First post, AF affected by autonomic system?

Hi this is my first post, I’ve been reading here for a while and appreciate all the good sense and support given. I had first episode of PAF immediately after surgery (mastectomy) six months ago. Since then I’ve had episodes about once every 7 -14 days. They are getting longer, now 14 hours instead of 2-3 hours. I’m on 3.75 Bisoprolol and now on Apixaban (thanks to what I’ve learned on here – I really had to push for it at age 64). Every single episode has woken me up, it always occurs at night (or after anaesthetic) and converts to normal rhythm after a few hours. I’m very interested in the autonomic nervous system input into this. As I’ve never had a daytime event could it be that the parasympathetic system is involved? Any opinions or info gratefully received, Thanks, Jane

10 Replies

  • Sounds like you have vagally mediated AF, that is triggered by the vagus nerve which links brain to many of the major organs. To have AF you need a pre-disposition which can be genetic or acquired and then just about anything can trigger it . Read up on the subject from AF Association website and learn all you can. For example beta blockers such as bisoprolol are not always the best treatment for vagal AF as they slow things down and since your AF starts when everything is slowed down during rest, bingo!

  • Hi Bob, Thanks for your reply. Does this mean the vagus nerve is weak and underactive in some way? Jane

  • Not not at all, but AF is more likely when the vagal tone is low i e when you are resting. Please consider the evidence re bisoprolol making AF worse if it is vagal. (see Rosy's post .)

  • Have you tried taking most, if not all of your bisoprolol before going to bed rather than in the morning?

  • Hi jennydog, yes I do take it all at 9pm as it helps me feel less wiped out during the day

  • I have vagal AF and the CCG looked at the evidence that both digoxin and beta blockers are contraindicated and can make vagal AF worse. The clinicians involved accepted the studies I had found and now have included this in their guidance. I think it might be not so good to take at bed time More in agreement with Bob that you are already on lower pulse rate and AF can kick in

  • Thanks rosyG this is interesting. Does your vagal AF mean that your heart rate is not very fast while in AF?

  • Hello Jane,

    I also have PAf for 17yrs you never comes on when I am busy,mostly evening or wake from sleep

    During the night.

    I take Flecainide 300mg all at once only when an episode comes on,used as Pill in pocket and prescribed only by Cardiologist,I also take a beta

    blocker every morning along with other medication.

    Having PAF,pip works a treat for me,within 40 mins to 60 mins of taking it.I carry my prescribed dose with me

    at all times and feel very confident with this.

    Hope this information helps you,keep well,you have been through a lot.

    Best Wishes.


  • Thank you Eleanor,

    I had hoped that the surgery was the end of my problems - not the beginning of a heart condition! Although I've learnt on here that I must have had a heart that allowed AF to occur in the first place, it has taken a while to get over the shock of it. Your medication info is very useful and I will be seeing an EP soon, so the more knowledge the better!

    Best Wishes, Jane

  • Thank you for your reply Jane,hope all goes well with

    EP,let me know how you go.


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