Can older people get vagal AF?

[Sandych55]

I am a 66 year old female diagnosed with paroxismal af last November. I've had a few episodes since and they always seem to start at night. Last night after I had slightly over eaten it wasn't the leaping heart I have had before but I just felt a bit strange. I used my Emay monitor which said I had arrhythmia. Luckily this was only a short episode lasting about 20 mins. I was wondering if I might have vagal AF although everything I read suggests it's only young fit men that are affected. Is there anyone my age with it? My very first episode was after a late spicy curry meal so it does seem to fit.

[BobD Volunteer]

No age bar with AF Sandy. Mind you there are still EPs who dismiss the idea that it exists. AF is AF is AF whatever triggers it.

Try eating smaller meals spread out more.

[Sandych55 in reply to BobD]

It's just that I have read that with the vagal type beta blockers are not advised and mine have been upped.

[Jalia in reply to Sandych55]

Yes, I've read that as well but they are still handed out automatically it seems ! My AF is thought to be vagally mediated and I have found beta blockers to be virtually useless.

[Hidden in reply to Sandych55]

Hiya,

Yeah I've read that too, however, unless it is a properly researched medical scientific paper I tend to disregard it. I was diagnosed with paroxysmal AF in Jan 2010 and within a year realised it was vagal. I was put on Bisoprolol right at the start and am still on it. My original dose was 5 mg and a year ago it was increased to 7.5 mg. ....... no sweat! no side effects! no problems!

Bisoprolol holds my heart rate at around 62 ish to 67 bpm daytime resting. Night when asleep 51 to 57 bpm.

I control my pAF with a combination of meds and diet and tend to eat my main meal of the day, small and light and as early as is possible in the evening - NEVER, NEVER late.

John

[mjames1]

No age limits with afib. As to beta blockers, from what I read here, they seem to be given out automatically for afib in the UK, mostly bisoprolol. I don't know know how prevalent they are in the US, but it was many years into my afib before I took a beta blocker (or calcium channel blocker) and then only for rate control during an afib episode. Don't know the specifics of your situation, but beta blockers can decrease the quality of life for many. So, if that's the case, definitely challenge your doctor to their necessity.

Jim

[Sandych55 in reply to mjames1]

Hi Jim, I'm in the UK and there was no option given to me over meds. I didn't know enough about it to do other than what they said. However it is specifically Vagal AF I am interested in.

[Singwell in reply to Sandych55]

Bisoprolol or similar is the first line of action for treatment of AF in the UK. Vagal AF not age limited as others have said. Note that this happened after a heavy meal and maybe wait 3 hours after eating to see if that helps?

[Jajarunner]

My Afib always starts at night. Was put on beta blockers at A&E after latest cardioversion but EP took me straight back off them once he knew. Lower my heart rate to 50 or lower and make me feel faint and breathless. He said the dose was so low (1.25) that it probably wasn't doing anything but making me feel lousy anyway!

[Hammerboy in reply to Jajarunner]

Exactly the same for me , cardiologist put me on Bisoprolol, EP took me off them

[Hammerboy]

Hi , I've had PAF for 5 years now . For the first 2 years I had various visits to cardiology and a private EP who recommended Beta blockers and an Ablation . Having a low HR the Beta blockers made me feel very fatigued so I stopped them after a few weeks , then had the ablation which has improved things but didn't completely stop the episodes .I have found over the last 3 years that it is predominently after eating that I experience either ectopics , faster HR or a sensation in my stomach that can sometimes flip into AF .It often lasts a few seconds or a minute or two and now and again I can control it by deep breathing or counting counting the beats in my head and willing them to slow down It sounds silly but has worked a few times .

You sort of get to know the signs and prepare yourself for it but certainly I've rarely had an episode that starts randomly , there's always a trigger of some sort .

When I spoke about my experiences with my EP he was confident my AF was triggered by a vagal response which he said was a common culprit.

I've tried cutting out certain foods and avoid alcohol but it can still be very random Sometimes I can eat a certain meal with no issue then another day the same meal triggers a response . Thankfully I now have only about 5 or six episodes a year and I'm on the list for a follow up ablation that I hope will improve things even more .

I think what should also be taken into account is any digestive issues you may have . I suffer from chronic acid reflux which affects my digestion and I'm sure irritates my esophagus leading to vagal stimulation .

It has changed how often and what to eat but also things like hydration , getting a good night's sleep and reducing stress helps .

There are some good videos you can watch that explain how the vagus nerve is involved in the process from Dr Sanjay Gupta which you can find on this site .

[stoneyrosed in reply to Hammerboy]

You have just described my life to a tee. Exactly the same as you Hammer boy.

[Ppiman]

I asked my cardiologist about this possibility with my own arrhythmias, and he was very lukewarm towards the idea, explaining that it is a real issue but that it was far less frequent than the internet and social media have made it seem. He explained that when the nerve was affected and caused arrhythmias that the effects were far wider ranging and included severe bradycardia and swings of tachycardia. I did point out to him that I get some degree of this, but he discounted that.

Steve

[Hammerboy in reply to Ppiman]

Amazing how specialists differ in opinion , it can only be a personal belief or they would all say the same thing

[Ppiman in reply to Hammerboy]

Well, I think myself there's as much art as there is science involved in the sense that they struggle to find the actual cause of arrhythmias (unless there is an obvious anatomical reason where the heart is enlarged or such like). Maybe they aren't so interested because knowing the cause won't change things significantly: once the cells become changed, that has to be dealt with as they aren't going to change back.

Steve

[Teresa156]

Hi Sandych55,

I have vagal AF, only ever at night, used to be after a heavier than usual meal….also alcohol and anxiety could set me off. I can eat curry though, but just not too much of it! I think it’s either over eating, or not leaving perhaps enough time between that and sleeping that used to do it for me. I’m female and started getting AFib episodes in my late 40s, only once a year or so initially. As others have said, it’s definitely not an age or a male thing. 😊 Cardiologists don’t appear to accept it though.

I also take a very low dose of Bisoprolol only ( just over 1.25) , which so far has stopped my episodes since November, so it doesn’t fit that you can’t take beta blockers with vagal either ( I’ve read that too). I’m not saying they’re perfect though and ideally I do want to reduce it a lot further or come off it altogether. Lifestyle and diet changes do also help enormously.

My Aunt, who is 84 is on atenolol and has been for over 20 years for paroxysmal AF and she hasn’t had one episode since. I think that is amazing and shows they can work well for some. We are all different at the end of the day 😊

Teresa

[Shazmoz]

I am a 64 year old female and have recently come to the conclusion that I have vagal AF. Almost all episodes over the last 3 years have been in the evening or at night whilst at rest. I am very sensitive to beta blockers, it made the AF worse. I cannot sleep on my left side, this triggers an episode. I have started sleeping propped up on two pillows. Flecainide is mostly working for me, whilst I am on a waiting list for a second ablation. Watch Dr Gupta's YouTube video about vagal AF. It's very informative.

[secondtry]

My thoughts are that AF is usually caused by an accumulation of poor choices (different for each individual) in life and that the 'cure' consequently needs a variety of different actions. Hence I can appreciate why there is a huge spread of opinions on explanations and drugs from the medics.

I have vagally mediated AF. My gastric system has been improved by cutting out 90% of gluten and 75% of sugar, as well as other changes. I have very simple early meals in the evening. I wind down slowly before going to bed (e.g. no late night crime dramas whilst snacking). Check for sleep apnoea, I have it mild and use nasal strips. No sleeping on the left side and use 2/3 pillows under the head; I sleep mainly on my back. I only take one drug Flecainide as my cardiologist said a BB/CB would make me feel unwell.