PAF and Ibuprofen

[Kent2007]

I've been on a good run lately - many months since I had any AF. Until last night. Woke at 2.30am with some odd rhythms going on. Kardia suggests PAF and I would agree. I know it's a way to madness to try to track down triggers, but I'm sure we all speculate from time to time. The only thing I did differently before bed last night was to rub Ibuprofen gel into my injured foot. Any connection? Well, it is widely known that Ibuprofen can affect the stomach (although I think just the lining) and the vagus nerve is associated with digestion and AF? Has anyone had similar experience? Any thoughts on a possible link?

[BenHall1]

My personal view, unqualified of course, is No ! Can't think that a gel would work on the digestive system. If you were on an anticoagulant, I might still say no ! Simply because a gel is not going through the digestive system per se as a digested meal would.

I would also say that we have no indication of your useage or Ibuprofen habits nor have we any idea of the meal you ate as your last meal prior to the possible AF event. Pure guess work ... it'll be to do with food/meal that did it rather than a gel. In other words I would have thought it more likely be food to inflame/ aggravate the vagal nerve than a gel administered the way you have.

You state "it is widely known that Ibuprofen can affect the stomach" I had always associated that statement with patients who were on anticoagulants ... particularly Warfarin.

You don't discuss your medication plan so it's a bit hard to say really.

[BobD Volunteer]

It is well known that NSAIDS such as ibuprofen can cause AF when taken orally. (nothing to do with vagus ) My doctor did say that used topically in gel form SPARINGLY should be OK but you never know. Many of use do occasionally use such gels with no problems though.

[Iamfuzzyduck in reply to BobD]

Oh that is interesting -I had ibuprofen right before my first attack- hmmmm

[KiwiBlake]

Ibuprofen (and dichlofenac) can set off AF with me. For my own situation, I wouldn't even apply to skin in gel form, as it is absorbed directly from the skin into the bloodstream. Personally I wouldn't risk it.

[cherylttt]

My cardio has given me the go ahead on topical NSAIDS and they have been great for the joint pain I experience. I haven’t experienced any increase in Afib.

[BenHall1 in reply to cherylttt]

I was given the opposite advice regardless as to whether I was on Edoxaban or Warfarin. Plenty of shoulder joint pain, working through it with CoCodomol 30/500 pending an injection into left shoulder. But then I've had no AF events for about 4 years that I can remember.

[kocoach]

I was at the emergency room last Monday, (Labor Day) with severe hip pain. After examination the Dr's diagnosis was torn soft tissue in my hip area and it would be painful for a few days and he wanted to give me 1,000 mg. acetaminophen but i refused and he saw on my chart I had diclofenac at home but I told him I have never used as it can set off an afib episode and he agreed it could, so I went home and took a 325mg acetaminophen and rubbed some walmart arthritis cream (salacylic acid) and lo and behold the pain was about 95% gone in the morning. Good Luck whichever way you choose to go.

[ThinLizzy1]

ibuprofen has set me off previously, it was a number of years ago so I may have remembered this incorrectly but I’m sure I was presctsomd gel that wouldn’t set my heart off.

[Speed]

Connected rather than directly relevant. I avoid oral NSAIDs due to the impact on how platelets work as I’m on Apixaban (DOAC). Combined they increase the risk of bleeds especially in the GI tract, I got a right telling off from my GP when I let slip I had taken some Naproxen! Topical NSAIDs are unlikely to have the same impact but I still use with caution and sparingly.

[Peacockmumma]

I read that you shouldn’t take ibuprofen when afib. ..or not recommended anyway..according to good old google

[Ducky2003 in reply to Peacockmumma]

That is orally. Topical gels are ok if used in moderation.

[sdgb]

NSAIDS are a trigger for me, however I can use topical NSAIDS but sparingly without issues. However my cardiologist did warn me to use sparingly as he has a patient who is hyper sensitive to NSAIDS and even the topical ones trigger their AFib.

[Profound15]

I had afib come on with ibuprofen and now steer clear. I have actinic keratosis on the scalp and was prescribed solaraze (Diclofenac). Got loads of ectopics and stopped using the gel and lo and behold the palpitations stopped. I reckon I’m just very sensitive to anti inflammatories

[babs1234]

I can’t take ibroprofen due to having had a stomach ulcer but can use the gel. I had no idea the vagus nerve is connected to AF. I use a Gammacore device which is to stimulate the vagus nerve, treatment for prevention of migrain. Now wondering could that have kicked off my AF. Will certainly bring this up on next doctors visit

[TopBiscuit in reply to babs1234]

Stimulation of the vagus nerve is supposed to help reduce AF by stimulating the parasympathetic nervous system, in the same way that it helps reduce your migraines. I have a TENS type machine that stimulates the vagus nerve that I use for exactly that purpose (reducing AF).

Edit: not that I know that it works, but it certainly isn't doing any harm.

[babs1234 in reply to TopBiscuit]

Thanks for that x

[Poochmom in reply to babs1234]

There is a thoracic surgeon in the US who believes that AFib is a nerve problem not a heart muscle problem. He has performed over 2,500 surgical ablations wherein he ablates the outside of the heart (not open heart) around the vagus nerve and ganglionic plexi. His success rate is about 90% so yes I would say vagus nerve is highly related.

[Singwell in reply to Poochmom]

AF definitely isn't a heart muscle problem- it's an electric signal problem. At cellular level is my understanding. If it was neurological I would you be ag all surprised

[Belle11]

There's research that has found that AF is more common in people who take NSAIDs (non-steroidal anti-inflammatory drugs like Ibuprofen). eg this analysis of medical records:- "A case-control analysis of a UK general medicine database showed statistically significant increases in the risk of chronic atrial fibrillation in patients taking NSAIDs, after as little as one month of treatment." The risk of AF appears to double after a month on the drugs. pubmed.ncbi.nlm.nih.gov/224... So it seems quite likely that the ibuprofen gel could have triggered your PAF.

My own AF started when after I had been taking Ibuprofen daily for arthritis, I had steroid injections in both knees, and within 48 hours went into sudden rapid AF (steroids have also been found to be associated with an increased risk of developing AF pubmed.ncbi.nlm.nih.gov/166... ). Looking back, I think I may have had more minor episodes of irregular heartbeat while I was taking Ibuprofen, but I hadn't thought them significant at the time.

I've avoided all steroids and Ibuprofen since then - apart from using a skin cream containing hydrocortisone in September. And it was just after using the cream that I went back into persistent AF after more than 3 1/2 years in normal rhythm. I've been thinking that hydrocortisone was too mild to set AF going again, but your post about potentially being affected by using Ibuprofen externally is making me wonder about the hydrocortisone ..... Hope you're soon back in a good run.

[Singwell in reply to Belle11]

I've a feeling a hefty injection of steroids I was given to treat quinsey as what triggered my AF. I felt.very weird the next day and never felt right for the whole year. AF was diagnosed at the end of that year.

[ozziebob in reply to Singwell]

Yes, research articles indicate large (hefty?) or long-term (?) doses of steroids can induce AF. Consequently, I often wonder if the 10 days of strong steroids I was given for my acute bilateral subdural haematomas in 2017 was related to the pAF I developed 2 (maybe less) years later. However I will probably never find a definitive answer to that question, but am definitely hoping I can swerve all future encounters with steroids.

[mcpacs]

I was not aware until recently that NSAIDs such as Ibuprofen and Naproxen can cause AFib. I have been taking Bufferin for years. It is basically just aspirin with some antacids to act as buffering agents to help neutralize stomach acid irritation.

I was taking Bufferin before my ablation for Afib, but don't remember it as a trigger for the Afib, even though it could have been. Does anyone have experience with Bufferin and Afib?

[Iamfuzzyduck in reply to mcpacs]

Does that mean aspirin can cause afib? Why would I be put on aspirin for my afib if it can trigger it?

[Kent2007 in reply to Iamfuzzyduck]

That is a different question. Aspirin is a very different chemical from ibuprofen, although both are classed as NSAIDs. So, they probably work in different ways, but I'm no biochemist or pharmacologist.

[Peacefulneedshelp]

We all know that everything we take weather ingested or on the body goes through the liver. I have long suspected that liver issues create heart issues. Since reading Kent2007 question and the responses peaked my curiosity and I found a great article. These two organ system do go hand in hand. ncbi.nlm.nih.gov/pmc/articl...

[Tullman]

I was put on a course of ibuprofen last week for ongoing chest pains. I had terrible stomach pains yesterday morning and started passing a substantial amount of blood in my urine. I also had a run of Afib but I'm unsure if it was related.My GP had said bleeding could be a problem as l am already on Edoxaban and should stop taking the pills if this happened. Which l have now done if the bleeding continues l will phone the NHS helpline for further advice.

[bassets in reply to Tullman]

That sounds worrying. Are you ok now? I was told as soon as I was diagnosed with AF not to take anything like Ibuprofen.

[Tenshun in reply to bassets]

Yes thanks the amount of blood seems to be much less than yesterday. It's only the first time l have taken ibuprofen since my diagnosis.

[bassets]

That's good but if it gets worse please get help.

[doodle68]

I was told by a locum GP I could use 5% ibuprofen gel on my painful thigh and hips/spine but I will not risk it particularly following an ablation . 'Skin patches' are a demonstration of how drugs are absorbed through the skin.

A good and safe treatment for external muscular or arthritic pain approved by a doctor and physiotherapist which I have been using 5times a day is alternating heat and cold pads which increases blood flow to the affected area.

[Vito-Iolo]

Hi, after reading all the comentsvabout AF and anti-inflammatories..I thought I would say what happened to me.. 22 years ago after coming back from Australia I had a instant attack for the first time of arthritis in all my limb joints.. I was put on a course of anti-inflammatories and the result I got very ill, diarrhoea, vomiting, and swets and loss of appetite.. Lost 12 lbs in 4 days… went to see the GP and he suggested I take a lower dose, Same thing happened and lost another10 lbs, this went on for about a month and I lost about 40 lbs.. My wife came up with the suggestion that maybe it's anti- inflammatories.. the Doctor had not mentioned that could be the problem, so anyway I stopped taking the tablets and I got my health back regarding the allergy to anti- inflammatories.. But I never connected that to me having persistent AF afterwards…Its pretty bad now if I do anything I get so out of breath.. I ended up getting ulcerated colitis, Aplastic Anemia, and liver problems… Had a liver transplant as well..Considering the list of health problems I'm coping ok except for the AF.. I'm on 12mg of steroids a day as well as all my other medication.. I'm 78

[sarniacherie]

Very likely is my reaction. My cardiologist has warned me off all anti-inflammatory products, internal and external use. I would mention it to your medic. X