Paroxysmal atrial fibrillation

I was diagnosed officially back in 2011 - diagnosis by way of ECG - it self terminated after an hour - oddly enough, I had had a prior major 4 hour episode in the late 1980's - tests proved negative and the Doctor attributed it to high stress - subsequent to the 1980's episode, I had no further episodes till 2006 when intermittent episodes, all of which would self terminate within an hour, started up - I would have anywhere from 4-6 per year, all of which would self terminate within an hour - it was not until the episode in 2011 that I actually went to the hospital and was officially diagnosed - I was discharged to follow up with a local cardiologist who agreed that I had the classic signs of vagally mediated afib. I was given the pill in the pocket approach, 20mgs inderal and .5 mgs of ativan - since 2011, I have had a total of 1/2 a dozen episodes, all of which self terminated within minutes of taking the inderal and ativan. I have had no episodes within the last 2 years

I am 62, in good health with no evidence of heart issues, I have a low resting pulse rate, low blood pressure and regularly exercise - I have no other health issues

I am a light smoker and enjoy a daily glass of red wine

Some things I have learned through trial and error include the following which can prompt attacks

Digestive distress

Quickly bending over with a full stomach

Sleeping on left side

Spicy food


I am sure there are certain foods that can cause issues but try as I might, I have never been able to confirm anything for certain

Vagal afib is quite common among endurance athletes and people who, like me, have low heart and pulse rates - so being in good condition is not protective but being in poor condition can be a contributing factor

Also, there is a definite pattern to seasonal attacks - I have never had an attack in the summer - all attacks have been clustered in the Sept/November and March/April periods - this is apparently similar to the increased frequency of ulcers according to seasonal patterns that follow major seasonal changes

What is interesting about the seasonal nature is that it appears none of my typical trigger factors cause problems in the summer while all potentially cause problems when the seasonal incidence is higher

There are still a number of doctors including cardiologists that have never officially acknowledged that there is vagal variant of atrial fibrillation but I am fortunate that both my GP and Cardiologist are on board

27 Replies

  • I have a low resting heart rate, but it's not because I'm an endurance athlete (far from it!), it's because I have been on a variety of beta blockers for around twenty years to treat high blood pressure - no medical professional will say that this is definitely so of course, but my opinion is that my heart rate (which tends to be between 44 and 55 bpm when I'm in sinus rhythm) played a significant part in the onset of my AF.

    Interesting to read your comments on seasonal variations. I can get episodes at any time of year, but I've found they are least likely to occur in December and January, while I don't get too many in June and July - if I had to nominate when I'm most likely to get them it would probably be September/October with March/April not too far behind.

  • Kind of ironic that a low heart rate is linked with afib since low heart rates, especially at resting level, are also linked with longevity - so we live long with afib

  • Hello Netpi, yes interesting your comments about seasons (maybe due to food or exercise changes) and your PIP drugs, I have never thought to record AF events in seasons or heard of your drugs.

    We are similar in age, circumstances and trigger points; the full name I believe is vagally mediated Lone PAF and I was given PIP Flecainide and then put on it daily in 2014 at 100mg x2.

    Your AF seems to be well under control and my suggestions are don't get complacent and keep up your vigilance on trigger points - the goal must be to avoid the need for those PIP drugs completely, as even small AF leads to more AF. I wonder do you take any other action to reduce the AF risk?

    You don't mention supplements. I am fairly sure my stability (no AF for 2 years now) is in part due to taking Nutri Ultra Muscleze (a compound of Mg, Potassium, Taurine & other) and CoQ10; as prescribed by my Alternative Practitioner and Mg/CoQ10 levels tested at BioLab London- the only UK place that does the Red Cell Mg test; there is a better test in the USA apparently.

    Keep us posted as we can't get enough of good news stories!

  • Interesting about the bio lab testing. Is it expensive. Is there an Internet site. Many thanks

  • From memory Elaine it was £60 for both tests, which have to be submitted through a practitioner. Yes if you Google them they will come up.

  • I've not found any foods that trigger me either, but what does start me off within 30 minutes is simply eating too much, and too much just means a normal sized meal. I try to never fill myself up and graze instead.

  • Hi netpi, very interesting as there are several similarities to my afib - which was diagnosed as tachycardia at the age of about 20 and seems to have morphed into afib as I've got order - now 55. My infrequent episodes often start with bending over and may only last a few seconds or minutes - I too have only 1 or 2 per year - but also had a stroke aged 50 - from which I thankfully made a full recovery - they are now changing my drugs from anti platelet to anti coagulants - riveroxaban. Can you tell me a bit more about the vagal mediated afib ie. What does that mean?


  • I found this particular explanation to be of assistance concerning the differences in various forms of afib

  • Thanks.

  • Hi I am 56 and have had what they call ventricular eptopic beats .I get these every day , I have had many tests ecg ; treadmill etc ,they first struck in 1998 and still scare me . I cannot get them off my mind and are always at the back of my mind , does any one else out there have the same

  • Regularly. Everybody gets them as they are a quite normal function of a normal heart. The problem comes when you get lots and become overly aware of them. My last 24 tape showed 2000+ although I was only aware of a few of those.

  • I have PAF with pill in pocket, have attacks very rarely and like yours terminate quickly BUT they insist on my taking warfarin! Are you on a anticoagulant?

  • I do take baby strength aspirin (81mg daily) but no anticoagulant - in as much as I only get infrequent episodes, my cardio and MD saw no need for anything more - I had a 0 score on Chad2, the reference for stroke risk

  • Oh ok, this site is so anti only using aspirin? Because they are told it us not good enough, I had a I score on Chad, my attacks very infrequent and would rather not take warfarin, but they almost insist at cardio Thanks for reply

  • Best practice in medicine first involves Primum non nocere - do no harm - the least amount of medication possible the better - my aspirin is more than sufficient for my situation but each individual's situation is different - if I had issues with my cardio or MD I would get a second opinion

  • As I understand it used to be thought that aspirin was the first level of Anticoagulation particularly for us AF sufferers. However over 18 months ago NICE as the responsible clinical body in the WITHDREW aspirin for this purpose due to its ineffectiveness. However many people are still taking it s an Anticoagulation medicine often because the individual is unaware of the change and, in addition, they have not had an annual medicine review which they should be having. Some GP practices have been very conscientious by looking at all patients who are being prescribed aspirin and getting the person to go in and then either putting the patient on warfarin or one of the NOACs. Using BobD's saying aspirin as an anticoagulant is as much use s a chocolate fire guard.

    Aspirin still has a role to play for a few heart / vascular conditions (eg as an antiplatlet). There are a few medics who appear to have missed NICE's withdrawal notice.

    This site is not anti aspirin per se but it is just that people want to make others, especially newcomers, aware of the withdrawal.

  • I agree that if one requires an anticoagulant, there may be better alternatives than aspirin but medical science remains conflicted with respect to aspirin therapy - there are as many pro as con sources relating to aspirin - referring to the nice study, they only recommend anti coagulants for a CHAD score of 2 or above - this is I believe, a British recommendation - in Canada (where I live) and the US, aspirin is still recommended in many settings - the choice remains up to the individual patient and his/her medical team

  • Just a clarification please - Aspirin is an anti-platelet medication not an anti-coagulant - they work in very different ways - hence the withdrawal by NICE which is effective only for the UK.

    I believe there is some discussion still in the US about the effectiveness of aspirin, in UK very clear - not recommended for stroke prevention in AF sufferers - hence the AFA campaign to get that message through to all GPs.

  • Correct but aspirin is used for anti-coagulation - things may be different in the UK compared with North America -

  • They are very different, in more ways than one.

  • I live in US and my EP has recommended aspirin therapy for PAF. I will definitely bring up the UK opinion about its ineffectiveness, thank you for the information.

  • Constipation is one of the signs of low magnesium and magnesium definitely helps AF.

    A good daily magnesium supplement, ~500mg to begin with, will put paid to any constipation.

    I have a naturally low heart rate too these days, despite being on no medication except the supplements I choose to take.


  • Thank you - I do take a magnesium supplement - 250 mgs per day - also take CoQ10 daily, 100mgs, vitamin b complex and a probiotic - my afib seems under control with no incidents within the last 2 years but I also have a mild case of Laryngopharyngeal Reflux which can impact afib due to influences upon the digestive system but that too seems under control

  • I have experienced the seasonal affect on AF. It seems to be more prevalent in the late fall and early winter. I live in Canada where the sun "hides" more at this time of year so I am wondering if vitamin D might have some impact. Some on this site have suggested taking vitamin D supplements which seem to help me. The operative word is "seem".

    The last time I had AF, I inverted myself on the total gym that I have and force stretched my arms above my head for 4 or 5 minutes and the AF stopped immediately. Coincidence or what; who knows. The next time I have AF, I will try this again to see if the same thing happens. My posture has never been the best; and, all my life, while in school and while working, I have sat at desks and I wonder if this could affect the vagal nerve in some way. Extreme stretching, where the back is forced to be straight and the body's weight is mostly suspended by the feet, may change something physically. Anyone else experienced anything like this?

  • I am in Canada as well, SW Ontario and I think from what I have read that it is related to reduced sun exposure as well as changes in air pressure - I don't take a Vitamin D supplement but I get plenty of D via my diet which is heavy in salmon and sardines etc.

    Your comment on posture rings a bell as well - after a large meal, I have to be careful not to slouch or even lean back too much as the additional abdominal pressure can sometimes set things off

    Your experience with stretched arms may be similar in effect to the Valsalva Manoeuvre which I have employed to stop a run of palpitations that felt like they were going to morph into afib - in my experience, it works best if you catch it right at the start

  • I tried your upside down method and it worked on my afib. I started afib about 15 years ago and at first it was only once or twice a year. Fast forward and lately it has been about once a week for short periods usually. We have a inversion table that my son had bought for his bad back and low and behold it worked like a charm to end my episode today. Thanks for the tip.

    I know once doesn't mean it will work every time but we shall see.

  • I have PAF and am really struggling to find ways to help myself rather than take up the increasingly toxic drug therapies. I have very similar triggers to you, and low resting bp with no heart disease. I look forward to hearing about other peoples experiences and how they cope. ATM I am on warfarin, bisoprolol and ranolazine.

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