Is your AF vagal or adrenergic?

[OzRob]

I am interested if people have studied their atrial fibrilation to determine if they have vagal or adrenergic AF.

The following is what Google AI has to say about both, which may help you determine which you have.

------------------------------------------------------------------------------------------------

Atrial fibrillation (AF) can be vagally mediated or adrenergic, and the two types differ in several ways, including:

Age: Vagally mediated AF is more common in younger people, usually between the ages of 25 and 55. Adrenergic AF is more common in older people.

Gender: Vagally mediated AF is more common in men.

Heart disease: Vagally mediated AF occurs in patients with a normal heart, while adrenergic AF occurs in patients with structural heart disease.

Triggers: Vagally mediated AF is triggered by vagal stimuli, such as alcohol, large meals, sleep, or post-exercise. Adrenergic AF is triggered by physical or emotional stress.

Time of day: Vagally mediated AF occurs more often at night or after eating. Adrenergic AF occurs more often during the day.

Bradycardia: Vagally mediated AF is usually preceded by bradycardia.

Some patients may experience both vagally mediated and adrenergic AF at the same time or one after the other.

-----------------------------------------------------------------------------------------------

I have pure vagal AF; sleeping or lying horizontal is my trigger.

I would also be interested in knowing from any newcomers if they have heard about vagal and adrenergic AF.

Robert

[OzJames]

Hey Rob I think mine Is mostly Vagal though according to the Google AI I should be affected mostly at night. In my case only one during the night the others have been triggered by alcohol or caffeine then vigorous exercise. When I was younger I would always self convert with exercise and even last week an indoor bike ride got me back into sinus

[OzRob in reply to OzJames]

I could never get back to SR through exercise; I would get up at 2am in the morning whilst in AF and jump on my road bike airtrainer. Would start at 130 bpm in AF and get up to 160 bpm, did Zip, so had to take 100 mg Flecianide.

[OzJames in reply to OzRob]

I would either have a brisk walk then sprint for 15 seconds then back to brisk walk and repeat 3 or 4 times. Last week same idea steady indoor cycle for 10-15 mins then finished with 15 sec bursts and 15 sec steady.. repeat 5 times all up. I guess it’s slow/fast/slow etc… One time I jumped into the pool and reverted. Mind you it can be risky to try on one occasion I flipped out of AF and into Flutter from the sprints. Was cardioverted the next day.

I also found that learning to breath through the nose can help balance the sympathetic/parasympathetic system. Not sure if you’ve read James Nestor’s book Breathe.. it’s an interesting read.

[OzJames]

hey Rob I came across this research… some parts I understand but others I’m lost! Nevertheless it is an interesting topic

frontiersin.org/journals/ca...

[OzRob in reply to OzJames]

That is a brilliant article. This extract explains the complexity of determining which subtype you may have.

----------------------------------------------------------

While the existence of a vagal AF subtype cannot be denied, there is no universal definition of a vagal AF. This is mainly due to the fact that vagal and adrenergic AF subtypes represent the extremes of a spectrum where most of the patients will present with a mixed subtype.

----------------------------------------------------------

I am curious what percentage of people have pure vagal AF; I believe I do not have the mixed suptype.

[OzJames in reply to OzRob]

Maybe a reach out to the study doctors might yield an answer?

Like in Melanoma some people are Braf positive and others not. There’s a drug developed for those that are Braf positive. I’m sure AF will head in the same direction and depending on the type of AF you have the treatments will be different

[TracyAdmin Partner in reply to OzJames]

Dear OzJames

Please ensure all external links to articles etc are approved in advance by Admin. This is to ensure all advice and information shared on this Forum is beneficial and on topic and relevant to the Members.

Thank you in advance.

TracyAdmin

[OzJames in reply to TracyAdmin]

Of course…do we just email you link first?

[TracyAdmin Partner in reply to OzJames]

Please contact me either via the CHAT function or by emailing [e-mail]

[Nick1957]

Vagual and mostly at night. Now manifested into reflux at night. Definately after eating perhaps heavy spicy meals. On a positive note now AF free since PVI ablation Aug 2021

[TracyAdmin Partner]

Thank you for highlighting an AI account of atrial fibrillation. I am sure many of the Members on the Forum will relate to aspects of the summary, however, AF is unpredictable and often painful and can cause a great deal of anxiety to individuals and their families. It is important to recognise that you listen to your body, take onboard the advice of the medical teams and look after yourself in the best way you can to help manage and hopefully minimise episodes.

For information and advice visit: afa-international.org

[OzRob in reply to TracyAdmin]

Hi Tracy,

It is actually about the subtypes of AF, something that requires further study, which is discussed in the article that OZJames posted above.

Most people are not told that subtypes exist; the majority of AF sufferers have a crossover of both subtypes. However, some AF sufferers like myself have pure vagal AF (which may be a tiny proportion of people affected by AF).

Robert

[ozziebob in reply to TracyAdmin]

I think it's a dangerous rabbit hole and morally questionable when Forum members are allowed to quote answers from the world of AI, which can often return misleading information and opinions as "fact".

Far better surely to refer others to scientific papers reviewed by peers, although we also know there are issues with this as well. As links to such research articles are already "forbidden" by Admin on the Forum, and at the risk of being seen as a killjoy, surely quoting from Google AI or ChatGPT shoulder also be "forbidden"?

Members can still raise the issue of concern in their own words without providing possibly misleading quotes from AI.

[OzRob in reply to ozziebob]

I totally agree, with the AI of the past, that is. The AI of the future is far different from what it was not so long ago.

The AI response I quoted is of what I always understood to be the subtypes of AF. But so much better explained than I could ever explain it.

If you research each of the points in the AI response, you will discover they are directly from scientific papers; read the published article link from OzJames, which covers most of what is in the AI response.

Perhaps I have opened a can of worms...

[ozziebob in reply to OzRob]

Well I understand what you say about the persuasive nature of the dialogue that ensues, but surely that's part of the danger. Recently, I was given links to research articles to pursue a medical matter I was asking ChatGPT about ("polio and mitochondria" I think it was) and when I tried the links I got nowhere, only articles that no longer existed or couldn't be found.

Be very careful of "persuasively articulate" information in the absence of detailed references. Just saying, but "can of worms" doesn't become close!

[mhoam in reply to OzRob]

Hi, I'm not sure what you are referring too with "the AI of the future" comment, it may be getting better with fluency but it is not improving the accuracy or understanding, it is NOT intelligent!

I used an AI (Large Language Model) to research treatment options for a condition (not AF). It gave me three options, two of which were well known and understood but the third was completely incorrect! It had "mashed together" statements and phrases from a number of areas that were not even for the same condition.

AI is actually dangerous because its fluency gives its answers an authority that are not deserved.

[Tellingfibs]

Well Robert, that is an eye opener ! I had never heard of Adrenergic Afib, but it fits me perfectly. I have read many posts here about vagal Afib and wondered why my symptoms seemed different. I am a 73 year old woman whose Afib doesn’t seem to be affected by food, has fairly Afib free nights, is made worse by stress and I have two slightly dodgy valves - classic Adreneric Afib, according to your post. This is fascinating. Thanks for sharing this here. I will dig into it further.

Annie

[JOY2THEWORLD49]

Hi

I'm neither I think.

Stroke, Rapid & Persistent AF, 4th day in Thyroid Cancer papillary.

Stroke - Embollic

AF Rapid - Metoprolol brought it down to 186 bpm Day no exertion, sweating & breathlessness. Bisoprolol changed to 1 yr 5mths later 156

Persistence - Given 24hr Heart Monitor before and the change. No symptoms throughout.

Findings- Metoprolol caused pauses at night remained uncontrolled.47avg bpm.

Bisoprolol no pauses mo breathlessness but not controlled H.R. 47avg bpm.

Private - Introduction CCB Calcium Channel Blocker - Diltiazem 180 CD 1/2 dose.

Within 2 hours 156 (still in Biso reduced to 5mg) to 51.

24 hr Heart monitor when reduced to 120mg CD AM showed control under 100.

3 years 3kg weight loss reduced heart rate to 60s Day rising late afternoon under

100. Normal Night rate 47avg bpm. No symptoms.

Today. BP low so reduced 1.25 .. still sight vertigo with eyes clsed.

Thyroid cancer - thyroidectomy 2020 Feb wit 12 lymph removed (2 affected) and lymph bed dissected.

Ultra-sound yearly check.

4th year recalled as 3 areas calcified but 2 CT scans & Pet scan inconclusive. Now 6 mthly CT Scans.

I don't understand why at night heart rate drops low only to pop up every morning.

What do you think?

I'm hoping one day I'll wake up and AF has gone. But I have a severely dilated left atrium with normal systolic function. Slight leak in ventricle valve with regurgitation.

cheri JOY. 75. (NZ)

[Jajarunner]

Totally vagal, after sleeping, mediation (🙄) and relaxing.

[WildIris]

Always happens at night, often after I lie down, but goes away during sleep, sometimes triggered by evening meal, usually triggered when I take more than 4mg of prednisone (cortisone) which I had to do for an allergic reaction recently. Huge reduction in frequency when I gave up sugar and most carbs and got down to normal weight (and BP) about 3 years ago. So, mostly adrenergic but also some vagal influence? Thanks for the link, wish I could make heads or tails of more of the article, its aimed at docs who've know nerves and stuff and have seen lots of tests.

[OzRob in reply to WildIris]

Sounds vagal to me; I would have the same; I would lie down and Af would start. Have you tried a Valsalva manouver as soon as the AF started?

[PurpleGirl05]

Rob, I for sure have vagally mediated AF: after meals and at night as I try to drift off to sleep. Never when my heart rate is elevated during exercise. I read another post where someone actually got relief when they went OFF of diltiazem because it was causing the bradycardia trigger. It's all so complex.