vagal a f

[trixie100]

what exactly does vagal a f mean and how can it be avoided?

[BobD Volunteer]

Vagal AF is not accepted by all doctors but basically , if it exists, it is AF that is mediated by the vagus nerve. Therefor if your AF starts at night when you are sleeping or following food whilst digesting, then is may be vagally mediated. If it is then beta blockers which slow the heart may not be a great idea as tehy may exacerbate the situation.

[Teresa156]

Hi Trixie,

As Bob says, it’s not ‘accepted’ by medics that vagal Afib exists, but many of us do think that we are affected by the vagal nerve when we have an afib episode, me included. My episodes have always been after evening meals, or during the night and have something to do with digestion. How to avoid it? Now that’s a good question and we all wish we knew the answer.

Some things are - best to avoid sleeping on a full tummy, leave at least 3 hours before sleeping after an evening meal, avoid certain foods…I do take a low dose beta blocker though and it has certainly helped my vagal afib, so avoiding betablockers may not be the best solution for it always, as there are exceptions.

Teresa

[Hidden in reply to Teresa156]

There are two disciplines at play here ........ the cardiac discipline which seems reluctant to even recognise the VN and the gasteroenterologist which would/ does and accepts the VN. Personally, working through an approved Nutritionist over the last 11 years I have succeeded in taming my heart through the process of calming my VN.

You only have to look at schematics of the VN to see what a significant influence it has on many organs in the human body - including the gut and the heart. The precise way it functions may well vary, body to body. I think the cardiac discipline operates in a bubble.

John

[Teresa156 in reply to Hidden]

Totally agree John.

The heart is very sensitive to any disruption too with food) changing diet and timings). Well done in what you have achieved.

[Hidden in reply to Teresa156]

What is funny is my first appointment with my EP, he spent nearly an hour with me, having me explain to him exactly what occurs leading up to, and after, an episode. Had me repeat myself a few times, telling me it was very important he understood the order in which things were happening etc. He then saw the clear connections to digestion, and stated to me that I likely have vagally mediated atrial fibrillation. 2 years later I saw him again, with the intention of asking him if he knew of things I could do with my digestive system that may help, or if he knew of any GIs that are aware of the heart/digestion connection who I could see for help. He shut me down before I got far - told me afib rarely has triggers (really), and that all a GI would do for me is do tests and I'd still have afib. While that last part turned out to be mostly true which was expected really considering my experiences with doctors - I did find supplements and diet changes on my own that are helping me greatly at this point.

It was sad - I was extremely distraught and confused at this appointment as it was unexpected - it seems to me that in those 2 years he went from being open to exploring vagal AF, getting to the root of the problem - to giving in as so many doctors seem to these days, to just using the standard testing, standard meds, standard surgery, letting the computer do all the calculating, shutting down any silly notions of research done by the patient immediately without actually listening at all for something that might be important to their treatment, and being done with it. It's a shame honestly, I thought he was such a wonderful doctor the first time I saw him. I really wonder how much it weighs on them, when they essentially end up abandoning the ideals that caused them to decide to be a doctor, due to profit mucking up the whole works all around them.

[Teresa156 in reply to Hidden]

It’s interesting how your EP changed his mind about vagal AF in those 2 years…it makes you wonder why & what led him to that, or if he forgot what he originally told you…it’s very strange. Sounds like you’ll never know. I think from what I’ve read on here, most of us know there are definitely triggers, especially when it’s paroxysmal - I know there are for me and there’s a lot on line about vagal afib, so it can’t be made up. Diet and supplements help me a lot too.

You may be right about your reasons you think he had a change of heart though.

[CDreamer]

The vagus nerve is the longest nerve in the body and part of the Autonomic Nervous System or ANS - which has 2 parts - Sympathetic NS and Parasympathetic NS - think of it as System Control Centre - you may know it better as the Fight, Flight, Feeze / Rest & Digest. When in balance everything ticks along nicely and appropriately. Out of kilter and the body doesn’t like it.

The ANS is part of multiple systems that regulates just about every automatic function in the body - heart rate, BP, digestion along with all organs and systems in the body. When it malfunctions there is a knock on affect so for example if you eat or drink something your system doesn’t like - the ANS responds. If you worry or over exercise - your ANS responds and you stress the body - the body’s response is to stress is inflammation and inflammation when not fighting pathogens is not helpful.

That’s why ‘vagal’ AF responds differently. Digestion can trigger vagal, especially if you eat without in Parasympathetic mode (ie: not in high alert) but so can lying prone or exercising trigger an inappropriate response - everyone responds differently. Some people need to be careful and keep their HR below a certain rate or AF will trigger whilst others find that exercise will flip them back into NSR. It’s weird and everyone’s response is individual.

You can have vagal AF, adrenaline induced AF or a mix. Beta Blockers block adrenaline which is why they help some types of high HR and AF and not others.

my.clevelandclinic.org/heal...

There is a LOT you can do to increase what is known as Vagal Tone ie: improve your body’s response to stress, digestion, sleep and exercise.

[JoniM in reply to CDreamer]

I may have the “mixed” type…my usual triggers for afib are meals. But then sometimes too much exertion or lying down will cause it. What seems to happen is something triggers tachycardia which can sometimes correct itself before becoming full blown afib…if that makes sense. Anyway, was concerned about going on beta blockers but have recently been on a low dose of metoprolol( 12.5mg) 3 x a day….take it timed to cover my meals and more active times of the day 9 am, 2 pm, 7pm and it seems to be working. It keeps my heart rate low enough that even if something causes some high beats, it doesnt go high enough to cause the afib or if it does, the afib is less bothersome, and shorter. I have Paroxysmal so it always self corrects. The main issue for me is that my HR and Blood pressure are normally low so the drug lowers them more and makes me pretty tired. But I seem to be managing. Also eating healthy, exercising, avoiding alcohol, caffiene, junk food, taking magnesium, etc.

[CDreamer in reply to JoniM]

Pleased it worked for you. Unfortunately Beta Blockers exacerbated the ANS dysfunction so much for me I couldn’t manage at all.

My frustration was that no cardiologist would consider that all the drugs, including Flecainide, made me so ill, that it made the AF episodes feel the least of my worries. Why feel so ill all of the time instead of just putting up with the occasional day or two? Of course it became a lot more problematic when episodes became very frequent.

[JoniM in reply to CDreamer]

Responses to this dx and the meds/procedures is so variable that it makes it so hard to generalize. I’m sure that’s also hard for the docs. The word is still out for me as to whether this will work long term but ok for now. It does make me pretty tired though I seem to manage the tiredness. I probably wouldn’t take it if my afib was occasional. I empathize with your situation, you do need to make sure the treatment is not worse than the disorder. Ablation has been recommended but I’m just not sold on it . Have seen research concluding that women over 70 have more complications, less success so I’m hoping I can continue to manage on meds.

[CDreamer in reply to JoniM]

I believe that unfortunately some, especially of the older generation, cardiologists are fixated only on rate control and Bisoprolol as first line treatment, after anticoagulation of course. Unfortunately many just do not listen to patient experience - it happens often with Beta Blockers & statins. My maxim is - are you better with or without so yes sometimes you need to suck it and see unfortunately. Thankfully times are changing. Just don’t believe that ‘doctor knows best’, question everything.

I chose ablation because I was not going to be on meds for the rest of my life. That worked for a while but AF returned. Now I have a Pacemaker - I hardly ever have AF and have feel better now than when AF started 20 years ago.

Hope you find your ‘magic bullet’.

[secondtry]

I found this article very helpful. afibbers.org/victor2.html

[Hammerboy]

Just for balance, my EP has always thought my AF is instigated by some form of vagal stimulation as 99% of the time an episode followed a light meal with some form of digestive upset .

I'm now 10 weeks post my second ablation with only one short episode of AF 15 days following the procedure and a few ectopics from time to time

I'm now back at the gym carefully working my way back to my previous fitness levels and am eating well with less digestive problems

Hopefully I'm on the road to a better QOL for the forseeable future

[smoothiepete]

I started to suffer AF in the early hours of the morning a couple of years ago. Doctors prescribed beta blockers but they didn’t help. After reading about the experience of others I decided it must be vagal AF. With the help of a nutritionist I changed my diet using the FODMAP diet and eliminated most of the IBS symptoms I had been suffering. I also persuaded my cardiologist to prescribe an anti-arrhythmic (Flecainide) instead of a beta blocker. Additionally I avoided sleeping on my left hand side. As a result I have been free of AF for many months and hope that continues.

[Ppiman]

I was convinced my problems were vagus related and asked my cardiologist about this. He said the internet is full of misinformation about it and that it is far less common than people believe. Irritation, compression or damage of the vagal nerve isn't unknown, he told me, but it is far less responsible for AF than many believe. He also said that it would cause far more problems than AF with severe swings of brady- and tachycardia and many other non-cardiac effects. I believed him!

Steve

[CDreamer in reply to Ppiman]

What your cardiologist described is exactly what I experienced - Tachycardia-Bradycardia, Very low BP, PoTS along with plenty of other cluster symptoms. However, I also think that others have more subtle symptoms which are ANS related and the biggest common factor is some sort of trauma in early life or multiple traumas in adulthood.

I have worked very hard at improving vagal tone and my general health and well-being has also improved as a result.

[Ppiman in reply to CDreamer]

That's very interesting CD. I have long thought "vagal" issues might well be more subtle than the doctor I spoke to implied. He is a learned and excellent doctor, though. Looking back now, I've generally come to think that the body systems and ills are too complex to point to a single cause. I've also come to the conclusion that anxiety plays a far bigger role than I used to believe, not in causing issues but in worsening them.

Steve

[ETHEL103]

My heart rate is definitely heightened when eating later.We usually eat our evening meal at 5.30 which suits us both.Just got back from a lovely 2 day break where we ate at 7 ish and my heart didn't calm down for hours .I would guess that is vagal.

[Rhea11]

Yes, it often is the Vagus Nerve causing the heart distress via the digestive system .. it's called 'Roemheld Syndrome'. I had to inform my cardio-doctor about the syndrome .. he never heard about it before, although he's been 'in the heart-health business' for over 25 years. He said he would look into RS. I don't know what he did with the information. drsanjayguptacardiologist.c...

[nwasyd1]

I am in my mid 50s and have suffered from intermittent vagal AF (ie while sleeping, after heavy meals etc..) for around 15 years. 2 years ago I read the book ‘Breath: The New Science of a Lost Art' by James Nestor … specifically I have eliminated mouth-breathing when I sleep. The impact has been profound as I have experienced an almost 100% REDUCTION in AF. Where I used to experience AF a half dozen times a month now it might be once every 6 or 9 months. I’d highly recommend looking into it.