AF is AF is AF. Vagal just means that it can be triggered by the vagus nerve. It has no baring on the efficacy or not of ablation. There is a suspicion in some groups that beta blockers may exacerbate Af if it is vagaly mediated other wise treatment is the same.
I have had PVI and a touch up with RF 2nd time - I know that you are an active member as have chatted in years past, so is a targeted ablation for vagal denervation successful?
Struggling to see next steps for me at the moment.
The vagal bit makes no difference to how the ablation is performed. You can't ablate the vagus nerve or all sorts of things will stop working!.
PVI (pulmonary vein isolation) is the usual first step in ablating for AF. Cryo has limitations especially if the veins are conjoined or overly large and the balloon does not fit too well. For this reason RFis commonly used second (and third times) as other areas within the atrium may be firing which a balloon can not be used on. Best dicsuss with your EP as and when you get your appointment.
There's a couple of articles here on vagal AF that I found when researching my AF. This cardiologist mentions flecainide, quinidine, and disopyramide for vagal AF, so you took a recommended drug:- richardbogle.com/blog/vagal...
Hi Bob What are the signs of AF being vagaly mediated? I’ve been diagnosed with SVT but in recent months I’ve noticed I get short runs of fast fluttering heartbeats after eating some meals and especially in the evening. Sitting in a slouched way can do this too as can lying on my side in bed. I shift position, get up, burp or pass wind and the fluttering heart episode stops. I’m on 2.5 my of Nebivolol twice a day.
Interesting question Fifteen years ago few doctors would consider the vagus nerve had anything to do with AF. I can only quote a leading UK EP who told me some years ago that " AF may be more likely when the vagal tone is low."
Many people find that during periods of digestion following a large meal or during indigestion (see above) they may start AF events. Similarly these may occur during sleep when the body is quiet. It is interesting that for this group of people beta blockers may not be a good thing and may perhaps even exacerbate symptoms. By slowing the heart down events may be more likely but getting risk/reward balance right may over ride this.
It is still quite new science so still lots to learn I fear.
I’m a bit confused as I think I have vagel AF, But not sure if it’s triggered by posture, for example I sat upright this morning slightly slouched having breakfast than all of a sudden my heart went erratic, than I quickly got up had 2 burps and had my beta blockers and it settled down, defently for me my heart misbehaves when I’m sitting or lying in certain positions and usually gets relived by burping
Thanks- out of interest when were you diagnosed (how old) and are you male ? I have been studying research papers and 40 to 50 year old males are 4 times more likely to have vagal af. Interesting that heart is normally in good shape as mine is if not for blasted AFib
Same situation for me. I’ll go back to my EP - not yet had an ablation - I’d settled down with my beta blockers 2.5 mg of Nebivolol twice a day. No major massive heart racing episodes as I first had nearly a year ago but now have daily short fluttering runs often around meal times - and usually worse at night lying in certain positions - relieved as you say by burping or passing wind. Debating an ablation still - probably no debate if I’m to be relieved of this daily intrusion?
I had an abalation in august last year and still getting these symptoms when in certain positions and relived by burping I just wonder what’s causing it, is it pressure on the stomach that causes these flutters?
My Afib is xactly what you describe - Afib started 3 years ago for me, at age 46, episodes mainly come in bed or after eating. Otherwise healthy and very active. Had RF PVI ablation 2 months ago, so far so good and fingers crossed. So much comes down to skill and experience of the EP? Wondering if you should find a 2nd, if that’s even an option.
I had 3 ablations. My cardiologist said that each one builds on and shores up the last one. Some people need more than 3. If your EP is offering to do another ablation, go for it. Sooner the better. Mine went from October 2018 to March 2019 with a cardio version in July 2018. Never heard of vagal triggered AF - just plain AF. I was first diagnosed at 56, now 69. Been in NSR since April 2019.
Vagal gangliated plexi - I believe they are fatty pads where the vagal nerves contact with the heart & can cause AFIB - they can sit close to the pulmonary veins but not always captured by PVI ablation
Not an expert just reading plenty of study papers online
Hi, similar to you, 54 ,ok shape, normal BMI and Chad vasc score is zero , suspect mine my at least partly vagally induced , on flecainde not had ablation but thinking about it.
Andy - from my experience talk with your EP about the triggers as do wonder if my 2nd ablation could have hit the vagal areas too & saved me the risk of another ablation
Thanks ,will do got a review end of the week so will pick it up there, cheers
Good luck Andy - would be interested to hear your review feedback if you don’t mind sharing. I think if we all share we could get closer to being cured
I started AF at 45 and have since had 2 Ablations in 2-years. Unfortunately the activity now sits near my natural pacemaker and unfortunately current Ablation procedures are to risky to assist any further. My EP suggests first Ablation was successful in isolating the PV but it’s moved!
Mine is most certainly Vagal Induced. Episodes normally occur during 2-4am with BPM around 160-180. I have Flecanide as a PIP strategy but with tiny does of bisopropol and I am ordinarily medication free. I take magnesium turate.
I’ve stopped caffeine, alcohol and most definitely sugar which I think irritates the Vagal nerve and try to avoid stress/extremes of emotions.
I get some strange activity when I’m resting now and particularly as I’m trying to get off to sleep. I splash my face with cold water, run on the spot etc which can sometimes shock it away. I am awaiting a heart rate variability test albeit I’m not sure it will tell me anything more than I already know. I really do share your frustration!
Thanks sorry that you have the issue with position- it’s interesting to see your age - it’s more common than I think people think & am sure is under diagnosed in early cases.My wife is convinced that mobile phones play a part as an electrical stimulation & by con incidence carried my mobile for years in my left breast pocket .... not anymore !
Mine is definitely triggered by eating and lying flat and also when i start walking sometimes. I was diagnosed with a hiatus hernia in September and my EP told me its definitely triggers my Af episodes. Having a tidy up ablation in march but might have to get the hernia fixed too
If you look where the vagal nerve is definitely. The other thing is have you been checked for a hernia as it really causes issues when lying down. After eating and walking after eating. Thanks for your good wishes
You might be able to stop your afib yourself via diet or at least make it much less severe. Give this a try and see if it works for you (does for lots of others):
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I have always thought we all have a similar problem happening within our bodies that is causing our afib problems. After 17 years of watching my afib come and go, and logging everything I eat, I am pretty sure our hearts are fine but we have a problem with a gland(s) or an organ(s):
1). The Sympathetic Nerve INCREASES the heart rate.
2). The Vagus Nerve DECREASES the heart rate.
3). The Adrenal Gland INCREASES the heart rate (with adrenaline), heightens
anxiety.
4). The Thyroid Gland both DECREASES and INCREASES the heart rate, and
heart strength.
5). The Hypothalamus Gland produces hormones directing other glands to do
stuff.
6). The Pancreas processes sugar, which cause other glands to do different
things.
7). To further complicate the situation, when one gland stops working, sometimes another gland will try to pick up the slack.
Plus - there are lots more glands in the body, plus don't forget the organs, which (some) also influence the heart rate, for example:
Medulla in Brain: Heart rate can be increased or decreased by impulses brought to
the SAN or AVN by nerves originating in the medulla oblongata of the brain.
The endocrine system of gland processing is complex – it’s a wonder it works at all.
For a neat picture/information on all the glands, check out this URL: (Ctrl and click):
Medications, chemicals, foods etc. can all cause our glands and organs to mis-fire. For me, sugar (and dehydration) are causing some gland(s) or organ(s) in my body to mis-fire, sending mixed signals to the heart - for example, telling the heart to beat fast and slow at the same time. This would explain why a healthy heart sometimes beats abnormally. It also explains why my heart afibs when I eat too much sugar, because the heart does NOT use sugar to contract (uses fatty acids) so obviously sugar/dehydration is causing something to misfire which in turn is directing the heart to afib. In our old age, I suspect a gland or organ is not working as it used to, causing afib or other heart palpitations. Unfortunately doctors and researchers don't know what it is (yet). In the meantime we will have to listen to our bodies VERY closely to see what is causing our problems and reduce or eliminate our afib by reducing what triggers it.
Here's how to stop it, or make afib much less severe:
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After 9 years of trying different foods and logging EVERYTHING I ate, I found sugar (and to a lesser degree, salt – i.e. dehydration) was triggering my Afib. Doctors don't want to hear this - there is no money in telling patients to eat less sugar. Each person has a different sugar threshold - and it changes as you get older, so you need to count every gram of sugar you eat every day (including natural sugars in fruits, etc.). My tolerance level was 190 grams of sugar per day 8 years ago, 85 grams a year and a half ago, and 60 grams today, so AFIB episodes are more frequent and last longer (this is why all doctors agree that afib gets worse as you get older). If you keep your intake of sugar below your threshold level your AFIB will not happen again (easier said than done of course). It's not the food - it's the sugar (or salt - see below) IN the food that's causing your problems. Try it and you will see - should only take you 1 or 2 months of trial-and-error to find your threshold level. And for the record - ALL sugars are treated the same (honey, refined, agave, natural sugars in fruits, etc.). I successfully triggered AFIB by eating a bunch of plums and peaches one day just to test it out. In addition, I have noticed that moderate (afternoon) exercise (7-mile bike ride or 5-mile hike in the park) often puts my Afib heart back in to normal rhythm a couple hours later. Don’t know why – perhaps you burn off the excess sugars in your blood/muscles or sweat out excess salt?? I also found that strenuous exercise does no good – perhaps you make yourself dehydrated??
I'm pretty sure that Afib is caused by a gland(s) - like the Pancreas, Thyroid (sends signals to the heart to increase speed or strength of beat), Adrenal Gland (sends signals to increase heart rate), Sympathetic Nerve (increases heart rate) or Vagus Nerve (decreases heart rate), Hypothalamus Gland or others - or an organ that, in our old age, is not working well anymore and excess sugar or dehydration is causing them to send mixed signals to the heart - for example telling the heart to beat fast and slow at the same time - which causes it to skip beats, etc. I can't prove that (and neither can my doctors), but I have a very strong suspicion that that is the root cause of our Afib problems. I am working on this with a Nutritionist and hope to get some definitive proof in a few months.
Also, in addition to sugar, if you are dehydrated - this will trigger AFIB as well. It seems (but I have no proof of this) that a little uptick of salt in your blood is being treated the same as an uptick of sugar - both cause AFIB episodes. (I’m not a doctor – it may be the sugar in your muscles/organs and not in your blood, don’t know). In any case you have to keep hydrated, and not eat too much salt. The root problem is that our bodies are not processing sugar/salt properly and no doctor knows why, but the AFIB seems to be a symptom of this and not the primary problem, but medicine is not advanced enough to know the core reason that causes AFIB at this time. You can have a healthy heart and still have Afib – something inside us is triggering it when we eat too much sugar or get (even a little) dehydrated. Find out the core reason for this and you will be a millionaire and make the cover of Time Magazine! Good luck! - Rick Hyer
PS – there is a study backing up this data you can view at:
My wife is going through the menopause & is under a private functional nutritional therapist. Her belief is it all comes back to the gut.
A really interesting one is SIBO (small intestine bacterial overgrowth) which can cause you not to absorb the key elements in your gut ...... including magnesium! Which could explain a lot.
The SIBO test costs £160 but if proven can explain why our bodies aren’t firing properly
Poor you- only 49 and previously fit and healthy like me but I'm now almost 76 (birthday in two days!)! I was diagnosed with paroxysmal AF over two years ago and am still to see an EP (in June!) on the NHS and only as a result of my persistence, so I presume you are in the States. I am not sure what type mine is as no-one has explored that but it might well be vagal. Having seen an EP privately, who prescribed flecanide, I just take 100mg when I have an episode and it stops within two hours usually, often less and very occasionally a little more. I often top up with low dose bisoprolol if the hr gets above 140 or if I just want to get back to sleep (my episodes tend to start at night). I experience one or two episodes a week and just take the flecanide (and bisoprolol) as a PIP. I presume you have a Kardia which is very useful . Taking flecainide regularly did not work for me at preventing episodes though they might have occured slightly less often.
I might consider an ablation if it really would stop the episodes but it doesn't seem to have a brilliant success rate and does seem to be a bit "sledge hammer to crack a nut"ish!
I do hope you find what works for you as we are all different.
Hi - I’m in the uk - Gloucestershire but has enough of being messed around by Gloucester Royal Hospital so have gone private twice for ablation.
The vagal methods that I use are blowing into a large plastic syringe (like a big injection type but no needle !) whilst pushing in the plunger. It has worked for me. I also have reverted by sipping & slightly gulping cold water which also has worked. There are other methods to stimulate the system such as ice cold water splashes to the face & bearing down (as if trying for the loo) - they do work but not every time
Amazing- I'm in Gloucestershire too- near Stroud - but the EP I saw privately prescribed flecainide which I use very successfully as a PIP, with added bisoprolol- even so today's episode which started out of the blue half an hour after a perfectly normal Kardia reading went on for four hours (a record for me since when diagnosed)- I've tried drinking cold water and the bearing down without success but then we are all different. I know what you mean about Gloucester Royal- I spent the worst night of my life there after already being diagnosed by the paramedics who took me there!
ps because of my dreadful experience at Glos Royal, I asked to go to Cheltenham in future and once that involved seeing Obi in Cirencester- then the "atrial fibrillation services" decided to stop seeing me without telling me so I had to ask to be re-refered! You have to be pretty fit to attempt to get the system to work!
Good luck with your journey!
It's supposed to be Challoner but I've only seen him once for under ten minutes. When I asked about taking a lower dose of anticoagulant as I looked like a victim of domestic violence with the resultant bruising on the full dose, he said that I couldn't do that as I had a 2.2 percent chance of having a stroke, to which I replied, "Then I have a 97.8 percent chance of not having one- I like to be positive! " That's what I do- take the half dose of Apixaban as I don't weight much over the 60kg cut off point for that. Mostly I've seen a guy called Dr Obi who I finally persuaded to pass me on to Dr Bond who I thought was the only EP they had but that was in October and I am not due to see Bond until June!!! The new reasonable young doctor at our surgery has come up with a new anticoagulant which I am going to try soon as it might prevent me feeling so tired though that might be old age finally catching up with me as I'll be 76 tomorrow (and my chance of stroke will go up to 3.2percent if it hasn't already!)
I have had a few bouts this year one interestingly at a music concert where the sound vibrations triggered afib. I get a slow down before I go in to afib. I have had some bumpy eptopics on a semi regular basis but my Kardia says normal. I also find worse with harpy fever. Hope u r ok
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