Curious as to what others experience is with proton pump inhibitors, especially those whose AF symptoms are vagal in origin? I came off daily PPI’s as I believed they were contributing to my episodes breaking through. After stopping the PPI’s I noticed a significant drop in my AF episodes, however three months on despite a daily Flecainide dose of 50mg and another 100mg kept as a PIP to terminate break throughs I am getting episodes virtually every other day and invariably after my evening meal late in the early hours and sometimes the following morning and occasionally during the day. Each episode includes rumbling stomach and often indigestion symptoms. I’m aware PPI’s can effect magnesium absorption and I am currently taking 400mg of magnesium chelate daily along with 60mg of potassium. I’m now considering going back on Omeprazole (PPI’s) to see if my AF episodes reduce in frequency. Thoughts please?
PPI’s and atrial fibrillation - Atrial Fibrillati...
PPI’s and atrial fibrillation
My AF is thought to be vagally mediated which is why I take Disopyramide as an anti arrhythmia drug. I've also been taking Lansoprazole fir a number of years ( gastritis, hiatus hernia) and can't say that this has affected my AF episodes at all. I find it extremely helpful as indeed it is necessary for my condition.
I have been on PPI for years, long before AF. Ive tried to stop in the past and suceeded in reducing. Since AF though Ive taken them religiously. My episodes have very similar triggers to yours - basically eating and lying down. I figured anything that keeps the digestive system calm is likely to help, and not the time to deal with indigestion and heart burn.
Am taking magnesium - not sure if it makes a difference.
Currently one week after an ablation so keeping my fingers crossed for good outcome.
Good luck with the ablation, I’m guessing you’re in the blanking period now? Good luck. That’s where I’m heading ultimately after discussion with my cardiologist, he’s referring me to an EP at the Queen Elizabeth hospital in Brum, fingers crossed! In the meanwhile I’ve increased my daily magnesium from 250mg to 400mg and have decided to try the Omeprazole again and also take 1000mg vitamin D as I’ve read good things about it’s effect on AF?
For what reason are you taking Omeprazole - sore stomach? When I first started taking Magnesium Citrate it made my stomach sore. Now I take Magnesium Glycinate mid breakfast and am fine. I would recommend you too try taking yours mid breakfast. Warfarin also caused soreness and I take that mid breakfast as well.
I agree with BobD it's not a good idea to take PPI's long term. Have you looked at the possible side effects?
If getting a sore stomach, cut all vinegar, fat and yogurt out of your diet for a while and sleep with your bedhead raised. If stomach becomes sore eat a banana or some almonds.
Jean
Please do not go near these drugs. Once taking them for any length of time they are self perpetuating . There are very good technical reasons for this as I found out myself many years ago when I was prescribed them (Long before AF by the way. ) and had to fight my way off them. If ever there was a group of drugs designed to capture and ensnare victims it is PPIs.
Interesting, can you elaborate a little on why you feel they are self perpetuating? I’ve been off them for three months but due to the endless almost daily early morning post eating Afib outbreaks I succumbed and took one tablet earlier today to see if it makes any difference at all?
It was explained to me that the lower sphincter in the stomach needs an acid environment to open and pass food down into the gut. Take that acid away and food remains there backing up and increasing reflux. More ppis to combat the reflux brings on more reflux ad nauseum . Yes I have been forced to take them from time to time but after my first experience which turned a minor problem into a major one I refuse to take them for more that a week or so. I know too many people who can never come off them and still have massive problems. Diet should be the answer not pills. End of rant.
(By the way there is plenty on the internet about this and I believe Mayo Clinic published a study a while back.. )
Hello Motov, please contact your health care professional regarding any questions or concerns you have about your medications. Any changes to the prescribed dosage must be agreed with them in advance. You may find the 'Drug Information for AF' helpful ahead of contacting them. To download visit : For Patients \ Patient Resources heartrhythmalliance.org/afa...
Bob, there are times when it is absolutely necessary to take PPI s. Not everybody treats them like sweeties.
I managed to get myself off PPI's. Try taking a course of Mastic Gum pills. I guess you could get some online, expensive but worth it to heal your stomach.
Jean
I’ve been off of PPI’s for three months but now, more out of desperation than anything else, I’m trying them again just for one week to see if there’s any significant improvement? I’ll look into the mastic gum pills you mention?
I think at the moment I will leave things as they are. I have a hiatus hernia which , according to my gastroenterologist, is to be treated with PPIs as surgery, in her words, would be incredibly risky!
I will bear in mind what you have said though and after I have recovered from my joint replacements (!?) I shall review!! I forgot to take my capsules one morning and had the most horrific burning sensation in my chest and throat at bedtime. Frantic search for Gaviscon......
Not only that but I have a quite rare stomach condition called GAVE......so mustn't rock the boat!
I have a hiatus hernia too. I wonder just how many of us do?
Most people I speak to seem to have one !! 😬
Same here strange.
Hi JeanMe too! Very strange.
I do. I believe it is very common.
Along with a lot on this post I take Omeprazole for a hiatus hernia I had years before AF there is no surgery i can have or I would it's a very pain ful condition without Omeprazole I have tried to stop them but like Jalia even missing one dose causes me to reach for the gaviscon for relief.
I know Omeprazole depletes magnesium so take 400mg a day but if any one would like to tell me what I should or should not be eating I'm willing to try to stop them again
Last time I got stuck in afib, for around three months till cardioverted, I had awful symptoms of a ball of wind in my chest that I could not burp to get rid of, slighted exertion brought this on and I was very badly affected by it. Told my gp and that gaviscon did very little for it and she perscibed omeprazole twice a day.
After the cardioversion I cut it down to one a day but after about 18 months I started to get awful stomach cramps and runs so bad that I would worry about going out.
I blamed magnesium and stopped it but no difference, also stopped any artificial sweeteners but when I stopped omeprazole the symptoms gradually eased off over about a fortnight.
For a while even taking gaviscon or orange rennies brought the same symptoms on as though I’d become sensitive to it but I can now take small doses of these..
Told the gp and she gave me lansoprazole to take only if I felt I needed it, I haven’t yet.
Strangely enough I was given a different brand of flecainade once and they sent my reflux symptoms crazy. Went worse over about a fortnight till my pills, especially the evening ones, felt like they were sticking in my gullet and would not go down. I stopped taking them, luckily was ahead with my Persciptions and I could start taking my next box which was my normal brand again and it eased off gradually but took a very long time to go completely.
I always put a note on my repeat requests now and check before leaving the pharmacy to make sure I don’t get given them again.
I too have been on ppis a long time, (Lanzaprosole) and have a very strong suspicion they have been the cause of my A-fib. Simply because they strip all the good bacteria from your gut as well as the bad. Tried cutting down but the heartburn was unbearable and was told the burning can cause too much damage to the oeasaphagus to be left alone. Rock and a hard stone comes to mind.
I have had AF long before taking PPI's and have taken them nearly 20 years, My lower Sphincter never closed and so therefore always had acid reflux and a large HH, that was fixed 10 years ago along with a operation for the lower Sphincter called Nissen Fundoplication, my consultant at the time said that he has never had anyone suffer like me and it is the worst he has seen (Acid Reflux). However I still take PPI's as I have a very over active Stomach.
Sounds to me like your gut has been neglected and plastered over with drugs. Re-check you are doing all the right things diet wise. I would avoid all PPIs and such like, then consult an experienced Alternative Practitioner e.g. a Naturopath; in the meantime maybe reduce the Magnesium orally and substitute with a spray on the skin e.g. ancient-minerals.com/produc...
No quick answers and no side effects, just slow lifestyle changes.
For me I believe they made my AF worse. Took them for stomach ulcers twice and each time I had more AF. Don't want to take them again.
To my mind an acid stomach definitely triggers AF but I only take omeprazole or esomeprazole for 4-7 days and then stop it. This usually works.
I have a hiatus hernia and AF. For many years I have tried to wean myself off Omeprozole by using other methods to control the acid reflux...Apple Cider Vinegar, Bicarbonate of soda, Slippery Elm....all to no avail. I have proved to myself the link between an inflamed oesophagus and an episode of AF. No episodes for a month when I was taking Omeprozole...stop and try other "cures" and AF is back...have proved this to myself several times. So to those who tell us how bad Omeprozole is I would ask what "cure" they have found that actually works as I would love to stop taking it.
I get only occasional AF, but lots of mild tachycardia. Both, however, seem directly related to gastric issues and come along with discomfort along my left diaphragm region and, sometimes, sternum and through to my back. I also take esomeprazole, having switched only recently from lansoprazole, which I had been taking for many years for reflux caused by a small sliding hiatus hernia. A few years ago, I did try to switch to ranitidine because of the fear of side effects, but it was a complete failure from which it took months to recover from the reflux that ensued.
I was told the cause of the arrhythmias was unlikely to be "vagal" since that was, despite non-scientific internet articles claiming otherwise, a rare thing, and one that would cause other important problems including bradycardia, rather than tachycardia. It was suggested it was more likely a physical cause as the heart can press on the diaphragm and be irritated when this is pushed up by the stomach. Apparently, this can happen naturally after a large meal, when gas or air is present, or during some types of movement. Climbing a ladder with a pruning pole the other day brought it on really badly - more fool me for doing it, I suppose, as the effects lasted the rest of the day and forced me to take some bisoprolol to calm things down.
From what I was told, PPI tablets reduce magnesium levels only in a very few susceptible individuals and do so more often in those taking diuretics. I read also, but now cannot find, that taking oral magnesium didn't work since the problem occurs in the magnesium transport mechanism in the small intestine, where oral magnesium is also absorbed.
This report might be of interest:
kidney-international.org/ar...
Steve
Interesting information. There appears to be lots of conflicting information regarding the origin of AF. My research and prominent heart doctors believe that most AF does originate with the vagal nerve. It is believed by some that is why ablations have such a low success rate, and is rarely permanent due to the fact it is a nerve problem not a heart muscle problem and when the nerves on the OUTSIDE of the heart (vagal) are ablated it stops the AF. Also when AF is set off by stomach problems it is definitely the vagal nerve.
I haven't seen that in all the reading I have done. That's interesting - how can I have missed it? I have, of course, read about vagal AF, but not that it might be the cause. The latest I read on the cause was that the cells and nerve fibres in the atria become stretched by various means, some genetic or BMI, etc., and this causes the cells to become arrhythmogenic.
If you could point me to a study, I'd be keen to read it. In my own case, I never know whether the chest discomfort I get, which goes on for hours and is in the left diaphragm area, is caused by the heart affecting the gastric region / diaphragm or vice versa - or, of course, as you suggest, vagal. I feel unhappy that the cardiologist and gastroenterologist I saw seemed uninterested in the possibility of the connection - one a prof at a leading teaching hospital. It seemed to me that the two specialities were too separate.
Steve
I don’t have any studies but In looking at the vagal nerve and reading about it, the vagus nerves run from the brain through the heart and down into the stomach and gut. So that tells me those systems are intertwined and one could affect the other. I just know that for me sometimes when I get acid reflux it sets off an episode.
Aha - I see, It was your mention of research and prominent heart doctors claims that took my notice. My doctor told me that an irritated vagal nerve can occur but is quite an unusual problem that would create a wide range of important symptoms and not just arrhythmias.
Steve
I have taken it for years and it does not appear to make my af worse. However I have suffered all my life with indigestion. Then IBS went to see a dietician who suggested the Fodmap diet and I have cut wheat out and it has significantly changed my life. Gluten free and I feel great around my digestive issues.
I would be looking at what you are eating for that evening meal. I have a hiatus hernia but I don't take PPIs. I can largely keep it under control by watching what I eat. A book which helped me greatly is The Acid Watcher Diet by Dr Jonathan Aviv. Also a game changer for me is that I have my main meal at lunchtime and I only have something very light in the early evening and nothing after 6.30 latest. That means I can go to bed with my stomach quiet. If I eat anything later I can get rumbling etc and disturbance when I go to bed and that's when trouble starts with tachycardia and possibly AF.
PP I's mall both my stomach (GERD) Worse and my Paroxysmal AF. I stopped them and started taking Vitamins and minerals daily alongside Magnesium and it did quieten down my PAF ( not totally stop it ) but did significantly reduce ecetopics, Tachycardia, thumping heart, etc. I Wouldn't touch PPI 's with a bargepole now.
I do still suffer Some Stomach issues that seem to affect my now permanent AF/A Flutter particularly of I eat large meals. However I have just found out from other non cardiac investigations that I have a small Hiatus Hernia which is apparently very common in over 50s so I'm guessing this may be affecting My hearts performance via direct pressure or irritating the vagal nerve. I wonder how many hearties may also have a' small Hiatus Herama' that they are unaware of ?
one thing that has helped me is raising the head of my bed by around 6 inches - helps with chest, stomach and heart.
I have the same thing Goldfish and was quite surprised when my acupuncturist told me I have a hernia. It comes and goes but significantly affects my reflux when it’s flaring. I also take magnesium, both Glycinate and taurate. I think it’s helped.
Have you tried taking 1/2 to 1 tsp bicarbonate of soda before eating or after? It works sort of like anPPI except it neutralizes acid, does not get rid of acid for as Bob says we need the acid to digest food. My herbalist told me this years ago and told me not to take ppis for the reason Bob says above.
It has worked like a charm. I take it after I eat if I’m feeling bloated or acid refluxy. I get a few big burps out and feel much better and have at times warded off an AF episode I believe.
Why do you take a potassium supplement? From what l understand too much potassium can be as bad as too little. As you can only find out what your level of potassium is by blood tests; how do you know what your numbers are. Are you having regular blood tests? If you are , you are lucky because my doctor stopped them because of covid. I have been in hospital twice with severe symptoms of a. f. and both times my potassium level has been too low and they gave me supplement drinks. They gave me some to take home once but not as a regular dose, because as l said too much can cause you problems too.
I get regular blood test via online postal labs that provide this service.
Been on Omeprazole for 12 years and apart from occasional Reflux its kept me well. Had chest pain and only after Endoscopy diagnosed with Hiatus Hernia. No AF symptoms until last year when single episode floored me. Total surgical shock. Commenced Bisoporodol next day and felt uncomfortable ever since. Resting pulse around low 40's, sometimes high 30's. Siblings all on PPI's and anti coagulants. Family trait
HiSounds like you could have 2 things happening with you.
Have a gall bladder test.. From bowel to stomach and throat to stomach.
Never felt better when I had my gall bladder removed through the tummy button.
It had disentergrated! Surgeon had to do more portholes to remove the bits stuck to other organs!
cheers JOY
I’m with Bob & Jean. Always refused to take them. I was prescribed them automatically before I had any symptoms when prescribed 3 separate drugs. For the life of me can’t understand why. I have 3 drugs I can’t live without. Unless a drug is life saving or prolonging I don’t want to add any more.
The long term affects of PPIs are not desirable & to digest many foods we need high acicidity in our stomachs. Problems come when it doesn’t stay in your stomach.
The only reason I can see where they may be useful is to prevent oesophageal damage when everything else failed.
I don’t believe taking or not taking would make any difference to vagal AF but changing Lifestyle, increasing vagal tone certainly would address both GI issues and therefore help vagal AF.
Just a personal opinion.
Ten years ago Australian GPs/chemists/ gastroenterologists were targeted in an education campaign about the harm of PPIs long term after it was found to be abused via oversubscribing. Few people truly require it. Lifestyle changes are better employed but few want to change behaviour so PPIs prevail. Like oxycodone, PPIs were originally developed for those post surgery (4-8 weeks) but today it’s a lolly you take before eating all the foods you know you can’t. We need acid. PPIs cause your gut to make more acid hence why it’s difficult to wean off it. Most medics will support the PPI habit. Be the agent of change and show them they’re uncaring by putting you on it long term without education or alternative remedies. Please educate yourself and please ask questions about long-term safety.
safetyandquality.gov.au/sit...
RACGP - Evidence of PPI danger grows
Recently, some concern has been expressed about the volume of prescribing of proton pump inhibitors (PPIs), mostly for GORD, in Australia. The Royal Australian College of General Practitioners (RACGP) has recommended, as part of the Choosing Wisely Australia campaign, that doctors ‘don’t use proton pump inhibitors (PPIs) long term in patients with uncomplicated disease without regular attempts at reducing dose or ceasing’. Similar concerns by the Department of Veterans’ Affairs led to the release of a Therapeutic Brief on PPIs in 2012.
racgp.org.au/afp/2015/octob...
———-
...the study found that more than half of the people taking PPIs did so without a medical need...
‘Most alarming to me is that serious harm may be experienced by people who are on PPIs but may not need them,’ Assistant Professor Al-Aly said.
www1.racgp.org.au/newsgp/cl...
Using PPIs for GORD wisely
The appropriate use of PPIs depends on:
only starting treatment with a PPI for 4 to 8 weeks with patients who have been diagnosed with GORD (according to the definition above)
regularly reviewing patients who are taking PPIs for the treatment of GORD, with the aim of reducing or stopping PPI treatment if symptoms are well controlled.
These approaches align with Choosing Wisely Australia’s recommendations from the Royal Australian College of General Practitioners (RACGP) and the Gastroenterological Society of Australia (GESA) on the appropriate use of PPIs in clinical practice.
RACGP Choosing Wisely recommendation 1: Don’t use PPIs long term in patients with uncomplicated disease without regular attempts at reducing dose or ceasing.
GESA Choosing Wisely recommendation 3: Do not continue prescribing long-term PPI medication to patients without attempting to reduce the medication down to the lowest effective dose or cease the therapy altogether.
nps.org.au/news/stepping-th...
How to step down PPI usage
nps.org.au/assets/50240b737...
Helpful chart shows how to wean off safely
I am pretty sure my PPI use may have triggered my AF. I was being treated for gastritis with 40 mg of pantoprazole for 7 months when I had my first AF event. My GE never indicated that the PPIs would affect the calcium, potassium, B12 and magnesium levels in my body and I think that deficiency set it off. I was able to wean off the PPI using ranitidine (a H2 blocker and not a PPI), but I had to go slow and it took me a year. My AF episodes decreased in frequency, but the diltiazem, digoxin and magnesium I was taking was not stopping my AF episodes. I was only 52 and in otherwise good health. I insisted on an ablation and have been AF free for 26 months. I am not even on any meds. Long term use of PPIs is bad news, get off of them if you can.
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