Atrial Fib:- Identifying Triggers ...

[Deacon-L]

Its interesting to read others A.F. triggers and reactions to alcohol.

I have paroxysmal AF and discovered that if I have 'too much alcohol', I wake up in the middle of the night feeling anxious and realize I'm in AF. The strange thing is that other times I can have a higher consumpion and totally get away with it - no symptoms at all. Confusing!

Why?

... Can it be the food I'm eating with my wine ? BBQ steak, perhaps harder to digest, which was before my last episode.

Is white wine more likely than red to set me off or vice-versa.... no idea?

General backgound of stress?

I only know that alcohol has proved to be a trigger as I've only had one episode that didn't include any alcohol for a week before and that was after a very strenuous gym session.

The only thing I have managed to identify -which might help others- is to be vigilant on the strength of the wine. After the last 2 AF episodes (months apart), I realised the wine we had been quaffing was 14.5% and 15% strength.

*Learning:- I now avoid all wine of more than 13.5% max (which has worked out well ...so far).

*I recognise sleep aponea as a trigger (perhaps in combination with alcohol). I have sleep apnoea and had 2 episodes of AF during a period when my CPAP mask wasn't fitting properly and I would wake up with a jolt and the AF irregular palpitations.

I also suspect a connection with consumption/digestion and its effect on the Vagus Nerve in the stomach and AF. I might be talking bollocks but on a couple of occasions I have had a cigar after a little wine and then, later when lying down in bed, had indigestion, palpitations and gone into AF . The same with no cigar but little single malt whisky 'nightcap' before bed.

In ALMOST all episodes Flecainide has beaten it - 100mg, then 1 hour later 100mg and if still strong AF 2 hrs after that, a third one (rarely necessary). I believe this is more than the recommended dose in that period, but it has worked for me. DO check your max dosage with your doctor to get advice on dosage and intervals between.

Most people try hard to understand their triggers, but its not easy !

Hopefully sharing my prime suspect triggers, might help others. There may be other triggers that are completely off my radar, so I'm sure most AF sufferers would find it helpful to know other people's triggers.

[Hidden]

So, flecainide as the backstop then....

[BobD Volunteer]

My EP told me 15 years ago searching for triggers is the way to madness. You have AF so you will get AF. End of.

[secondtry in reply to BobD]

My take on this is it depends on the type of AF you have, there are many different types based largely on that we are all different.

I know no-one will persuade me to over-exercise, have alcohol, caffeine, cold soft drinks, eat a late heavy meal, re-visit places where I have had a bad AF episode, build up work or social stress, sleep on the left .......need I go on! I accept I could still get AF strictly observing these rules (so you are right there) but the longer I have the issue the more I think success is about reducing the odds rather than thinking you can eliminate them.

[jedimasterlincoln in reply to secondtry]

I agree secondtry. There are always things you can do to improve lifestyle and reduce or eliminate certain risks.

[Auriculaire in reply to BobD]

Given that there are recognised triggers for AF such as dehydration , overuse of certain drugs such as salbutamol and for many alcohol and too large meals before lying down it seems sensible rather than mad to take account of this and avoid triggers so as to reduce episodes.

[whiteface in reply to BobD]

That is my experience too. You can certainly identify triggers but you just find more and more triggers and life becomes a misery trying to avoid them all.

[pottypete1]

You are so right about all these triggers.

One major trigger you have omitted is stress.

Trying to identify and investigate why each trigger affects you is stressful.

I and many others have been diagnosed as having “Lone Paroxysmal Atrial Fibrillation “.

The definition of Lone Paroxysmal Atrial Fibrillation is Atrial Fibrillation that comes and goes from time to time for no particular reason nor because of any other heart disease.

Having said all that if you find that something in particular causes you to get AF, for example alcohol, then these triggers are best avoided.

Pete

[Pam296]

I am fortunate in that my episodes are infrequent and short. This weekend I have had 2, one due to being right in front of the speakers watching a Deep Purple tribute band (happens nearly every time I see a live band). The second started during an extended coughing fit as I currently have bronchitis.

Always seems to be something different!

[wilsond in reply to Pam296]

Hope you enjoyed the gig!one of my faves. Also hope the bronchitis shifts soon xx

[Pam296 in reply to wilsond]

Thank you. Gig was great! 😊

[wilsond in reply to Pam296]

Rock on Pam! Xx

[secondtry]

Firstly, great musical taste. Secondly and back on topic my guess is you have like me vagally mediated probably Lone PAF. The bass beat could be part of the problem as I have felt uncomfortable with that before now but equally and this is the bit I hesitate to mention (but do so because I believe avoiding AF developing is more important than even such music and I am a life long fan!) its related to you relaxing when enjoying something a lot. I wouldn't now go and see Fleetwood Mac live even if Christine and Lindsay were in the band and I was given a ticket...need I say more.

My theory is (and I haven't heard this mentioned elsewhere) that for some people when you are totally relaxed the 'main drummer' eases up giving the other 'little drummers' chance to get started. My way of dealing with this is avoid those situations (a small price to pay), if I am there, consciously take some deep breaths and focus on something else for a while) and also another related cause avoid collapsing into bed at night exhausted (nighttime AF used to be a problem) but wind down slowly.

Apologies if this sounds all mumbo jumbo but over 5 years plus of identifying triggers you end up following your own hunches.

[wilsond in reply to secondtry]

That makes complete sense to me ,secondtry!

[Pam296 in reply to secondtry]

Yes, that makes sense. Fortunately, it soon went off. Bryan Adams next!

[Hidden]

I have found the same thing. A couple of glasses of wine doesn’t seem to cause any problems but beer (often) does. Perhaps it’s the temperature or the temperature +the alcohol. I’m keeping a diary to see if I can identify patterns and combinations (for example of foods and drink) which cause problems. I’m hoping that I will be able to have a few drinks (3 or during the week) without problems, but I’m aware that isn’t guaranteed. Like you, I tend to get PAF at night/during the evening. It seems to be vagal. Perhaps drinking at lunchtime is to

Be preferred to the evening.

[needlestone in reply to Hidden]

I can only drink gluten free beer and alcohol. It is surprising what alcoholic beverages have gluten/wheat in them. Gluten/wheat always sets me off. That may be an issue for you with the beer.

[MarkS]

I'm with Bob, I spent years trying to identify triggers and there weren't any specifically. If you have AF you're going to get it regardless. Having said that sleep apnoea promotes AF. People with sleep apnoea can be a bit overweight, so if that is an issue that's definitely worth tackling.

[Hidden]

Just breathing seems to also be a trigger for me. I can be happily sitting reading a good book and off I go! No rhyme or reason.

Di

[jennydog]

I cannot identify any triggers beyond STRESS. The AF tends to start 24 hrs or so after a stressful occurance.

[momist]

If I have learned anything repeatedly on this forum, it is that everyone looks for triggers. I too can tolerate alcohol, but sometimes I can't. This Christmas and New Year being a case in point. My birthday in October also ended badly.

I think there's much truth in the link between alcohol and AF, but it's not a simple relationship. For me, it also involves food, and the temperature of the drinks (I like my beer warm and cocktails cold - cocktails are a no-no). Much can be done if you do not overeat ,and you take plenty of water in between the drinks - without the ice!

[Beffohol]

Amen to the food consumption triggers. My flutter was only diagnosed because I went to GP with severe IBS symptoms and now I try to stick to a low fodmap diet....the other day unavoidably had meal out, heavy with garlic and msg, and omg the panic attack was horrendous...never again! I'd rather starve 😁

[Hidden in reply to Beffohol]

Garlic fine, MSG a definite no-no!!

[jedimasterlincoln]

Of course if you have AF and it impacts on your life human nature is going to mean you want to try to identify the cause and eliminate/reduce it to give yourself a better quality of life.

It's not madness, but it can be fruitless. Many people have and will change diet lifestyle etc and feel better bout themselves generally as a result. There may also be an impact in how their AF presents, and frequency.

I don't know my trigger for sure - but here is a list of things I have changed and reduced/avoided in 5 years:

Caffeine

Salt in cooking

Loud music/bass

Booze

Sleep deprivation

Dehydration

Overdoing exercise particularly when tired

Working 37.5 hours a week in 12 hour shifts

Also losing weight may or may not help but I've given it a try anyway because it will certainly help with other things. I saw a video of myself today, from 2018, where I wobbled when I laughed with the kids. I don't do that now.

People will have all sorts of advice and regimes for you, some will work some won't. And there will always be sceptics. At the end of the day life how you want to live try what you want to try and if you can help someone else, or someone's changes help you then win win.

[djbgatekeeper]

Based on my own experience when alcohol is a trigger the only sensible approach is to stop drinking alcohol. When AF is not present unless triggered why encourage the problem.

In the end AF won't need a trigger as it will just do it's own thing thanks to being consistently irritated. Reading the posts on this forum I would say alcohol is one of the most common triggers but certainly the one most people try and avoid stopping, in the long term you will wish you had stopped sooner. There's more to life than drink i.e being healthy.

[JanettePearson]

For me it's definitely alcohol and caffeine. I avoid all of it. Also stress and being overweight and eating badly. So I have decaff coffee, flavoured fizz if I feel like it. I can't seem to get rid of the stress but can eat healthily and exercise sensibly. All worth it to lessen the AF and it definitely does.

[bonnie54]

Hi, I found once I managed my diet to reduce fructose, my PAF was more manageable. It was not that eat high fructose leads to AF soon, but reducing fructose in my diet improved Af and general health.

[Deacon-L]

Interesting! I’ll look into that.😊

[wilsond]

I think a lot of people here mourn the person they were before AF. It's not perhaps the drink itself,but the social activity around it. Often feel like an outsider in pubs or gatherings where drink is flowing,and feel a little saddened. Try to think of Reasons to be Cheerful..better for you not to drink...etc...!!!!😀 but...sometimes...grrrr!

[jedimasterlincoln in reply to wilsond]

Yeah it took a while for my walking/pub buddy/quiz team to realise "shall we go for a drink" really meant "go and pay for lemonade when you have some at home in your fridge"

[KathFrances]

I have lone PAF and have identified my triggers as stress, dehydration, low blood sugar and over-exertion. By monitoring these and being aware of when I'm at risk of a PAF attack I've reduced my PAF episodes considerably. I can feel when my heart rate starts to climb or when it goes into AF and before then, I take the necessary action - stopping activity and sitting quietly for a few minutes, drinking or eating something. From having one PAF attack about every 6 weeks, they've gone down so that in the whole of 2018 I only had ONE episode that lasted for only an hour. I know this doesn't work for everyone, but it's working well for me so far.

[Deacon-L in reply to KathFrances]

Thank-you, that is very helpful Kath. My PAF episodes generally take place on fishing trips (3 or 4 a year) where I am standing all day in cold water, casting a reasonably heavy salmon rod. As there is a little heigher consumption of alcohol on these trips, I have considered wine to be the sole cause. (Yet other more sedentary times I have consumed more alcohol with no PAF).

Its very likely the combination of a day or 2 of over-exertion together with alcohol is the trigger rather than just alcohol.

[KathFrances in reply to Deacon-L]

Also alcohol is dehydrating so are you drinking enough water? And eating often enough? Sounds like there could be quite a lot of physical stress on the body!

[Deacon-L in reply to KathFrances]

Good suggestion Kath. I love water and drink lots of it, even during the night. I think its heavy physical exertion combined with alcohol.

[Hidden]

I too have Paroxysmal and the only way I could cut down on my alcohol intake as advised was not to have any! I have the occasional sip of gin and tonic or small glass of wine or cider with no ill effects but no more and not often. We are quite obviously all different!

After twelve days AF free I was woken by AF at 1am this morning - it was slow not over 135 but irregular - I took 2 flecainide tablets and later on a 1.25mg and was soon back to sleep and perfectly fine by the time I woke up. Interestingly my husband was woken with indigestion. I can't imagine what we ate that could have triggered it as we only ate light meals yesterday! I'm beginning to suspect the latest herb tea we bought!