

I don't want to advocate ablation, but please consider ablation if Afib gets bothersome. Catching the Afib early increases the chances to recover your QOL and have a drug-free life. Ablation in vagal Afibbers -if done properly - can have a 1st time success rate of over 90%

(Yes, its just my EP's quote, not backed by studies and therefore arguable. UK EP's state much lower succes rates)


thanks for your informative post - so helpful


Thank you for this information, I have never seen it set out like this before. When I have actually digested it all (no pun intended!) I think it will be very relevant to me!

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A doctor told me that taking lorazepam reduces parasympathetic tone and increases heart rate by about 8/minute, I tried that and was able to abort afib episodes before they started when I was able to feel the pac 's starting to pound.

I researched other techniques to reduce parasympathetic tone and couldn't find any, do you know of any ?

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I have never heard of vagal AFib. I was diagnosed with PAF but would be interested in learning what vagal AFib. I did Google it after reading your post but didn't understand the information. Would be grateful for any information, thanks


Search this post / blog site. It has come up quite a few times in posts both as in the main subject heading and also in responses to other posts.


I get vagal AF as well. Just after eating dinner, but never after breakfast or lunch. As you saying always just after eating when relaxing in front of TV. Cant say Iv'e noticed difference in what I eat or how much. My worse trigger fro Vagal is bending down!

suddenly bending down to pick some up Ive dropped, or putting on shoes - can easily trigger AF for me. Very annoying as does not always happen and of course I forget.

Turning over quickly in bed to left side is also vagal I believe, have to be careful of this.

I suffer from IBS as well. I am menopausal so hot flushes/sweats at night also trigger AF, mostly when it happens and I'm sleep I wake up sweating with AF. Great isn't it!!!!!

Hopefully after next Tuesday my first Ablation I will be sorted with no more AF or Flutter.


My AF is definitely vagaries related. I have Paroxysmal AF, usually in the early hours of the morning. Just prior to being diagnosed with AF (after almost 4 years of events), I was sent to see a Gastroenterologist ref possible acid reflux. After an endoscopy, I was diagnosed with a tortuous oesophagus with strong peristaltic waves and a sliding hiatus hernia and this was confirmed after an oesophageal manometry. I also have a very high contraction wave (whatever that means). They were reaching as high as 426 mmHg and normal range is 30-180 mmHg.

My EP agreed that the problems with my oesophagus were causing my AF. He prescribed Diltzem 180mg and Apixaban 5mg twice a day.

I have since lost 33lbs and avoid eating after 7 in the evening. I avoid anything that is hard to digest, eg meat and bread. I don't drink alcohol or anything containing caffeine and unfortunately chocolate 😒 has also had to go. Since the medication has kicked in, I have been able to have the odd treat but as alcohol is not really something I am bothered about, haven't tried it yet.

I hope this helps.



I could 'Google' Vagal AF but to save me trawling through possibly dozens of pages-can you please give us YOUR precise understanding and explanation of it please? I find that the descriptions of sufferers are SO much better than wiki pages or doctors.


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I have vagal Af and find that sleeping on several pillows helps and also making sure you have enough potassium in food has stopped my episodes, at least for now!


Yes, low potassium is definitely a trigger for me. One mouthful of white wine sets off AF as well. The first 8 or 10 episodes of AF for me was when resting in bed just before sleep. That has changed, now is anytime. On Metoprolol and Diltiazem as well as Pradaxa. Not AF free though. Considering ablation. Doc stopped Metoprolol and prescribed Amiodarone which I will not take due to its dangerous side effects.


How long was it before it changed from just at night to anytime?

Do you eat a potassium rich diet now?


I'd probably had 6 or 7 events over the course of a year when it changed. I try to eat a potassium rich diet, use a potassium based salt substitutes as well. I often take potassium pills as well. The first time I had an episode my potassium levels were checked and was found to be almost absent. Also dehydration is sure to trigger an episode. I also take magnesium citrate daily.


Jiust had to add my bit on this one . When had first AF attack the paramedics got me to strain the idea was a later found it was to stimulate the vagus My understanding is the vagal nerve runs from your head to you tum with branches j to various organs. Stimulation can affect nerve and organs including heart. It seems this can either ease a problem or trigger it. I was convinced and to a degree still am that excess noise is my trigger. My first attack was after reluctantly staying in a pub that had a loud disco and second attack followed a curry and a visit to a noisy pub . (ate and drank with in limits) I have found I want smaller meals so did wonder if certain foods were a trigger for me but after giving up on enormous Christmas meal but still felt bloated till Boxing Day have now decided it is not food . (docs now say is down to a valve ) Still worried about loud noise though

I think the point I am making here is that the vagal nerve can be triggered in many ways but the same trigger may not bring AF for some but will for others - we are different thats for sure.


Thanks for all explaining vagal AFib, I had never heard of it. Maybe that is the reason why I go into AFib if I sleep on left side. I heard with AFib good idea to not sleep on left side so for about 4 years I slept only on right side or back. About six months ago I was so uncomfortable and couldn't sleep so I decided to roll on my left side. Within ten minutes there it was, I went into AFib. I couldn't believe it but it happened! Also I remember once picking up my purse from the floor of the car and triggered an attack. I'm so happy to now maybe have an idea of what triggers some attacks. That saying, most attacks happen when I'm resting in bed before going to sleep or during the night. My Naturopath thinks getting attacks during night could have to do with blood sugar, who knows. It's great to know I'm not alone and we are all in this together !


Endorse the points already mentioned to fix it: Light meals (min meat) before 8pm, cut out alcohol, carbonated/cold drinks, 90% of gluten, reduce sugar by 50%+ smooth your day so you're not exhausted & dropping into chair in the evening, go to bed with some energy left, evening relaxation exercises/mindfullness don't sleep on the left and use 3 pillows.

I started 2 years ago with AF episodes immediately I sat down in the evening so feeling it coming on I had to get up and do some light domestic rest but a tidy house! Mainly here, I learnt my PAF was vagally mediated and my gastro side needed improving to reduce the stress on the stomach. Since then I have developed the above and with 200mg/day Flecainide, no more AF.

Good luck, I hope some of the above helps.


Hello Choroba 13 - I was diagnosed with Lone Atrial Fibrillation 3 years ago - it came aided and abetted by major trauma and anxiety from multiple major illnesses and bereavements in our family and friends - along with strange viral symptoms I experienced - the day AF started simulataneously with walking rushing and eating - it continued on for 4 hours finally settled with Sotalol given by my GP beta blockers have not helped at all since and as you will learn are not advised for ' vagally' triggered AF. I was on 75mg of Aspirin daily - which the cardiologist said to stop and within 3 days my oesophagus and swallowing discomfort was so much easier. I then sorted the acute anxiety with the help of counselling/hypnotherapy/ mindfulness during the last 3 years all of which have helped enormously! I was still struggling to get my digestive tract settled IBS and bloating had been a constant trigger for AF episodes I persuaded my GP to test for a bug called H.Pylori which to everyone's surprise was positive following treatment for that my gut discomfort eased a little bit - the real breakthrough has been since I discovered by chance on line 'Are your Heart Palpitations,your Vagus Nerve and Stomach bloatings connected?' She talks about taking Root Ginger / Digestive enzymes / and probiotics. I can honestly say they have been incredible at easing to a major extent my digestive symptoms thereby reducing markably the frequency of my AF. I say easing not curing I also deal was the stress so much better than before I avoid caffeine and alcohol which had both proved to be triggers. I'm now on 60mg of Diltiazem at night and can take an extra one if I need it. Good luck - Regards Cathy.


I believe the key step to cure one from Vagal Afib for confirmed "vagal" Afibbers with no underlying heart disease is to restore the nervous system's symphatic/parasymphatic balance at first.

- I have to say I am not a Doctor, and its just my believe (I did extensive research, however)-

Based on the reason for the imbalance and one persons vagal state- Physical Activity& Poor Rest, Drinking, eating; even body moves (bend over) and positions (left sleepers) who trigger the vagus nerve one can take counter actions accordingly without having to worry doing damage to the body.

As emergency cure to stop an episode, everything that increases the symphatic activity and restores balance helps:

For wrong body moves, the "vagal maneuvre" (lying on your back and put your legs up 90deg - leaning them towards a wall or similar support) will stop the episode

Physical activity always increases Symphatic activity...

Cold showers,...

Even Guided Breating- if done right- will balance and may end an episode.

think yourself!

We have to keep in mind that there are vagal afibbers (like me) who have trained themselves over the years into a constant parasymphatic state with low resting heart rate in the low 40ies or even below (Cycling, Long Distance running, XC Skiing) If Low HR is combined with high HRV, there is a big chance that AV node takes over as safety mechanism of the heart.

Although the mechanism is not completely understood, vagal nerve ends are the trigger. Good thing is that in this case HR in Afib is always low, usually well below 150bpm. To cure, only stopping physical activities (not acceptable for most lifetime Sports-veterans, like me) or Ablate the vagal nerve ends in the left atrium is a complete cure.

I recommend to know your state symphatic/vagal or balanced with measuring your heart rate variability with related APPs and take your own conclusions and action.


I am definitely a Vagal Afibber. I'm so interested in the positional ways to stop an Afib event. Once my heart starts rocking in my chest it usually lasts for 3 to 4 hours :( My pulse dances up to 170-180 beats in seconds and I feel like my heart will leap from my chest. It is very scary. I have just realized that my cardiologist has missed the diagnosis and is treating me for traditional Afib. I will meet with him in two weeks and will hopefully come to a new plan.

I have started sleeping on my back with many pillows in hopes of preventing another sudden attack in the middle of the night as well as bending over carefully when need be.

Have you ever tried vagal massage to stop Afib?

Thank you for sharing so much information...


Thanks so much for sharing this information. How did you get a confirmed diagnosis of vagal AFib? If I'm considering an ablation is it important to know if the vagas nerve is the trigger or not?


Hi Gracey 23 - I haven't been diagnosed with Vagal AFib the cardiologist gave me the diagnosis of Lone Atrial fibrillation - at that time I wasn't at all clear myself that my digestive problems were the main triggers - the triggers be they Vagal or not are not the CAUSE of AFib. Cathy


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