First post, AF affected by autonomic system? - AF Association

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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

11 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!

countrygirl1 in reply to BobD

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

BobDVolunteer in reply to countrygirl1

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

countrygirl1 in reply to rosyG

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.


Been taking Apixiban since my by pass surgery in june 2016. Prior to that I was on warfarin and having check ups every month and A/f about every 3 months, now I get A/F about twice per month. The specialist messes about with try this try that but the result is just the same. theonly good thig about Apixiban is no I N R checks. It feels like we are all guinea pigs and the docs are fumbling in the dark. Ablation was mentioned but nothing came of it.

Nebivolol was a extra 2.5mg at night and Bisoporal moved to evening but no difference .

All my attacks happen in the evening after 9 pm but preceded by passing lots of water and my swollen ankles getting thinner. I stick it out at home some events lasting 20 plus hours.The last time my wife sent for the medics and I was sent to A&E I was stuck on a trolley from 11 pm Until 6 pm the following day. Nothing to eat or drink except from a volunteer who supplied a couple of sandwiches and a cuppa. I think I would still be there but for my wife kicking up holy smoke. ( it doesn't pay to cross Margaret) thank goodness she is on my side

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