I took the advice of this forum and eventually had the opportunity to see an electrophysiologist. We only have one electrophysiologist in our city and he is booked out well into next year, we do have another that travels 1800km once a month to our region and I was lucky (or unlucky) to get an appointment with him.
He dismissed the fact that I can stop Afib in it's tracks with a Valsalva Maneuver. He suggested it was a coincidence, and if anything, doing this type of maneuver would probably bring on an Afib attack! Well that was a wasted $300...
So my question to the forum is two fold:-
1. Do you have Vagal Afib or Adrenergic Afib?
2. Does your cardiologist understand these two branches of Afib, or do they only recognize paroxysmal, persistent or permanent Afib?
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OzRob
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Don't deal with Cardiologists now, diet ( with the help of a nutritionist) and meds has largely fixed my AF issues over many years. Reading material over time suggests anecdotally, that Cardiologists do not accept Vagal Afib or Adrenergic Afib probably hasn't been introduced in their training. Vagal AF I think is more likely to be accepted and understood by a Gastroenterologist than a Cardiologist or EP. Don't know about the Adrenergic stuff. Certainly not for me ....... I don't exercise, nor would I contemplate it. I'm quite sedentary.
I am unsure whether the medical world would agree that Vagal and Adrenergic are "Branches" of AF as such ........... bit hard if they don't understand the vagal nerve. I would only use the label of "Triggers" for these.
Prior to AF mugging me ( between 2007 and 2010 ) I was on Simvastatin and Ramipril only.
Post the AF mugging, I remained on those and had added by Cardiologist Bisoprolol (5mg) and Warfarin. Both of which I am still on.
Prior to 2007 I was on no medication at all.
Three things have worked in my favour a speedy diagnosis and treatment of AF started ( around 9 hours from feeling unwell), then the above drugs, then diet ..... recognising food I'd eaten - last meal of the day - was giving me a dysfunctional vagal nerve. Using diet I attempted, eventually quite successfully, to calm the vagal nerve, thereby calming the heart.
Sorted ! I still get 3 to 5 short bouts a year mostly only around 2 hours duration, sometimes as much as 15 hours. I just let them go and sort themselves out, can't be bothered fussing. The 15 hours hit does wipe me out I have to say. This year (2022) remarkably, I've had only 2 short hits.
Dr Bogle spoke at the Surrey Support Group here in the UK which is where many here first heard of vagal AF.
I had mixed vagal and Adrongenic AFib and yes my EP recognised and treated both, with consults with my neurologist (I had autodystonia, PoTs with low BP) all logged and recognised. Certainly cardiologist did not accept there was a connection.
I would say it took me many years to find an EP who would at least talk to me about the connection. I was admitted to hospital with being unable to lift my head off the pillow without passing out and my HR exceeding 200 and my BP through the floor. Prone - no problem, sit up and I passed out so there was absolutely no argument about it. I was prize patient for 24 hours and as every doctor in the hospital came in to my cubicle and asked me to sit up - darkness - Oh,…..never seen that before!
Other person to look at is AFA consultant on Autonomic and AF is Dr Boon Lin of Imperial, London. He lectures around the world and last year there was a video on the subject on the AFA Patient Day Curriculum. Not sure if it’s still there?
What surprises me is the lack of understanding about vagal Afib generally.
I wonder how many members here on this forum have been medicated without having the opportunity to discover if they have vagal Afib.
If vagal Afib can be treated without drugs or ablations then it is a missed opportunity.
I usually get Afib as soon as I lie down. I had read about people exercising to get them out of Afib. My routine now is I get on my exercise bike just before bed for 5 minutes and get my heart rate up to 115bpm, then lie down no Afib.
I think the process of lying down lowers the heart rate.
I am in the US and I don’t know if you have read anything on this site about Dr Randall Wolf in Houston Texas that does a Mini maze that he developed for treatment of AFib. He is a cardiac surgeon specializing in AFib. He believes that lone AFib(AFib with no other heart problems) is Vagal AFib. His procedure has about a 93% success rate. I have had the surgery and am AFib free since surgery 4-1/2 months ago. Many people who have had this surgery have been AFib free for many years. The only reason I tell you this is for confirmation that there are cardiac doctors that believe Vagal AFib. The other type I don’t know.
I keep saying, and have done over the years (since 2010 ), that the speed of an accurate AF diagnosis AND the commencement of treatment is critical to pleasant outcomes. The longer AF is left, ignored, misrepresented, misunderstood et al the worse long term outcomes will become. Thank goodness I don't have othe onset of AF in the current era .......... the way the NHS is, at surgery level, ambulance level and hospital admissions level ........... forget seeing a Cardiac Consultant or EP -its a total disaster. NOT TALKING ABOUT GOING PRIVATE BY THE WAY - just bog standard NHS.
The other issue is of course that AF in all its glories is a hydra headed monster and all things to all people.
You may remember me as I posted a couple of months ago about how I stopped my ‘vagal’ Afib with a manoeuvre, after waking up with it in the middle of the night.
I have read that ‘vagal’ Afib isn’t really accepted by many cardiologists and some think it isn’t what we think it is. I thought I did have vagal Afib, in respect that it’s bought on by digestion issues ( in my case gassy food, spicy food, eating too late) and relaxing in a particular way, or both. I have had some adrenaline based Afib in the past though, but I’d say 80% of mine are ‘vagal’ - and whether it was a one off I don’t know, being able to stop it so quickly, but it can be done it seems, as I did it.
I haven’t discussed it with my cardiologist as I don’t yet have an appointment ( now overdue 🙄) I do have a feeling though that he might not accept it.
It’s really disappointing that you had that experience. Even if it is a coincidence, it was very good for me, so, I’d definitely try it again.
I have had doctors tell me that something "isn't what I think it is." Curiously, they are not able to then say "it is this."
After rejecting the recommendations for ablation and more risky meds (almost died from Tikosyn trial) from my EP, I instead went to work to reduce and relieve the trapped stomach gas that welled up into my chest, especially when I lay down for bed, and triggered Afib. I was told that would not help.
After reaching a point of suffering episodes of Afib every two weeks or so that lasted 12-24 hours each time before dealing with my gas issues, I have now been free of Afib for the past 9 months. It is clearly due to my efforts in gas reduction, including going gluten free (celiac disease diagnosed), avoiding gas producing vegetables and fruits, using antacid pills sparingly and regular exercise.
When it comes to knowing my triggers and what to do about them, it apparently "was what I thought it was!"
The web has much information about Vagal Afib, I am surprised it is not discussed more on this forum. Or when new members join they are made aware of Vagal Afib.
If someone has symptoms mainly at night, after a big meal or when in bed then it points to being Vagal Afib.
My usual cardiologist (not the EP) is now very interested in my case as I think I am his only patient that is inquisitive enough to pass up on the drugs to try other things.
Have a 24 hour recording device to record at night is a great tool while trying to work it all out.
My Afib burden now is very low and my ectopics are reducing, in a few months, if it all continues as it has been I will create a very long post outlining everything I have tried.
I’m sorry you had that experience with your EP, that is disappointing but not surprising, I fear.
I don’t like to throw a spanner in the works but not all nighttime AF is vagally driven and if episodes are happening at night, or if someone with AF is aware of waking with a start at intervals during the night, it would be worth checking for sleep apnoea, too.
I was getting AFib episodes exclusively at night, usually starting in the small hours, so was convinced I had vagal AFib. Like you, I had no joy from my EP so did my own investigations and found out I had sleep apnoea and that was triggering AF episodes. It turns out my AF is adrenergic, as the drops in oxygen levels caused by the apnoea events triggered adrenaline release to rouse me to start breathing again but also triggered AF! Had no idea I had apnoea as I wasn’t aware of waking in the night, just waking up in the morning feeling wrecked. Happily, going onto CPAP therapy has sorted that problem.
Sorry for hijacking your thread, as vagal AF is definitely a cause of AF at night but just thought it worth raising sleep apnoea as a possible cause as well. My EP was all for going straight to an ablation and wasn’t interested in looking at causation at all!
I am currently trying to figure out why I wake up several times in the night and wanting to pee and for that matter during the day too much as well. Just had this week annual blood tests and not pre-diabetes or PSA/prostate problem.
I have mild sleep apnoea, which I try and control with nasal & lip strips plus 3 pillows. Maybe I have to go onto CPAP.
I certainly think it’s worth you looking to into it, Secondtry.
I’m on a couple of Facebook forums for sleep apnoea and it’s quite surprising the number of times new users mention that, once they’ve got used to therapy, they sleep through the night and don’t keep getting up to pee - me included😊 I used to get up a couple of times a night but not now. Initially, I did try sleeping propped up and using a nasal strip / chin strap combo to keep my nose open and mouth shut but was still getting O2 drops , it was only the use of the CPAP machine that has reduced those.
All the best to you. I’m by no means an expert on the subject but if I can be of any help you’re welcome to PM me.
Yes, sleep apnea does also bring on Afib, I was not aware that sleep apnea was not vagal. I don't suffer from sleep apnea that so it has not been on my radar.
Good to hear that you muddled along until you worked it out. I am muddling along also as it seems that it is up to us to work it out for ourselves...
I have vagal - at least that is all I have ever noticed.And it has almost completely stopped now (without drugs or surgery, I might add). The only 2 cardiologists I ever spoke to did not seem to assign any relevance or importnace to the vagal vs adrenergic question. I however think it is very important to determine which you are. and some people are mixed.
For one thing beta-blockers are (or may be) contra-indicated in vagal affibers, since they lower blood pressure and heart rate... which heightened vagal state itself already does.
The difference between being vagal or adrenergic also explains why a strong cup of coffee can trigger afib in some people (adrenergic) but actually convert others back to NSR (vagal afibbers).
So in my opinion, it is quite important to figure out which type you are. It can help you avoid your specific triggers if you know whether you're vagal or adrenergic. and it can also help you design an effective conversion strategy. Doctors will not help on that question of whether you are vagal or adrenergic, in my experience. But it is not too hard to figure out on your own.
Great post. I wonder how many vagal afibbers are medicated immediately and never have the opportunity to discover if they have vagal Afib. No opportunity to let their minds and bodies try to work things out.
Mines always seem to be vagal related. Bending or turning wrong way. But GP or cardiology don't think so. Even last week I was in hospital went into nsr. 2 hours later turned on bed to put headphones on afib kicked in again. Asked to stand up streched/ cracked my chest and stopped it. Came back again for and hour after getting bed put up. Nurses were like wow that's so weird. I also have slight funnel chest.
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