A bit of a mixed bag.

[Frances123]

PAF (symptomatic in the main) for circa 18yrs and bouts roughly every 3-5 weeks for last couple of years. It was anything from 6-36 hours but could still get on with life.

End of July 2024 I had to have keyhole surgery for an abdominal problem. Surgeon said he would be surprised if I didn’t get relief from my GORD symptoms as well. Music to my ears.

I wish I had never had the surgery. 2 weeks Post surgery and 999 thought I was having an aortic aneurysm and sent 2 ambulances? morphine administered and whisked off. Had a CT for pancreatitis and/or gall bladder. All clear thankfully. GORD has been worse rather than better, abdo pain worse and Afib has become very troublesome, every 3 weeks, lasting longer and more symptomatic. One session of 9 days

Current Afib started 2 weeks ago. Thursday I had a barium meal, swallow and a pelvic X-ray. Felt fine even in Afib. That evening I felt quite poorly, was symptomatic and stomach and pelvic pains. Yesterday was an awful day and when I went to bed last night I did wonder if I would wake up this morning. Needn’t have worried as I didn’t get any sleep. Couldn’t get comfortable and each heartbeat was more of a thump.

All this has happened since the surgery. I can’t help think there is a connection and something tipped the balance? Im wondering if the barium solution made me feel so poorly yesterday. Can’t see anything on checking. I have felt quite a bit better today. I also had a gastroscopy a couple of months ago. So I have been through quite a bit.

Lastly, with Afib for 9 days previously and now into my 14th day this time one would say Im now in persistent Afib, but am I? I have flitted from Afib to sinus tachycardia and supra ventricular ectopy each day for up to half an hour or so a time and a couple of NSRs (10 minutes here and there) thrown in for luck over the 14 days. As it hasn’t been afib 24/7 is it classed as PAF or persistant?

Im only on Flecainide 50mg bd and Apixaban and magnesium. No, never had or offered a BB as resting HR tends to be on the lower side. It’s never been a problem.

Thanks for reading. xxx

[BenHall1]

Hiya Frances123,

Well reading over your post - and from what you tell us - it would seem ( and I'm a former victim, not a medico ) that everyone seems to have tinkered with everything EXCEPT - the Vagal Nerve. I'll leave you to research that but simply put it is a nerve in the central nervous system - which acts like an information super highway - between the brain, heart and gut. To best understand it also research schematic diagrams of the Vagal Nerve.

Assume it was a Gasteroenterologist that did that bit of surgery - did he/she ever discuss this nerve ?

[Frances123 in reply to BenHall1]

Thanks Ben. Ohhh I am well aware of the vagus nerve despite not knowing all its intricacies and oddities. Surgeon (he) didn’t discuss it and it never entered my head. He sent me for the scope and barium as wondered if I had a twist lower in the gut. The consultant who did the scope was the head honcho (felt quite privileged) and he didn’t mention it either. I do have a check up when results are back and will mention it . He is a bariatric surgeon and I nearly cried. I know I need to lose a bit of weight but come on, that’s taking it a bit far lol. Apparently surgeons who deal with any upper GI surgery are called that.

Oh and s@ds law, back in sinus since 2:30am this morning. Yippee.

[BenHall1 in reply to Frances123]

Great news u r back in sinus👏👏hope it lasts. When I went through all this back in 2010/11 I ended up consulting a Nutritionist and have never looked back. I still have to be careful with diet but it was life changing. Got more value from Nutritionist than from my GP and other so called specialists and now my AF events are about 4or 5 years apart.

[Frances123 in reply to BenHall1]

Thank you.

[pip_pip]

GORD ?

[Frances123 in reply to pip_pip]

Gastro Oesophageal Reflux Disease.

[Model52]

I took 150 mg of slow-acting Flecainide daily and it caused my AF to increase to very frequent episodes, almost daily. I stopped taking it and replaced it with D-Ribose, L-Carnitine and Ubiquinol. Now an episode every 8 to 15 weeks. When it occurs, I take 250 mg of fast-acting Flecainide as ‘pill-in-pocket’. All the best!

[Frances123 in reply to Model52]

Thanks. I can’t take more than 50mg at a time as it doesn’t agree with me. Have to leave a couple of hours between doses if I needed to.

[Ppiman]

Well, bad luck! It's so disheartening when this kind of thing happens, drawing the short straw. Keyhole surgery can take a long time to settle as a friend of mine found. It's possible that the diaphragm has been disturbed and is somehow, perhaps from abdominal bloating or phrenic nerve issues, pressing upwards against the heart. That is known to set off atrial ectopics in some and those can lead to AF. I doubt it's a vagal issue as your heart rate would plummet with that before oscillating - my cardiologist told me that it is a rare occurrence and more of an internet myth than a reality, but many do blame that.

What are your symptoms when in AF - such as heart rate? Can you still cope well enough?

Steve

[Frances123 in reply to Ppiman]

80-90s. Only over 100 when tachycardic. Usually cope very well but didn’t the last couple of days this time which I feel was the Barium. Lot better since that cleared.

[Model52 in reply to Ppiman]

Vagally induced AD a rarity and internet myth? There are at least 20 scientific papers that I found about the relationship between vagal tone and AF!

[Ppiman in reply to Model52]

That's not what I was referring to, but I could have been clearer. Sorry!

My cardiologist explained that the vagus nerve itself, if affected say by some physical irritation or pressure (from a hiatus hernia, for example), would not cause AF but would cause quite severe bradycardia, followed by swings of tachycardia. The myth is that irritation causes AF episodes - at least in his (rather learned...) view.

So far as I understand it, "vagal AF" (which is perhaps what the studies refer to) is one of two postulated forms of AF. These are an attempt to explain why some people's AF is more common when they experience higher adrenaline levels, such as from emotion or exercise, while others have AF occurring when they are at rest, eating or sleeping.

if you have evidence of vagal irritation causing AF I would be interested to read it, as that was what I thought I myself had and why I discussed the possibility with my specialist.

Steve

[Model52 in reply to Ppiman]

Vagal AF specifically refers to AF episodes triggered by increased activity of the vagus nerve, which can be influenced by factors such as digestion, stress, or certain medications.

While paroxysmal AF can sometimes progress to more persistent forms of AF, such as persistent or permanent AF, it is less common for vagal AF to progress in this manner. This is because vagal AF tends to be more episodic and may be more influenced by transient factors, rather than underlying structural heart disease or other risk factors that contribute to the progression of AF.

Cardiologist Norio Hashimoto describes the relation as follows: “It is well known that vagal nerve tone plays a crucial role in atrial fibrillation”.

[Ppiman in reply to Model52]

I am referring to physical aspects such as irritation or pressure on the nerve itself rather than the impact of the sympathetic / parasympathetic tone on the heart.

Vagal AF has been suggested to be a cause of AF in young people, where more certainty lies regarding its involvement, but still, from what I can read, the explanation is still more tentative than certain. I look forward to reading Hashimoto's work - thanks for the suggestion.

Steve

[Model52 in reply to Ppiman]

Physical pressure sure is a trigger too: I once started an episode by showing someone how they can push with their hand on the heart area!

[Ppiman in reply to Model52]

My cardiologist would disagree, I presume, given what he explained. Physical compression of the vagus would induce rapid and deep bradycardia, he said, which would then swing to tachycardia, but not to AF. If we are prone to AF, then that might set it off, but the cause would not be the pressure on the vagus, rather the atrial sensitivity to AF.

Steve

[Model52 in reply to Ppiman]

I have to disagree and so would my friend, a cardiologist. There is something like ‘vagally induced AF’, well proven in scientific research. I found more than 20 papers on it.

[Ppiman in reply to Model52]

I believed it to be a medical reality that disturbance of the vagus induced bradycardia.

I thought that the term “vagally induced AF” was an attempt to categorise those whose AF occurs while resting, when tje parasympathetic NS dominates, rather than with exercise / emotion - or was a tentative explanation for the seemingly different kind of AF younger people get.

I shall do some more reading as you have spurred me on!

Steve

[Model52 in reply to Ppiman]

From one of the papers:

“Enhanced vagal tone can be associated with atrial fibrillation in man. Previously we studied acetylcholine induced atrial fibrillation in isolated canine atrial preparations. The arrhythmia started as a multifocal ectopic activity following acetylcholine induced asystole which triggered reentry. These early polytopic impulses were ascribed to asynchronous firing of multiple atrial pacemakers. Searching for more physiologic model we used vagal stimulation (10-50 Hz, 1 ms, 10-17 V, 5 sec trains) instead of acetylcholine in open-chested dogs (n = 6). This intervention induced premature atrial beats (single or multiple) and atrial fibrillation in 5 of 6 dogs. Occurrence of atrial fibrillation increased with increase in vagal stimulation intensity. Epicardial mapping (254 unipolar electrodes) of both atria revealed uni- or multifocal activation patterns during first two beats (A1 and A2) of each tachyarrhythmia. In some cases clear right atrial reentrant circuits which started during A2 were mapped. The A2 beat (potential or actual trigger for atrial fibrillation), usually emerged outside of the area of the earliest activation during normal rhythm (caval region), most often from the right atrial appendage. Our data suggest that the sources of primary atrial premature beats induced by vagal stimulation are widely dispersed over both atria. This means that either vagally induced atrial premature beats are not the unique property of pacemaker cells or the latter are widely distributed over the atria.”

[Ppiman in reply to Model52]

This is fascinating, but it seems to me to be far from where this thread began which was the idea that a barium meal had set off AF.

Vagal stimulation is surely a different thing from direct vagal irritation? It is this latter that my cardiologist insisted would be unlikely to lead to AF in most people and that the first effect would be bradycardia. Perhaps he is wrong?

Direct irritation of the atrium, rather than the vagus, by anatomical means - the diaphragm pressing against it from bloating , for example or from a large hiatus hernia - is a known cause of ectopic beats, which can then lead to AF.

Still - I am pressing on reading! Fascinating.

Steve

[Frances123 in reply to Ppiman]

Thank you and yes it is far from the thread I started. It’s always something Im wary of and why I don’t often post as I’ve seen many threads hijacked sadly.

I was already in Afib when I had the barium but wondered if it was responsible for it to last as long as it did. I also felt quite poorly generally that evening and all the following day. Get results Wednesday thankfully.

[Ppiman in reply to Frances123]

I always enjoy reading your posts. You give interesting detail and a real sense of warmth. I hope all gets sorted soon!

I loved this part, "I went to bed last night I did wonder if I would wake up this morning. Needn’t have worried as I didn’t get any sleep"!

I've been there - not a pleasant feeling at all.

Steve

[Vonnegut]

Poor you! All I can offer is a big virtual hug! Guess I’m fortunate that Flecainide works brilliantly at keeping my heart in order and I’ve even been able to reduce the first dose of the day to 50mg with 100mg at night. Hope you get some useful help soon that is appropriate for you as we are all very different.

[Frances123 in reply to Vonnegut]

Aww thank you. Just pleased it’s stopped on its own accord. Glad Flecainide is doing a good job for you. x

[Vonnegut]

That’s good- that your heart has settled down- did you just rest as that might have helped?

[Frances123 in reply to Vonnegut]

I was already resting as I didn’t feel so good but thank you for the thought.

[ForensicFairy]

I had a barium meal test many years ago and it made me severely ill. This was years before I developed a heart condition so I had no issues there.

[Frances123 in reply to ForensicFairy]

Thank you, I had one donkeys years ago and wasn’t a problem. Didn’t have Afib then and was a hell of a lot younger, which may have helped 😉.