I listened to a cardiologist on utube. He mentioned vagal a fib. Does any one what this is? It seems to be a younger cohort but I presume it comes with the usual meds. How can you find out if you have it? I seem to be able to stop a fib attacks with vagal manoeuvres and sometimes my a fib is brought about br gastric probs which seems to be an indicative of vagal nerve stimulation. Any ideas?
Vagal a fib: I listened to a... - Atrial Fibrillati...
Vagal a fib
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Yes, it’s quite common. You can tell if you have vagal AF if your episodes are triggered by gastric discomfort, exercise, rest and stress.
It’s an imbalance of the ANS - Autonomic Nervous System and there is lot one can do to help oneself. I think Dr Gupta - York Cardiology- has a YouTube video.
First read - Dr Richard Bogle on vagal AF - a speaker at a local AF support group.
Then look at ‘how to improve vagal tone’.
Learn about your ANS and how it works and know your vagus nerve is the longest nerve in the body - commonly called the wandering nerve. It passes directly behind the esophagus and very close to the heart and is easily triggered in some people sparking AF.
Hope that helps.
Absolutely, I agree that it'd very common and in my case certain 'heavy foods' cause it, for instance, sometimes I fancy a bowl of porridge oats for breakfast, but I can guarantee that it will be followed by a few hours of AF!
PS - it doesn’t come with the usual meds, if you have vagal AF then Beta Blockers are sometimes not helpful.
I'm on apixaban and bisop. Don't know if the latter is a beta blocker
Bisoprolol is a cardiac specific beta blocker.
Agree with CDreamer. Some view it as an information super highway connecting brain, heart and gut. It took me a while to realise my AF ( back in the day ) kicked in after certain meals I'd eaten. Some people are affected in a similar way by different drinks. After a bit of a walk on the wild side I eventually consulted a Nutritionist and have followed her advice ever since. For me at least, certain foods I'd eaten created a dysfunctional vagal nerve - most likely created an inflammation of the vagal nerve, which kicked off the AF. There are schematic diagrams of the vagal nerve and how it wends its way through the body. I now haven't had an AF event for about 4 years that I know of. I can be asymptomatic but not all the time.
My stroke doctor just told me it was probably caused by a fib... that was it. I was in a stressful situation at the time. No feedback from any doc since, just get on with it.
Hi John
Do you take any beta blockers, or other medications? I know you take an anticoagulant .
Jean
Hi Jean,
Yes I do. Beta blockers first ...... From first diagnosis in Jan 2010 to August 2023 I was on 5mg Bisoprolol .... I then found myself becoming so sluggish and tired I spoke to my GP and we agreed I switch to 3.75mg of Nebivolol. Got my life back .... will be on it for well into the future or at least as far as I can see.
Yes, you are correct about anticoagulants ..... was on Warfarin but my GP tricked me into moving onto Edoxaban. So, rather than express my annoyance by switching back to Warfarin I put up with it and am on Edoxaban forever, or until it gives me a problem. She had been frequently asking me to change for the last few years, I kept refusing.
Yes also to a shedload of other stuff ........... Finasteride ( prostate reduction - which it is doing very well ), been on that since 2019. Ramipril ( for BP ) since 2007 ( 3 years before AF mugged me ), Simvastatin since 2007 but this was changed to Atorvastatin in October 2023, Felodopine for BP since 2013. I also take BioQuinone Q10 and have done since AF mugged me back in 2010.
😊😊😊
John
PS. For the benefit of others reading this, on my first diagnosis in discussions with Cardio Consultant in 2010 I elected to go the drugs route for life or as long as possible and not go down the cardioversion or ablation route.
Amazing really that you've managed to get yourself AF free by changing your diet.I took your advice and no longer eat oats or yogurts. Feel quite well now.
Jean
Very glad to hear that Jean. Must say I have been able to return to some wheat products nowadays without unpleasant side effects ..... not so oats and yoghurts. Rice is always good though. Even so Jean, I still closely monitor what I eat/drink and if I have a choice I'll always err on the cautious side.
Pain control for me these days is a far bigger issue than AF ever was and my GP decided to ramp up my Pain meds to Gabapentin and when that upset my gut very much with diahrrea she tried me on Amitriptyline, that gave me the same problem. So for now at least its back to CoCodomol 30/500.
Anyway, I'm glad that you are having some successes. 😊
John
What's wrong with oats and yoghurt, John? I'm intrigued!
Hi,
Apologies for delay in replying. Nothing per se, most likely nothing wrong for you .................... but, for me this is what happened .. read below:
DIET EXPLANATION
I went down the diet track once I’d began to associate the onset of an AF event with food I’d eaten - some foods more than others. I discussed it with my GP who ran blood tests for Coeliac Disease and IBS. Both came back clear. I then consulted a Nutritionist who advised a diet. To be fair, not a diet like, say, The Paleo diet - more a food plan/process.
So, the Nutritionist prescribed me a course of Probiotics, and suggested going Gluten Free, Wheat Free and Oats Free. Then she suggested keeping a food diary and capturing details of other foods that I could identify a trigger for AF. I also as an aside cut out all added sugar. I had already cut out all added salt some 20 years earlier.
Still not enough though to improve things. So, Bit by bit I worked on the food diary and from this cut out ... onions, ( but spring onions, shallots, radish were OK ), no lettuce, no tomatoes, no soft cheeses ( but hard cheeses were OK ). No peas, no runner beans, no baked beans. Junk food like Mcdonalds or KFC is fine. Green leaf veggies are fine too - even though some I shouldn’t have ‘cos I’m was on Warfarin at the time. Celery is Ok as is Watercress. Certain cooked eggs - fried egg is OK scrambled not so. Roast Pork with crackling is out but pork loin cuts were fine. Roast Duck is also out. Gravy and sauces can be troublesome, some, even if gluten free. Packaged Chinese meals from supermarkets are out, however, Chinese from a resturant ( eat in ) where I can be highly selective is Ok. Many other dairy products too which is where Yoghurts come in. My gut cannot process it, even today.
I trust you’ll see now what I mean by a process - its all evolved since Sept. 2011. Of course it all begs an understanding of the function of the Vagal Nerve, that information superhighway, connecting the brain and the digestive system and the heart. ( Amongst its many other functions ). Many regard the gut as a body's 2nd brain. Plenty of reading matter available on this subject. Fascinating.
Much of this is an extract from comments I'd made some years ago. Some foods I have been able to return to, some not so. Oats are still a definate No! No! Pity, I'd love a plate of porridge at breakfast. 😊
John
99% of my episodes happend either when going to bed or soon after I woke up. So basically almost always in laying position. When I heard about vagal AF and vagus manevuer, I tried it. So interestingly the last two episodes I had (in early December) I managed to stop them with vagus maneuver and no extra meds. I just sat on the bed and tried to blow air through almost closed mouth to create maximum tension and both episodes stopped in 2 seconds. I was really surprised it worked. Luckily, didn't have a chance to try it again since I didn't have an episode since then. But I do take propafenone daily, no bisoprolol. So I presume I have vagus AF since it never happend outside of bed. And putting myself back in sinus with maneuver only adds to that.
But to be honest, it doesn't even matter now.
Waiting for ablation in less than 3 weeks. Hopefuly no episodes till then.
Snap. Dr gubta mentions mentions the sleep node
How did you get diagnosed for vagal AF?
Reading comments and research it seems most likely but I still have open mind
I didn't. I was diagnosed with paroxysismal AF. And since majority of my episodes happened while laying on my left side and generally whilst being in bed and since I managed to stop last episodes with only vagus maneuver, I can contemplate that maybe my afib falls into vagus induced category. But as I said, it doesn't really matter because I doubt it makes any difference if a person doesn't make lifestyle changes. And I did, a lot of them. My diagnose was on 3rd of Novemeber and since then I stopped completely with alcohol, sugar foods, lost 25kg, lowered my cholesterol and trying to eat healthy. After first few episodes in late October, I had a few short episodes in early December which I managed to stop with vagus meneuver and since then I am episode free so far.On the flip side, I developed anxiety disorder from the whole afib ordeal and I battle with chest anxiety almost every day even though I didn't let this cripple my life. We went on a vacation recently to Morroco and even Sahara because I don't want to lose life joys because of this. Everything went ok. I hope this anxiety will subside after ablation.
I suppose health anxiety with AF doesn't help as this causes symptoms along with the real thing
That's true. Prior to my first afib, I was under a lot of stress due to nature of my work. That didn't help for sure, but once I got afib I developed anxiety which with time grew into disorder since I'm battling chest anxiety almost every day for the last 4 months. I was scared the chest pain was angina or heart related but it has a pattern. It always starts when I sit in front of my computer and start editing which is my work. And when I take anxyolitic occasionally, the chest discomfort always stops. So it must be anxiety. Hope it subsides soon.
Hope so too, role on Summer
I have the same , woke up in AF four times, ( 5 th and first time March 23 triggered by exercise with unknowingly shingles coming on )twice I noted on my back, try to stay on side sleeping now. Im on ablation list now, does it mean that the ablation will more or less likely to be successful if Vagal nerve induced do you know? Or not make much difference ?
I really don't know if it makes any difference regarding ablation. It would be great if the succsess rate goes up because of it. My first two episodes both happend while laying on my left side watching something on laptop. And other episodes happend while laying on my back or just after waking up. Last 4 months I sleep on my right side and on my back but with elevated pillow. Seems it's ok but elevated pillow sometimes gives me neck and head pain later in the day since it's not the best position foe the neck.
I can relate..Exactly my routine, 3 pillows and two cushions to create a slope, can't relax knowing and trying to stay on right side. Ordered a wedge pillow hoping that helps, until ablation. Good luck
Bed risers help they usually coming in one inch risers and sit under each leg of bed. I have 4 inch riser at head of bed and 2 inch at middle and that gives me the desired slope. If you want more then a 2nd pillow or wedge pillow helps. The risers can be bought online for around $20
Can you say more about the Vegas movement you did please.
When I was laying in my bed and felt afib episode kicked in (usually feel it in my throat and when checking on my pulse it feels my heart is all over the place) I would get up and sit on my bed. Now imagine blowing a baloon which basically wouldn't inflate or the air would move really hard. So I would almost completly close my mouth and try to blow air outwards to create a lot of tension in my abdomen. Kinda like going on a toilet but with much more force. Well, last two episodes I had I was able to put myself back in sinus rhythm in a matter of seconds with this. But I don't know if this works everytime, since I didn't have an episode since. Before I learnwd about this maneuver, I would take one or two propafenone tablets and my afib would stop in 20-30min. I don't know if this would work for somebody else, but it's worth the try.
I think I would prefer first option. Sounds like what I do. Long may it last.
If you google you'll get a few. Mine is hold nose and close mouth and make a downward push on your stomach as if you have constipation and are trying to get it to move. Twenty seconds and its job done for me. Somebody on the forum suggested thumbs in ears and move upwards.... that was a new one on me and sounds more civilised.
I have vagal AF, now controlled 100% with meds.
I resisted meds for quite a long time so I could study and record the beast. How to best stop a vagal attack in it's tracks, novel methods of how to stimulate the Vagus Nerve etc. The funniest way I could stop an attack was to insert my thumbs in my ears and move them up and down. (the only place the Vagus nerve comes to the body external is the ears)
I tried many things and put in a lot of study into Vagal AF whilst recording all my results. If you read some of my past posts you will see how much research I did on Vagal AF which may be helpfull.
Sleeping on your left hand side we usually bring on AF if you have Vagal AF.
very interesting information, thanks! I stopped an 8 hr bout of a-fib with a vagal maneuver (tried two different ones, one after the other…so unsure which of the two fixed it virtually immediately)
that a-fib came on while I was vomiting and continued until I looked-up info from Dr Gupta of YORK cardiology on youtube… I suddenly recalled listening to his bideo some time ago… before I ever knew that I had A-fib.
I was about to go to the emergency room but held out because I had a $7500.00 co-pay out of pocket and was worried about how my husband would be stressed out about the cost and trying to pay it off. I never felt bad while in A-fib, just uncomfortable because I could feel my heart doing the very irregular beats and what felt like extra beats etc. Have had palpitations since 2007 so I learnt to breathe it away and not worry as it had been happening for years, and I was still alive and cardiologist said it wasn’t serious back then.
I suspect the influence of the Vagus Nerve is still not prioritised by many cardiologists due to them playing safe and not moving out of their 'heart expertise' silo. Definitely relevant to many, keep up the research and start changing your lifestyle to de-sensitise the nerve.
"heart expertise silo".......love it 😂
Hi Tilly I was convinced that I had Vagal AF as my AF was almost always occurred after meals and in bed particularly if I had indigestion. Also I’ve always exercised to excess throughout my life (which is also a factor) and could revert back into sinus rhythm with vigorous exercise. My resting heart rate is on average about 50 BPM another factor.
Flecainide worked for me for 15 years until I was diagnosed with mild coronary artery disease and taken of that drug. I had AF on a weekly basis for 2 years following this.
I’ve also had 2 Ablations the first around 16 years ago and the 2nd 3 years ago never worked for me
I read numerous articles about Vagal AF and discussed my theory and trying a drug called Dysopyromide with my EP. Since being on this medication I’ve been free of AF for over 2 and half year and can even enjoy a few beers. Got my life back
Hope this helps
Against some of what I had read, been told, and what my GP thought might be the case, I think there's likely no easy answer, and perhaps even, no such thing. It's an area that seems to energise debate on social media and about which, on the internet, there seems to be much poor or frankly wrong information. How useful and relevant the idea of "vagal AF" is to any of us seems debatable, too.
I learned a good deal from a cardiologist I came to know, and we talked at length about "vagal" AF since I thought that was what I had.
He explained that it has been theorised that there are two possible pathways for AF to initiate, both involving the autonomic nervous system (i.e. the ANS, as opposed to the central nervous system, the CNS) The ANS is the part we have no direct control over and it has three aspects: sympathetic or adrenergic (SNS), parasympathetic or cholinergic sides (PNS) and enteric (ENS). There's a kind of "balance" between the first two in a push-pull relationship, with adrenergic active more when we are energetic or emotional and cholinergic when we are passive and relaxing, for example, while food digests and we sleep. Some people's AF seems more likely to occur during the adrenergic phase (e.g. when exercising); others during cholinergic phase (e.g. when resting).
I asked if my arrhythmia issues were "vagal" as mine seemed linked to my digestive problems and the vagus nerve runs physically close to the stomach and oesophagus. He said not and wasn't at all convinced there was any link between a person's gastric troubles and their AF, despite my GP thinking that there might be in my case. He went on to explain that the idea was something of an internet and social media myth because any direct irritation of the vagal nerve (which carries both adrenergic and cholinergic pathways) would lead to surges of slow and fast heart rate - and much else, besides, since the nerve innervates a number of major organs as well as the heart. This and my worsening AF spurred me onto a good deal of reading, especially about something called “Roemheld” or “gastro-cardiac” syndrome, which you might like to look up on Wikipedia. Again, he was sceptical of this.
My layman conclusion is that the root cause of most AF is likely genetic and linked to Western lifestyles. Once the heart cells misconduct, for whatever reason but one that likely to be many years in the making, we are stuck with it. Medicine can damp the misconnection down chemically (e.g. using bisoprolol or flecainide) or try to destroy the damaged pathways with burns (e.g. ablation).
Steve
Thanks Steve, read BigDunc's reply above. It seems doctors differ.
Thanks Tilly. I suppose doctors, like us sufferers, will surely differ based on their knowledge and experience, but the medical and scientific studies still seem unable to ascertain just precisely what is going on in AF. As an example. the vagal trunk, which goes on to innervate of the heart (and much else), has recently been shown to carry both sympathetic and parasympathetic nerve fibres, which seems at least to bring any simple classification of "vagal" into question.
Also, what many associate with the "vagal nerve" might surely be more simply explained in that both the stomach and the oesophagus have been shown to affect the heart directly because of their intimate proximity to it, with the former pressing the diaphragm against the base of the heart and the latter itself pressing tightly against the atrium in many of us. Such direct irritation of the heart is known to set off ectopic beats, and PACs are accepted precursors to AF. This physical and mechanical explanation seems to me much more likely to be the cause of what many ascribe to the "vagus" or ro various "triggers"..
My own conclusion is that many sufferers, of which I am one, rightly seek comfort from the fear that this horrid condition causes. Attributing a cause, a trigger, a label or finding a tablet, a manoeuvre, a doctor, a supplement or whatever helpful is a way to find such comfort and is natural and understandable. These are, sadly, also ways for unscrupulous individuals to turn a profit, and the internet, and most especially what we call social media, offers major opportunities for that which are unique in history.
Steve
I didn't spend any money Steve just followed D. Afib's simple advice and it worked for me so happy days.
Well if there’s simple thing to cure us, I’m missing out. I’ll read what he has to say. Thanks for the tip.
The money is made on the internet from monetised Google and other ads, so you don’t have to spend for people to thrive from that. The problem is, it’s causing a whole raft of flotsam to surface which is easy to present as trustworthy and useful.
Steve
I suppose he gets a few bob through utube and he has a course on offer. I think it's mainly lifestyle. Have a look and see what you think. He's located in california I think ... Dr morales, electro cardiologist
I've heard of him and will have a look. There must be many genuine doctors who are keen to spread the knowledge and experience they have gained ethically. He sounds like one.
The "few bob" you mention can be many thousands of dollars. One infamous individual I have read of made well over £100,000 last year (and he spreads misinformation about covid vaccines, not treating AF).
Thanks for the tips! I keep trying different things.
Steve
Sorry, I must disagree with your quote "He went on to explain that the idea was something of an internet and social media myth because any direct irritation of the vagal nerve"
My electrophysiologist would be having a fit if I put that statement to him. I think he would tell me to ignore what people say when they deny that Vagal mediated AF exists.
From my experience, cardiologists I have seen don't agree with modern electrophysiologists in general, that is here in Australia, not sure if that is the case worldwide.
I think the problem might be that only a small % of AF sufferers are 100% Vagal AF sufferers like myself.
Your phrase "modern electrophysiologists" intrigues me. Maybe in Australia (and the US) this is now a discrete branch of medicine, but in the UK and I believe Europe, a cardiologist can specialise in arrhythmias just as an EP can. The EP is a consultant cardiologist who has undertaken a short course in the practical use of cardiac catheterisation so that, in and of itself, makes them expert only in that particular application, but I suppose their interest and experience might well bring them to want to learn more than their peers.
I was careful to be tentative, but I smuggler to find much worthwhile evidence that identifies "vagal AF" as a real thing as opposed to a theoretical idea. That's what I learned from that doctor told me and, later, from reading as best I can. In the literature, "vagal AF" is said to be enigmatic for perhaps that reason. As for 100% vagal, whatever that might mean, it is more of a loose term since no study I can find shows it to be a single cause of one "kind" of AF. The root causes and cellular dysfunctions that are a part of AF still appear to confound science. I was reading yesterday of the why Ca++ agonists might be safer long term than beta-blockers and, my, it became clear just how much remains unknown.
What also might now muddy the water a great deal is that the vagal nerve, which innervates the heart and many organs, has recently been shown to carry both sympathetic and parasympathetic fibres.
So, I am beginning to doubt that "vagal AF" really is a useful categorisation myself inasmuch as it won't help us to deal with the condition we have in any useful way. "Stimulating" the vagus by various means can rapidly lower the heart rate (as the EP I spoke to explained) and so is useful in tachycardia, but whether it is useful in AF, or even in AF-mediated tachycardia, I just don't know.
Steve
The fact that some (lucky) people are able to terminate their afib episodes with vagal manouvres does help them to deal with their condition in a very useful way. The fact that these manouvres are free might make some pooh pooh them. Just because one ( or even several) cardiologist has dismissed the idea of vagal afib does not mean that it does not exist.
I learned about vagal manoeuvres through an EC on utube. Dr Afib. He didn't really differentiate about any types of a fib but it works for me. When I got it initially doc just gave me meds. End of story. It's nice to get different views.
You miss the point I was trying to make. I think it was pretty clear, but it, in summary, it was only to say that the term vagal AF doesn't seem to me to be all that useful. I did say that some "vagal manoeuvres" terminated tachycardia but that I wasn't sure whether they did the same for AF.
Steve
There are people here who report that they have stopped their afib with vagal manouvres. Are you suggesting they are imagining it or lying?
I feel sure that I have made myself clear. From what comment does your second sentence arise?
Now, much more interesting. You live near to where the world's greatest wine is produced. This evening, I'm having one of the most pleasant glasses of it that I have ever drunk. It's a 2015 La Raisin Close Montesquieu. Superb.
Steve
That must be an expensive glass for the 2015 millesime! We do not buy expensive reds as we drink only a small glass with our main meal and even with a vac u vin they do not keep that well. So we have a cheapo but very good box wine for everyday red and treat ourself when we go out to eat to more expensive reds. But we buy at the local supermarket's wine fair every autumn very expensive sweet whites which keep very well when opened . They have a catalogue ( online now which is less fun) and we choose in late spring and put in our order for the autumn delivery. Drinking sweet white with fish is looked at very askance here but my husband does not like dry whites and I have got used to it. The Sauternes and other Bordeaux sweet whites are delicious and sometimes I curse my afib for limiting me to the one small glass!
Luckily my heart seems to benefit rather than come to harm from a glass of wine. Well, I convince myself of that. 😊
That bottle wasn’t that expensive. I think it was from a supermarket but can’t be sure (Waitrose if it was). I rarely spend more than £15.00 on a bottle and then usually wait for the regular 25% of six bottles offers.
I only ever buy French wines. I feel I owe it to your great country - one that I enjoyed so much visiting in my marketing days. The many French people I met were just delightful and so welcoming. I can’t say Italy was far behind, and Portugal is it’s near equal but France remains my favourite. The home of Camus, Monet and Debussy and, of course, my childhood heroine, the brilliant chemist, Marie Curie. The list is long.
Steve
I agree and would rather try a vagal manoeuvre before having ablation. They usually work for me
I'm not hung up too much. When I got a fib I had no knowledge or idea of what to do in the dark hours of the when it struck. Then I got onto the Dr afibs web site and he discussed ways of terminating an attack at home. He went into vagal manoeuvres and I tried it . It worked for me. He is an electro cardiologist so I'm not going to argue with him.
I am in the US and Cardiologists and the EPs differ, widely, in the belief and treatment of Vagal AFib, at least in my area. The Cardiologist is always quick to start a patient on beta blockers, when a patient has viral induced heart failure, which I believed started my AFib. I had a LBBB, but, had never been in AFib, before taking those meds. The anxiety became constant and I had several episodes, the first 2 years. My EP believed I had Vagally induced AF, since eating and heavy exercise brought on the episodes. I was switched to a Calcium Channel Blocker, and had only a few episodes, in the past 7 years, one that was brought on by the Covid vaccine. I am now thinking an ablation might be the right course of action, against what my Cardiologist recommends. He is a wonderful doctor but thinks I should leave well enough alone. We are moving South and I have no idea how those heart specialists think about ablation. Is their anyone here from the Coastal South area?
It’s not a straightforward life with anything heart related, I’ve concluded, however expert the doctor. The reason, I’ve come to believe, is that there is often no easy consensus on quite what is happening in the heart and where it will eventually lead. I have LBBB like you, and with an otherwise healthy seeming heart, apart from “electrically”. I was told I should be fine and the heart bundle block not cause any symptoms. Now my GP does tend to blame it for my many ectopics, although my insomnia doesn’t help those one bit.
There is some small but equivocal evidence I’ve read that keeping the heart in NSR adds to long term health and survival overall. There’s some small evidence, too, that an ablation forAF is better than medication overall, but again, equivocal. My elderly friend is now a reasonably healthy 90 and he’s had permanent AF for years with no treatment except warfarin. He refused an ablation but did have a cardioversion, once.
Steve
I take a pragmatic approach and just focus on what triggers episodes of AF for me - eg certain kinds of alcohol, heavy meals being too hot etc. I don't really worry about any internal mechanisms like the vagal nerve which I don't think I have any influence over.
Would someone care to explain to me how any atrial fibrillation would NOT be "vagal" ? It is my understanding that the vagus nerve controlls almost everything about our heart.
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