vagal afib

[Tomred]

hi can someone enlighten me as to how we would know if afib is vagally induced , thanks.

[BobD Volunteer]

There are many who would not agree that there is such a thing. Generally we conclude that if your AF starts after a meal, at night when you are sleeping or if your heart rate drops too low than it may be vagally mediated. Beta blockers are not good treatments in such circumstances.

[Tomred in reply to BobD]

thanks Bob

[Nannysue1 in reply to BobD]

Funny you should say thus Bob. I mentioned this a while back to both my EP and Gastrologist and both said that there wasnt enough evidence/ research to prove vagal connection to AF?.

[Hidden]

G'day Tomred,

Quite agree with BobD's thoughts.

That said I was not aware of vagal stuff for quite some months after I was diagnosed and started the AF journey. Initially, the kick off was bending over in a low armchair feeding papers into a shredder. That finished, I settled down to other domestic tasks and began to feel unwell .... BUT, nothing cardiac related. more like going down with man flu.

Then came a dramatic fall in BP 136/80 ish down to 76/50, saw GP straight away. GP then got me admitted to A & E who initially diagnosed Atrial Flutter which according to my write up from the Cardiac Consultant in A & E later in my stay converted automatically to full blown Atrial Fibrillation .... and that started the journey - Jan 2010.

However, I didn't make the full connection with vagal AF for about another 9 months or more when I noticed certain symptoms then AF followed a meal. The symptoms were massive, massive bloating, loud intestinal gurgling, burping and diahorrea - all at random, never could be predicted. The bloating was always extremely painful and the worst of all symptoms and would be the one to trip me into AF.

I was initially put on Warfarin and Beta Blockers and am still on this diet, amongst other stuff more routine like a statin and high BP medication. Over the years I went more for lifestyle changes than ablation which I declined unless it was a last resort. I had blood tests done for IBS, Coeliac Disease which came back clear - so - then I consulted a Nutritionist and we sorted out a more sensible diet and the rest is history. Very, very slowly the diet tamed/calmed the vagal nerve and over the years I managed to go maybe 3 years inbetween events. These days not so, not quite as infrequent - I get a hit about 3 to 5 times a year sometimes insignificant, sometimes crippling but nothing lasts longer than 3 to 15 hours and certainly not bad enough to send me to A & E or even to my GP. Even as recently as a week or so ago when I ate pork that made me feel so, so ill, not in the gut by a very rapid increase in BP ...like from the normal 132/70 ish up to 162/89 in about 2 hours, with a corresponding drop in HR down to 54.

You cannot begin to imagine just how ill I felt. It happened once before, real bad. We went for a long weekend away with friends in Twickenham and on the way stopped for a snack at a Services somewhere. Forget what I ate but it kicked everything off and I spent the first two days in bed feeling so ill, again not gut but chest and general dizziness and no interest in food. Didn't have my devices with me but could tell from feeling pulse exactly what was going on inside.

So there you are ....... apologies for the length of this ... but you did ask how we would know. Thats my experience. so my personal mantra is " calm the vagal nerve ... calm the heart."

John

[saulger in reply to Hidden]

Hello John. Years between episodes, or even a few episodes a year, sound like a dream come true for me !Can I ask if you take daily antiarrhythmic or other medication?

All the best. Saul

[Hidden in reply to saulger]

Hiya Saul,

Sure - I was diagnosed with paroxysmal AF in Jan 2010. Prior to that, between 2007 and 2010 I was on Ramipril for high BP and Simvastatin for cholesterol. With the diagnosis of pAF in 2010 I was then put on Warfarin for life and Bisoprolol (5mg).

A little later my then GP add to the party bag Felodopine ( high BP). Then in Jan 2021 my new GP increased my Bisoprolol to 7.5mg. The rest of the 'kicking the ass' of AF is diet ... Gluten free, wheat free, oats free ( as much as possible) very little fruit, and very careful with green veggies, not because of Warfarin, but, because of what some of them do to my guts. Cabbage - in, Brussels - in, Cauliflower - in, Spinach - in, Broccoli - in, Peas and assorted beans (pulses) - out, Broad beans - in. And so it goes on. Lettuce - out, tomato - out, Onions - out, shallots - in, etc etc. Soft cheeses - out, hard cheeses - in.

At 77 now my average BP is around 132/70 ish with HR of 52 bpm at night and 64 to 72 during the day - all with the help of the medicinal content of my party bag of drugs.

Hope thats of interest.

John

[saulger in reply to Hidden]

Thanks, John. Our stories overlap to some extent.

I am 75 and was diagnosed AFib in 2018, but been having heart irregular rhythm sensations for many years prior, which I ignored.

Sensitivity to onion, garlic, cabbage, etc. Mainly high FODMAP, due to bowel intolerance, so it seems that we could be classified as having vagal AFib.

My episodes follow exercising, emotional stress, and food and dink triggers and happen either later the same night or even a day later, so I am on the minimum Bisoprolol 1.25mg and Flecainide 100mg a day, taken one time before sleep, as the episodes tend to come on at around 3:00 am.

I am low blood pressure, typically 110/70 and resting HR 53, which is due to the effects of the AFib that can cause bradycardia, and the Bisoprolol that lowers the HR.

It took me four years to find the medicinal / diet combination that is helpful to me, and my episodes, for the past month are about weekly and will resolve after an hour, whereas they would last up to five hours previously. The HR during an episodes is about 100 bpm, with some minutes at HR 120 or so.

I am not taking an anticoagulant because I tend to do stupid things and take stupid risks (forgets that he is elderly) and don't trust myself.

I came across the WMM (Wolf Mini Maze) developed by cardiac surgeon Dr Randall Wolf in Houston Methodist Hospital, Texas. It has a 95% success rate after ablating the exterior of the heart and clipping the LAA (Left Atrial Appendage), so no more AFib medication for life, including anti-coagulants. You would need US medical insurance because it costs some $150,000.

Good luck, John. Let's share if we come across a magic potion...

Saul

[Tomred in reply to Hidden]

thank you very enlightening carneuny, its a dreadful ailment for sure, wish there was a one pill fix.

[P0rtnahapp1e]

I am totally convinced that there is a connection, if not with AF specifically, then definitely the heart. I had diarrhoea constantly for five years, a few times a day, with accompanying drop in blood pressure, and particularly in the mornings.

My consultant rearranged my medication over the years until I had completely changed my regime, all to no avail.

I had quite a healthy diet and nothing that would ordinarily have been considered to be a cause of this constant unpleasant symptom until about a year ago when I was diagnosed with type 2 diabetes resulting in the instruction to avoid sugars and sweeteners. Fruit was limited to one piece a day and obviously all sweets, cakes and biscuits etc., were off limits.

My symptoms have almost disappeared, and even the odd quick rush to the loo isn’t accompanied by that horrible feeling of weakness and impending doom which I had had previously.

I used to have a mental image of Elvis’s last moments in my head and a strong belief that I would go the same way!

[Tomred in reply to P0rtnahapp1e]

thank you p.

[Ppiman]

When I raised this, my cardiologist said that "vagal AF" is indeed a reality but was far less common than the anecdotes on the internet imply. He called it a bit of a fashion, and likened it to magnesium being touted as a bit of a wonder drug.

He dismissed my arrhythmia troubles as being caused by irritation of the vagus nerve telling me that if it were, I'd be having swings or severe bradycardia and tachycardia, which I don't. I have since had a good read of scientific articles on the internet and concluded he was - no surprise - right.

Steve

[Tomred in reply to Ppiman]

thank you proton pump inhibitor man

[secondtry]

The important thing to realise IMHO is that AF is caused for the majority by a mix of factors, hence the difficulty in just lifestyle changes stopping them. So moving to the Vagal Nerve that can also have a strong or weak influence on starting AF episodes depending on the individual. Don't get too influenced by medics not concurring, they are trained to act only on what they know and most don't have the knowledge to comment without risking going out on a limb.

From what I have read and my personal experience there is no doubt that AF can be vagally mediated. I was personally convinced by triggering AF, rare for me, in the early days by relaxing in the evening, then after the correct medication stabilised me, revisiting an old site of a bad episode (i.e. mind) and drinking a fridge cold fizzy drink (i.e. gut).

[Tomred in reply to secondtry]

thank you

[LaceyLady]

Well, seeing where the vagus nerve is positioned, I personally think it’s a possibility. It’s the largest nerve in the body. There is also no proof it isn’t implicated.

[Tomred in reply to LaceyLady]

thank you

[TechGuy62]

It took me 4 years before I found an EP who properly diagnosed me with Vagal AF. I could trigger episodes simply by turning to the left or right in a seated position. They didn't believe me until I was hooked up in the ER and they saw it themselves.

I had normal sinus rhythm and 70bpm on the monitor. I asked them if they were ready and they told me to show them, so I did. I turned my back and I went to 140 bpm with tachachardia and aflutter.

Even then, I was told not to do that any more and given the same meds that never seemed to work. I had events where I was waiting outside in the cold weather to go to the ER while the wife was getting ready to take me and it would simply go away.

I began documenting events in order to find out what was causing the issue. Vagal maneuvers could bring down the heart rate and sometimes resolve the issue. The ER visits always involved a sore back and/or stomach.

I am in the IT field and I sit for hours at a time. I found that if I took NSAIDS for the back pain the issues would go away. Taking Prevacid for the stomach also helped when the stomach was the only culprit. Neither are recommended for long-term use.

I replaced my chair, and got a new mattress which corrected the back issue but the stomach still caused problems. All of my events always occured in the evening.

I've had the same up and down BP issues described in other posts as well. It is a horrible feeling and my episodes have been so bad I get uncontrollable shaking and excessive urinating. It's like your whole system has gone haywire.

It seems like this is more of a vagal issue than an AF issue. The AF is a symptom of the vagus nerve. My heart has been checked and it is structurally good. My first episode occured in 2012. Afterwards, I lost weight, ate right, exercised regularly, and never had another incident.

By 2018, I was back to old habits. I was up to 256 pounds and my back and stomach began hurting again. I love spicy foods and big meals, but the body was now telling me otherwise.

After the EP told me about Vagal AF the pieces fit together like a puzzle. When I found this forum it was such a relief! I am reading posts from people who experience the same symptoms as I have. I have a source of knowledge that I never had before and it has empowered me to beat this.

Today, I am down to 209 pounds and I'm still losing weight. I'm eating low carb and my last CBC count was normal. My stomach pain is gone. I need to watch how much I eat. No overstuffing the gut! I drink bone broth instead of taking a PPI. I learned about the bone broth from reading posts. It works just as well for me as the PPI.

If I eat too large of a meal it can come back to haunt me in the evening. I can tell when I'm in trouble by the pain level in my upper abdomen or the middle of my back. As soon as I start feeling any pain I know to stop the meals, drink the bone broth, and give the stomach a rest for a day.

My EP has switched my meds to Diltiazem and Flecainide. They work much better than the Metoprolol and Digoxin for me. But even on these meds, if I overeat for too long - three big meals in a day for two days - I will begin to feel the palpitations.

The rate is controlled with the Diltiazem - unlike the metoprolol, but the "bad symptoms" can still come back - even though the rate remains regular. I've had ectopics while on the meds but they only last as long as the stomach pain exists.

What I have noticed is that there is a direct correlation between the stomach pain and the irregular rhythms. Get rid of the stomach pain and the irregular rhythms are gone as well.

I am very thankful for the information that others provide on this forum. I apologize for the lengthy post, but I simply want to 'pay it back' by providing what I can to help others as I have been helped.

I've had to replace my wardrobe as well, but it has been worth it.

[Tomred in reply to TechGuy62]

thank you very much .

[theohappy in reply to TechGuy62]

So about six weeks after starting Eliquis I developed horrible acid reflux. Diagnosed by barium test. My question to you is your bone broth has worked better than a PPI for your acid reflux?

[TechGuy62 in reply to theohappy]

Sorry so late on this reply. I wouldn't say the bone broth worked better but it has worked just as well as a PPI for me. I take 1-1/2 tablespoons of chicken bone broth powder in an 8-ounce cup of water - microwaved for a minute. One cup in the morning as soon as I get up and the other cup just as I am getting ready for bed. I elevate the head of the bed at night to prevent any possible stomach discomfort.

My irritation has been more related to lower stomach inflammation than reflux. I have had reflux, but it has been rare and only if I go to bed on a late meal and lay in bed flat. I was diagnosed with gastritis back in March of 2021.

[Belle11]

A UK cardiologist, Dr Richard Bogle, wrote the article in this link richardbogle.com/blog/vagal... He mentions triggers for 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." His experience is that it gets worse with beta blockers. He also lists drugs he has found to work better. More in the article.

[Tomred in reply to Belle11]

interesting thank you, will give me something to ponder over.