AF occur at specific times of the day?

[madm00se]

Newbie AF here. Does anyone AF (PAF) come on at certain times of the day? Mine seems to be when I've been asleep. Thanks

[CDreamer]

AF during sleep is very common and often an indicator of vagal AF.

This article is a good explanation richardbogle.com/blog/vagal...

When to suspect vagal AF: If the arrhythmia occurs at rest, after meals or during sleep then it is more likely to be vagal stimulated. Commonly this type of AF stops in the morning or during periods of exercise and can be precipitated by cough, nausea, after eating, swallowing and ingestion of cold foods and drinks. Vagal AF is more frequently seen in younger patients (30-50 years old), typically men and usually the heart is structurally normal on echocardiography. If the patient participates in endurance sports such as cycling, marathon running or cross country skiing then AF is also more common. ECG recordings often show a combination of atrial flutter alternating with atrial fibrillation. When a 24h ECG monitor is performed sinus bradycardia usually occurs before the onset of the AF. The ventricular rate during the AF is generally not fast. It is possible to measure the activity of the autonomic nervous system but it is difficult. One way is to assess heart rate variability which can assess the balance between the sympathetic and parasympathetic or vagal tone. Vagal stimulation shortens atrial effective refractory period and augments the ability of a single atrial premature beats to induce AF.

Sometimes AF can be totally vagal, partly ie: you have episodes at random with no ‘trigger’ or without any vagal trigger.

AF can be very random. My nocturnal AF was stimulated by my HR, BP & O2 sats dropping at night. I now have a pacemaker and no problems. It’s interesting that I spend most of the time when asleep at a HR which is at the minimum for the PM to kick in meaning that without it my HR would dip.

One thing which may help is to raise the head of your bed by 15degrees.

[rosyG in reply to CDreamer]

I agree with raising bed. I have had to sleep on back sitting up after bi lateral knee replacement and have had no episodes since September and I have vagal af Dr Bogle was our first medical director so liked his article here!!

[Lbeat796 in reply to CDreamer]

Mine are definitely vagal too. Happen for no reason apart from turning head which I think puts pressure on vagus nerve but I have noticed that when I have a lot of ectopics which can start an arrythmia that my heart rate is under 60 when normally it is a bit faster. I cant lie on back as need to keep chin up so lie on side. Even edge of pillow touching my neck can start arrythmia.

[pottypete1]

I am now very stable and rarely get AF at long last just hope it does last.

When I was very bad and had episodes sometimes twice a week I kept records and entered them onto an Excel spreadsheet.

The conclusion was that at that time 54% of all my AF episodes took place on waking.

I now suffer from Bradycardia and feel awful for the first hour in the morning.

I think the heart slows significantly at night and when AF lurks it finds paths between the regular beats.

Pete

[Nerja2012]

madm. I fit the bill exactly the same as you. I also have naturally low HR and low BP. I am having a 24hr BP monitor fitted soon along with a Heart monitor at the same time. Iv been told to stop taking Bisoprolol 1.25mg which I'm reducing at the moment. Even on a half tablet my Diastolic is only 50 during the day so can expect it and heart rate to be in the 40s when sleeping THATS when the AF kicks in. Heart otherwise OK. Good article CDDreamer provided. Thanks for that.

[Boyatthood]

My AF is just like CDreamer describes- completely vagal. All my episodes are at night. I am generally very fit, run, gym etc. My HR is 50-53 during the day but as it hits night time my lower heart rate predisposes my heart to AF. Sleeping upright with an extra pillow certainly prevents episodes. Avoiding heavy meals and a lot of alcohol also helps. My episodes last an one-two hours and generally have no or few symptoms. I go back to sleep and my heart seems to reset when I clear my mind. Its the anxiety I hate especially before bedtime. Its also making me feel down worrying about eating something nice or having that glass of beer with my food. As my AF gives me relatively little grief I wish I could be more pragmatic with my mindset!

[secondtry in reply to Boyatthood]

Your experience resonates with me. My suggestion would be reduce the daytime exercise a bit and late evening before bed relax with something helpful instead of dropping into bed tired out. So the heart doesn't experience too big a contrast. Cut out late alcohol & 3 course dinners also...try it and if too difficult you can always go back to your previous regime.

[Boyatthood in reply to secondtry]

Thanks. I find the exercise helps me around tea time as my average HR tends to starting lowering and need a kick. Definitely agree about food portions and trying to avoid eating after 7pm. Will try to do this more. These England games are not helping much!

[bassets]

I think I fit this bill too. I used to wake up at 1 am each night with Af or feeling as though it was about to start, or often after breakfast. I have a naturally low heartbeat too. I saw my Ep a week or so ago as I am down for an ablation which I was dithering about like a fool. I am very symptomatic, but he said my heart is basically sound and an ablation is a good move but I can defer this if I still feel ok for a while. I think anxiety is a trigger. And also too much to eat before I sleep so now I have reduced meals, stopped alcohol and caffeine and lost 2 stones. I've been vegetarian for over 30 years so keeping to a plant-based diet doesn't bother me, but it didn't stop the AF beginning in the first place!

I find that if you can try not to worry about it things get easier. Hope this is of some help?

[pickypolly2]

It helps some people but did not suit me. It made my AFib worse. I hope it helps you.