AF Association
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AF and Hiatus Hernia

For the last 6 months I have been investigated for Hiatus Hernia problems and more recently attacks that I thought were gastrointestinal originated which have now been diagnosed as AF attacks. Echo cardiogram and angiogram have recently come back all clear The cardiologist and gastroenterologist struggle to see the connection with the AF attacks which follow eating specific foods or occasionally high stress events.The cardiologist intends to manage the Af initially through medication, flecanide and if that dosnt work ablation or cardio version.The gastroenterologist appears more interested and sympathetic but is looking at medication or Hernia repair.Attacks are up to 2/3 times a week and life is pretty difficult at the momentFatigue and irritability are prevalent for 70% of the time. All comments welcome and has anyone solved this twin problem.Thankyou

23 Replies

Look up vagal AF - I have to be extremely careful as eating will often induce AF.

The vagal nerve is part of the autonomic system and runs through the stomach and very close to the heart. If I don't eat anything for a while I often get nausea - then a painy knot just below my diaphragm which feels as though I am breathless only I really am not - I eat and then find my HR goes up - Atrial Tachycardia - which flips into AF.

Look up Dr Sanjay Gupta's video on Vagal AF by doing a search on this forum, good explanation. I am amazed that a doctor hasn't picked up on this connection?!

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Thanks for your very prompt reply I am collecting information to discuss this with the gastroenterologist.The NHS one didn't want to bother so I am paying privately to develop this line of investigation further


You are welcome - I posted the link to the video below.


I do have the same problems. Did the ablation resolve the vagal AF? So many doctors are so puzzled about it here in US. There is no significant research about the vagal afib in US. I had a cryoablation and now I am getting flutter after afternoon eating. I never get any problems after breakfast, but always late in the afternoon or in the evening. I also get the nausia and then afib or flutter approximately one hour after eating or sometimes right after eating.

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Thanks for your reply Will post further news when I have it

However will be trying even harder to moderate diet and try and get a run of days together without AF if possible

Thanks once again


When I had the ablation I believe I had what is termed mixed AF - that is vagal could trigger an event but I also had AF with no reason and no triggers. 2nd ablation left me free from AF for 2+ years. Recently returned and is now vagal AF but the episodes are not as long or severe. But I am not typical and have various complications with other chronic conditions.


Thanks. Food and occasional serious stress are the triggers for me.Just turned 60 and previously in good health. Thanks for advice Also presently on Bisoporal Flecanide and Omeptazole as a coctail of drugs which are supposed to help.Apart from the side effects the only thing that seems to help in sensible eating


What CDreamer says about the vagal nerve is correct.

By a process of careful study of my food intake I have calmed my vagal nerve and as a consequence have had no AF for a little over 2 years.

Frankly, if neither your cardiologist or gastroenterologist know about or understand the vagal nerve then I'd be sacking both and getting onto consultants who do understand this nerve.

It effectively controls both heart and digestive system and acts as an information superhighway between heart and digestive system and the brain.



Thank you for your reply. I have found that by removing or reducing food items that seem to trigger the AF, it does help. Alcohol Chocolate Certain Breads Butter Chinese and Indian takeaways have all now been removed from my food intake.Food portion size has also been reduced and consequently I have lost 4 stones in 2 years. Any suggestions about your process and your strictness of regime would be welcome


The process started under the care of a Nutritionist. She prescribed me a course of Probiotics to sort out my gut flora. She then advised me to go gluten free, wheat free and oats free . Much much later I went added sugar free. I also picked bits out of the FODMAPS diet.

None of this was for me anyway, ever designed to loose weight, and I haven't. It was aimed at calming the vagal nerve in the hope that as a consequence it would calm the heart. It has.

Initially it was very strict. Less so nowadays, more like being careful. Reading food/drink labels.

OUT - oats, wheat, anything with gluten including all real ales, soft cheese, raspberries, peas, runner beans, baked beans, pork and crackling, full cream milk, yoghurt, bread, any spicy foods, most Chinese resturant foods be they eat in or takeaway, anything with pastry unless its gluten free and even then much care is needed, puff pastry regardless of being gluten free, sausage rolls, pasties - regardless of gluten free) onions, lettuce, rocket, nuts like walnuts, almonds, hazlenuts etc. ( I can tolerate limited amounts of salted cashews and salted peanuts), limited intake of tomatoes.

How about that for starters.

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Brilliant Thank you


Oh how familiar! I spent ten years and three gastroscopies before my AF was discovered but that was twenty five years ago and I had hoped that things had improved by now. Seems incredible to me that your doctors are not aware of the connection. Sadly whatever treatment you get for the HH it is probably too late for the AF which is now established and will require its own treatment. Do read up on this on AF Association website and gather as much info as possible as you need to be your own expert and argue your case with these people.

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There is a book on the subject:

Heal Your Vagus Nerve, Heal Yourself: Lucy Hoyd.

I bought a copy for my Kindle, at not much money, just out of interest.

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Thanks for replying I will try and get a copy


I have a small Hernia, and did suffer from SVT/AF for approx 4 years. I took me a while to convince Doctors and my EP that I had trouble with stomach problems at the same time as I was diagnosed with AF and I did eventually get a referral to see a Gastroenterologist.

I did however record what I had eaten, and started to eliminate any foods that I thought were effecting me at this time, with the help of others on this site.

It turns out that the general things such as as coffee, and eating too much at one sitting greatly improved the episodes which were around twice per month. Specifically the main problem for me was MSG 621 which is the flavor enhancer and one of the biggest culprits, along with wheat and certain fruits. Since seeing the Gastroenterologist it appears that I was suffering a mild form of IBS and was referred to a diet called FODMAP (you can look it up on the internet). Basically Gluten Free, with other sugars and sauces which caused a lot of discomfort. It seems that new information has come to light recently regarding this (see Videos from Doctor Sanjay Gupta) speaking with a Gastroenterologist from York Cardiology. Since then I have had a Cryoablation, which went extremely well and no problems since (touch wood) after 8 months, he was interested in this diet also. Hope this helps.


Thank you for this reply.It pulls together several streams of advice in a clear comprehensive manner. Did you get any relief from any of the af medications or any of the ppi (Gastro ) medications. Did you have any discussions on repairing the hernia

Thank you


Sorry to be a pest but was wondering how you were doing I am still struggling with attacks every 3-6 days but gaining some control by choosing what I eat

My gastroenterologist has put me on hold until I have an ablation but thanked me for teaching him what vagal af was

My cardiologist has taken me off flecanide and put me on sotalol I have stopped stomach treatments at the moment because they(ppi) didn't seem to help

In fact gaviston seems to help more

Anyway if you can further help would be grateful



I found that I did get some relief from AF Medications, I tried (3) one of which was Metoprolol, which I am still on now, only 12.5mgs morning and night, but I gained more relief when I started my own elimination diet and even more when I followed the "fodmap" diet. I didn't value the medications, simply because they only lasted around 8 months tops, then I was offered different ones. The better relief came about when I drastically changed my diet and lifestyle. ie Tai Chi and walking, nothing too strenuous, together with any medication.

I was fond of dropping my dose when I started feeling better (I let my Doc know what I was up to). My ablation came about when the 8 months of Metoprolol started to wain, but the EP was impressed with my the next day.

I didn't know enough to ask about different medications from the Gastroenterologist at that stage, and wasn't offered any, but I figured the problem really stemmed from my diet so I concentrated on that. I did try peppermint tea, which was soothing, I still get bloating, and use De-Gas x 2 which seems effective for me but you can get advice from the Chemist for this. I don't need to use it much now, but did take a couple if I was going out for dinner in the past.

However if I had an episode I would treat my stomach first, and then took about (half) extra of any medication that I was on a little later if it didn't calm down. This was a very effective method along with stomach breathing.

We didn't discuss the Hernia but he didn't seem unduly worried about it, I checked it out anyway, and it seems there is nothing much they can do. Since seeing the latest findings however, I will be asking more about this, and will also discuss my gastro medications and dietary information when I see him next Tuesday.

I had worked out already by the (2nd year) of SVT/AF (80% of episodes) came after eating, so to me it was a foregone conclusion. I will give you some feedback after my visit if you like.

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Yes please


Hello again Kelvin. Not a problem, and not a pest either. I am glad your diet has improved things for you, it will take a lot of getting to know, what you are eating and drinking that aggravates the AF and your stomach. Even more so, that your guy is taking the heart and the gut together seriously., so I hope you are keeping a diary of sorts.

My Gastroenterologist checked me over physically again, to see about the hernia problem, things have quietened down quite a bit since my ablation, and he didn't see the need to do anything about an operation. Even though he doesn't do them himself he explained the procedure in case I chose to go down that path, this would mean that a mesh needs to be inserted to keep the Hernia in one place, the morning I saw him, I could feel it was calm and not extended or 'pushing out' as he put it, the only problem with this though, it seems worse at night after a full day of moderate activities including walking/Tai Chi and others that were given to me a long time ago, plus I am not blind to the fact that I still eat too much at one sitting, but I do love my food so its still a work in progress. Since I don't have any more episodes of heart arrhythmia and the Hernia is not so aggravating, I will leave it be for now.

He also mentioned that the supplements of probiotics that I was using need not be used continuously, and explained that these need only be used if I am on Antibiotics, which I am not unless I have an infection. The use of peppermint oil tabs were suggested (brand name Mintec) as being the ones he would recommend, I have had these before, but in my view if you stay on one type your body gets used to them and doesn't always achieve the desired effect. I would stick to what medication suits your body and your pocket.

In saying this my use has decreased since my ablation but it does point to the fact that your stomach is directly linked to the heart. As to which comes first, the AF or Stomach I am still unsure. (the chicken and the egg conundrum) He did not commit to any idea that the Hernia or IBS was the cause of Heart Arrhythmia.

I had SVT and AF and it was only in desperation that I changed my lifestyle and diet to suit IBS and heart Arrhythmia, (the episodes were difficult to tolerate) the biggest game change came from going Gluten Free and only having one coffee in the morning, and declining any unknown sauces whilst out for dinner.

I left him with my written list of supplements including my own (salvation if you like) Diatomaceous Earth (Fine Grade) for humans, he looked it up while I was there and explained this was to help in both Constipation and/or Diarrhoea in that; it is a binder to help expel even loose stools (not a great subject to be talking about). He didn't see any reason to stop this, and since I do have IBS along with the Hernia, I am staying on it as I see fit, even though its not scientifically proven.

We also discussed my modified "Fodmap diet" but I left him the key ingredients, which I discovered were a no-no (for me anyway). These were:- MSG 621, too much MSG 450 (ok in small doses) Any fermented foods, like pickled gherkin etc, vinegar and too much citric acid. Only one coffee, no unknown sauces, and eating smaller serves (not controlled as yet).

Loosing weight is another plus for helping with the stomach but it takes time, I think its wise to wait until you are over your ablation regarding the Hernia, as he says, but you might like to start defining your own triggers with food and drink analysis.

I hope this is of some help to you, please let me know what stage you are up to and what you have discovered.


Thanks for the detailed reply which really helps.Unfortunately I am still having 2/3 attacks every week which last 8/12 hours.During an attack I slow down and rest or just potter around the house. Whilst I have lost 4 stones in weight over 2 years I still find that indigestion is the main trigger.

I have my assessment for ablation on Wednesday but am finding that none of the medications are helping. Presently Sotalol but previously Bisoporol and Flecanide

My gastroenterologist doesn't want to know until after the ablation and isn't keen to offer Hernia repair.

I will keep battling on the stomach front as I feel that is the key Everytime I have an attack it feels like I am back to square one It has been several weeks since I last managed 6 days without attack

Thanks for your help Tomorrow is a fresh day and a new start in this battle


Dear Kelvin, I feel for you, its difficult I know, I understand the feeling only too well. Give yourself pats on the back for loosing so much weight I only managed one dress size.

The problem on the digestive front takes a while to work out, it is not the same as loosing weight, but you are so much more experienced to be able to do this now. Give yourself some breathing space, and rest, plenty of stomach breathing for relaxation, about 5-10 of these if you can.

I was getting attacks every 2nd day before the ablation, but these particular ones I put down to anxiety more than anything else. You are right in saying that one of the main keys is through your gut, and you will notice the difference once you get your ablation, then maybe is the right time to work out what kind of food is irritating your stomach more. I did a lot more deep breathing and meditation leading up to my ablation, and tried out some natural anxiety medication (which you can get from the supermarket) I don't need these now of course.

My episodes were short but horrendous ie: 4 hours max. I had SVT/AF and they had to ablate the 4 entry points. Extra Metoprolol (which I requested to be put back on seemed to do the trick too). I had tried Metoprolol to begin with, then Sotalol which was terrible, (it mimicked the condition) then onto Amiodarone, which I admit did stop them but could see long term problems with this medication, and I eventually told my EP and Cardiologist and My GP that I wouldn't be taking them any more, and that I wanted to go back onto Metoprolol. My experiments with foods must have helped a lot because Metoprolol worked this time, for a long time and I had no after effects from the medication.

When you go to your EP next, I would ask if there is a different medication you can try at some stage, other than Sotalol, as well as the ablation procedure you will discuss. Let me know how you go


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