Can I test out a few elements of my understanding of the vagus nerve and vagally induced Afib with any of you that understand it better than I do please?
1. Vagally induced Afib is triggered by an over-active or over-stimulated vagus nerve, which in a sense means that you are too calm or relaxed in that moment e.g. when digesting a large meal or resting after exercise, and so your heart rate drops too far.
Hence it seems counter-intuitive to respond to this by deep breathing or other yoga breathing techniques designed to increase calmness and further stimulate the vague nerve and the parasympathetic nervous system.
Is the answer that once the episode is triggered then presumably the sympathetic nervous system kicks off in a big way and so the body needs to be calmed down? Or something else?
2. The other (odd) question that this begets is that if episodes are caused by being too relaxed then why would you want to practice deep or yoga breathing if this makes calm and relaxation more likely in your day to day life?
Is it that these practices in some way “heal” the vagus nerve (how?) and moderate the “activate response” and so make it less likely that the vagus nerve will become over-activate?
Many thanks.
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BigArnie
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I would not necessarily agree, however, that AF was a result of an overactive vagus nerve. I remember Richard Schilling saying probably 2008 our patients day conference that AF was more likely "when the vagal tone is low." This being the reason some people find events starting at night or after a large meal. I think there is quite a difference between vagal tone and levels of arousal/stimulation. Maybe CDreamer who is more atuned to such matters has an opinion?
Thanks Bob, so as I think I understand it, vagal tone is low = vagus nerve activity is low, but if you have just eaten then vagal tone should be high to facilitate the digestive process. So what you say might indicate the vagus nerve is malfunctioning and that causes the Afib somehow…?
From my conversation with Richard Schilling you would appear to have it the wrong way round. Don't confuse organ activity with vagus nerve activity in other words . Yes it does seem counter intuitive I know.
I think you asked a great question! Bob is right according to my understanding- the issue is normally that vagal tone is too low I.e. not sufficiently responsive when needed, and therefore does not counter the sympathetic nervous system. A high vagal tone therefore should allow us to calm down quickly and adjust our metabolic rate when digesting and resting, also on waking. And you mentioned something else that can be confusing - why do the calming breathing if we need to increase vagal tone? Same reason - it's part of the parasympathetic nervous system, which helps calm.us down. We're helping the vagus to do it's job by doing these slow breathing exercises. When my digestion is overwhelmed I'll typically do some slow breathing for a few minutes. Then I might get up and walk about a bit. Passive sofa slumping is problematic immediately after eating, attractive though it may be this time of year.
Thanks for posting. I have had the same query. That said, as other posts have discussed, some episodes of vagal PAF may be stopped by increased sympathetic activity, as with a bout of exercise. Some have stated that for vagal AF, beta blockade may be contraindicated. So what about the appropriateness of “preventive” vagotonic activities and vagotonic interventions for PAF?
It does seem really complicated when you start to think about it, I guess because it is. I seem to have both sympathetic and parasympathetic triggers, but my Afib is much more under control now with significant weight loss and lifestyle changes alongside daily Bisoprolol. However I want better and realised that I really didn’t understand some of the underlying processes. So, for example, having done the weight loss and lifestyle changes, do I still need the Bisoprolol, which does have side effects? Frankly I am scared to play with the equilibrium, but might do if I could rationalise it…
Hi BigArnie,
I was diagnosed with paroxysmal AF ( with a tendency to be asymptomatic) back in Jan 2010. Many many months later I realised that my AF events when they occurred, when I felt them, followed a meal. For quite a while the AF events were strong, frequent and regular etc. They also wiped me out totally. Then it became a journey of discovery.
I experienced, bouts of diahorrea, intestinal gurgling, massive, massive pain from bloating and burping. not all at the same time, all at random, anyone that felt like it wanted to happen, happened. My GP back in the day had me tested for Coeliac Disease and IBS but these were all clear although he commented at the time he personally thought I could be marginally IBS.
Then I read posts on the AFA Forum when it was hosted by Yahoo ( long before HU) about the Vagal Nerve. Then I consulted a Nutritionist who got me gluten free, oats free and wheat free. The prescribed diet, by keeping a food diary, enabled me to widen the diet to include all manner of food stuffs. Since those heady days now over 11 years ago my AF has been tamed ... not cured. I get about 3 to 5 bouts a year, most about 3 to 4 hours in duration some as much as 15 to 24 hours, which again wipe me out. This year has been the best ever only one event which put me off work for a couple of days.
So basically, food and ingredients ( something silly like gravy or fat from a roast duck) could kick me into touch ! That is it would aggravate and/or inflame or whatever, the vagal nerve and I'm a gonner.
Thanks John, I have read a lot of your posts with interest over the last couple of years and they definitely contributed to my thinking and improvements. Mine started 3.5 years ago and after a few false dawns I am much more under control - 6 episodes in the last 8 months after periods of often 2-3 per week. (And a couple of those episodes were in a bout for Covid and a couple due to pure stupidity!)
I have vagal Afib, started about 16 months ago. The last 4 months or so I have been getting it nightly, but my Afib burden is low, perhaps 4 or 5 times a night and only for a few minutes each time. I don't take any medications as I am either asleep and they resolve naturally or if I am awake I am stimulating my Vagal Nerve to stop the Afib immediately.
My system must be very sensitive as I get Afib as soon as I lie down, for example this morning I went to the toilet at 4am with my monitor attached, 65bpm right up until I lie down again. Then bang, Afib up to 145bpm within seconds, a quick Valsalva Maneuver and it stops.
I take preemptive action before I go to bed to stop the Afib starting, I ride an exercise bike to get my heart up to 115bpm then lie down, that works great.
I do get a lot of PVC's and even more PAC's also.
Is your Afib similar? If not how different is yours?
The supine and left lateral positions increase left atrial volume, and atrial stretch may contribute to the mechanism of atrial fibrillation (AF).
Front Physiol. 2021; 12: 708650.Self-Reported Onset of Paroxysmal Atrial Fibrillation Is Related to Sleeping Body Position
Background: Because stretch of the atrial myocardium is proarrhythmic for atrial fibrillation (AF) and a left lateral body position increases atrial dimensions in humans, we hypothesized that left lateral recumbence is a frequent AF-triggering body position in AF patients.
Methods: We performed a questionnaire study of symptomatic paroxysmal AF (episodes of AF < 1 week) patients scheduled for a first AF ablation therapy at Catharina Hospital, Eindhoven, the Netherlands and at University Hospital, Bordeaux, France.
…
Conclusion: Body position, and the left lateral position, in particular, is a common trigger of AF in symptomatic AF patients. Moreover, positional AF is associated with overweight. Understanding of the underlying mechanisms of positional AF can contribute to AF treatment and prevention.
The authors’ discussion:
…A left lateral or supine position triggered AF symptoms in most of these patients. Moreover, nocturnal AF occurred in the majority of patients and these patients preferred similar sleeping positions as patients without nocturnal symptoms.
A left lateral recumbent position increases the dimensions of the left atrium and the right pulmonary veins and thereby increases local myocardial stress (Wieslander et al., 2019). Stretch of the atria and pulmonary veins is proarrhythmic for AF (Ravelli and Allessie, 1997; Chang et al., 2007). Because the pulmonary veins are fixed to the mediastinum, we speculate that a body position change contributes to AF genesis by augmenting wall stress in the pulmonary veins.
Increased parasympathetic nervous activity is known to be proarrhythmic for AF (Chen et al., 2014) and may mediate an arrhythmogenic effect in left lateral recumbence. …
I take a simplistic non-scientific approach to my vagally mediated AF, as follows:
Some are given a more sensitive Vagus Nerve than others.
Two things affect the VN the most, at the top end 'stress in the brain' and at the bottom 'gut issues. Both can reach the heart and cause AF.
Just as it has taken a long time of stress and gut issues before the VN reacts sufficient to cause AF, so it will take a long time after the causes have been addressed to return the VN to the norm. Over the years, the biggest changes I have made have been to business/social stress and diet.
I appreciate this doesn't answer your questions but what I am trying to say is ( I think!) instead of working out how to counter episodes when they occur or VN ideosyncroses, address the root cause.
Indeed, Secondtry and I have been very significantly influenced by your thinking in my own journey of improvement, so thank you! After years of research I more or less agree 100% with your assessment and am definitely pleased with the progess made from some of the very dark periods. Addressing your two big things I have amongst others: lost two stone in weight, improved my diet and eliminated many triggers, stopped running (sigh), introduced daily relaxation and yoga breathing sessions (both dedicated sessions and just whenever I think about it), had acupuncture for six months, now take daily digestive enzymes and "good" gut bacteria etc. Essentially for me it is all about reducing and eliminating mental and physical stress, alongside building up your body's capabilities for dealing with what you can't eliminate. Now I just have this urge to better understand the physiological stuff!
Yes, very much so. It was likely a few things coming together at the same time, but there was a really distinct step-improvement very soon after I started taking them. I take these:
I’m on exactly the same path right now as you Arnie! I’ve identified my AF as vagal (I can switch it off at will with a yoga “hare” pose) and I’m just about to consult my naturopathic therapist to start investigating my ‘physical’ stress levels. Like others on here, I can do all the meditation and breathing techniques to calm my mental state, but this chap will take a look at what stresses my body is under.
I think much of his remains theoretical. For example, an "over-stimulated" vagus would lead to severe bradycardia, I was told, then to swings of brady- and tachycardia.
Yes that makes sense to me. I guess the trick is to (somehow) eliminate the overstimulation in the first places, because once either bradycardia or tachycardia kick in then the body WILL have to take corrective action.
It's also possible that the vagus isn't as "involved" as many seem to think., and maybe not at all, in a direct sense, anyway. The autonomic nervous system might be the actor rather than the vagus itself since adrenergic AF is much more accepted as an idea, for example (i.e. AF that arises from stress responses, both physical and psychological). Certainly the evidence for "vagal AF" isn't solid. Also, the vagus innervates so very many organs apart from the heart that any "stimulation" of it might well be rather dangerous and have a whole constellation of effects on the body - lungs, heart, digestive tract - lots more:
Thanks Steve, and you may well be right. I think the vagal theory arises because so many of us have episodes apparently triggered whilst in rest and digest mode with no obvious physical or mental stressor, which indicates the parasympathetic system and hence the vagus nerve may be in play.
My GP wondered whether I had vagal AF caused by my hiatus hernia but when I asked the EP cardiologist I was seeing, he told me that it was very unusual and was more of an internet phenomenon than a reality. His main point was that AF is usually associated with tachycardia, whereas vagal irritation would cause severe bradycardia followed by swings of brady > tachy.
I also wondered whether what seemed to me to be a "vagal" (i.e. parasympathetic) cause might, instead, be caused by its opposite, i.e. a lack of sympathetic / adrenergic stimulation brought on by resting.
In the end, though, I have decided, in my case, it could be that my stomach and digestive system press not on my vagus nerve but on my heart itself, indirectly via the diaphragm. That did appeal to the doctor I saw as it's a known cause of ectopic beats, apparently. It would explain why my problems sometimes seem to arise not only when sitting down during nor after a meal, when first lying down in bed but also when I stretch up or kneel down for extended periods, such as when I was recently decorating.
That is very interesting, not least because I was once told that I had a small hiatus hernia, but that it did not require treatment. For sure I have also experienced (occasional) triggers when bending over etc. although less so since my weight loss, which would seem to indicate some “internal overcrowding” might have been to blame - at least for those triggers and perhaps others too.
Now, there’s a coincidence. A small hernia can be more troublesome, I’ve been told, than a large one. An X ray once showed the diaphragm muscle on the hernia side (left) was not smooth as on the right. Goodness knows why, but what it also showed was the stomach pushing up and pressing the diaphragm against the base of my heart. Back then, no AF, only ectopics.
I often wonder whether anatomy isn’t considered by doctors when AF strikes.
I have had this. A sliding hiatus hernia is intermittent. I can sometimes feel a pulsing just at the junction point of diaphragm and lower oesophagal sphincter. Nowadays since my ablation it doesn't trigger AF but I do pay attention to my posture and always leave 3 hours between my last meal and bedtime.
Hmm, might be on to something here. Before I lost weight the other thing was I often felt that certain sitting postures (after filling up with a meal) would often precede an episode. And I’ve never really had issues when in bed as long as I’m careful with posture there as well.
Just to introduce a second area of confusion here: is it possible that vagally induced Afib does not require a misfunctioning vagal nerve at all and it is just that the normal vagal nerve pulses affect the heart because the atria wall has become stretched/distended by too much exercise and is touching the nerve? Or because you are overweight then everything is just too cramped together in the abdomen/chest area?
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