What Are Your Triggers?

Hello Fellow Travellers on the Afib Road,

I realise the topic of triggers has probably been addressed here a number of times before, but I am relatively new to afib and the forum and am in the initial stages of discovery about this condition generally and my condition specifically. So please bear with me.

I am relatively asymptomatic, so with my newly-purchased Kardia at my fingertips (thank you, wolfpack, for your input) I am starting to track my episodes and hope to identify any potential triggers. So far the only thing I have identified which will most likely put me into afib is a long run - not during the run, but within an hour or so of finishing (is this a vagal afib characteristic)?

What have you found that causes you to leave sinus rhythmn? How long after the triggering event do you go into afib? Does the trigger seem to have any relationship to how long it takes you to convert back to NSR?

I am grateful for any and all input - thanks very much.

Kind regards,

Anne
New South Wales, Australia

Hello Anne,

You are going to get quite the array of triggers here for sure.

Triggers for me are/were recovery from excercise, msg, caffeine, thinking or talking about it (ie. How's your heart been acting?), eating too fast or too much, alcohol, dehydration, electrolyte inbalance, anger/frustration, stress or worry, and lack of sleep.

Those we're all things that I know for sure that we're triggers. I was also highly suspect of milk. Not that drinking it would cause me to go into afib but something in the milk made me more susceptible to it.

I never noticed any pattern of time to converting back to sinus rhythm other than as time progresses I would stay out of rhythm longer. I am also a cyclist and did do some competitive cycling early on In my affib journey. I was able to prevent an attack by not letting up right away after a hard effort but by slowely tapering down the effort. Hard on and off efforts that you esperience during a cycling race would always throw me out of rhythm.

The other pattern I noticed is that for whatever reason I was always more susceptible to an event during the off season when I was less active.

Hope that helps.

This was all prior to me having an ablation.



Edited 1 time(s). Last edit at 07/20/2018 06:40PM by rocketritch.

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AnneC
So far the only thing I have identified which will most likely put me into afib is a long run - not during the run, but within an hour or so of finishing (is this a vagal afib characteristic)?

What have you found that causes you to leave sinus rhythmn? How long after the triggering event do you go into afib? Does the trigger seem to have any relationship to how long it takes you to convert back to NSR?

Chronic fitness was my path to afib, 14 years ago. My first episode was several days following a training run for a 21 km race that gained 2400 m elevation topping out at 4300 m. The training run was on another mountain that topped out over 4300 m. My vagal exercise triggers for me could have afib a few hours to a few days after the exertion. It took me two years to decide that detraining and avoiding endurance cardio would be prudent. I maintain a very significant level of fitness, but primarily through HIIT both strength, body weight and Tabatas on a wind training bicycle or rower. I focus on minimum effective dose.

During the first two months I converted with either exercise or time. Then I had an episode that lasted 2.5 months (which likely makes me a complex case if I ever go for an ablation), I converted that episode with 300 mg flecainide. I've subsequently converted most all episodes with flec as one goal is to minimize my time out of rhythm. Recently I figured out I could convert episodes with increased serum CO2 with breath holding on an exhale. <[www.afibbers.org] Because I now go out of rhythm very infrequently, I've not retested this method.

Since the 2.5 month episode, I've used magnesium to bowel tolerance, taurine and potassium citrate to mostly stay in remission. Not taking magnesium will bring afib within 24-36 hours, hence a significant trigger for me.

There was a period of time when I was stress eating wheels of brie due to a divorce. It took me 18 months to figure out the excess calcium was a trigger. During that time, things that acted as triggers expanded. Lying on my left side, drinking an ice cold drink quickly, the time right after orgasm when heart rate decreases quickly, lower levels of exercise became a trigger.

Now I have a subjective level of exercise I try not to exceed. For example, I can alpine ski off piste on the steeps (at 3,800 m) fasted without ever stopping for 6 or 7 hours, but adding hiking to each lap would turn the day into a trigger. Same with trying to do as many laps as possible in the shortest amount of time. If I just ski in a more relaxed fashion, it is not a trigger.

Early on, time used to be a trigger, meaning if I hadn't had afib in 10 days or so, it seemed to be a trigger. People wrote about it in the Conference Room <[www.afibbers.org] back in the day.

George

Prior to my ablation, it was mostly the diurnal cycle. I'd go out of rhythm every night about 8 PM. That is textbook vagal AF. It was always, 100% of the time, preceded by PACs in increasing frequency.

Post ablation, I've gone out of rhythm twice now without a single warning sign beforehand. Once while running, going to stopped to start very quickly at a traffic crossing. Just two days ago, I took a big gulp of water after a bike ride. Immediate AF. Fortunately, through rhythmic breathing I was able to convert the episode in under 2 minutes. That was fortunate. The episode also taught me that my Kardia is broken because the battery inside it leaked acid everywhere (thank you, China). So now I've bought another.

I figure the "new normal" is because of the ablation. The electrical substrate has been changed by the PVI lesion set, so the old normal doesn't apply anymore. What it all means is that the PVI lesion set has developed a "leak" somewhere and now I have to decide what to do about it.

Quick(within minutes) triggers are MSG food additive and cough medicines.

Medium are too much carbohydrates (ice cream) , too much coffee.

Longer is being more than 40 pounds over ideal weight, which now down.

In retrospect, the only certain triggers for me were all tied to dehydration: heat, exercise/exertion and alcohol.

I identified dozens of triggers... and then discarded virtually all of them after actually testing them. The only ones that proved reliable were as AB said above: dehydration and the electrolyte imbalances that come with it, particularly low potassium. I came to realize the search for triggers is pretty much just a snipe hunt.

I will wade in here and voice what may be an unpopular opinion: that searching for triggers is likely a snipe hunt that will turn you into a paranoid, miserable human being.

I did it. It kept a log of everything I did and everything I ate. For over two years, I thought I found correlations. But then a few weeks would pass, and the correlations would prove to be false. The cost? Hundreds of hours of work and years of anxiety over what I might eat or do.

The ONLY reliable trigger I had what when I was going through chelation (I did test high for lead and mercury, so, you know, give it a shot.) EVERY time I did a round of oral DMSA, I would go into AF. Every single time. That's a trigger. That's a real one. And it was most likely due to mineral/electrolyte depletion, when you get right down to it.

Now, I am not a doctor, but having gone through this whole rodeo, including a Natale ablation, I'd say the most logical course of action is to:

1. Get on the Strategy, enumerated on this site. That absolutely did change the complexion of my AF, for the better. It did not eliminate it, but it made it much better.
2. Have your blood sugar and inflammation checked, and, if high, take steps to reduce them, up to and including low-carb diets and additional supplementation.
3. If you have compounding problems (overweight, sedentary lifestyle, etc), strongly consider lifestyle changes to address these issues.

And, if that doesn't work, get your butt on a plane down to Natale and nuke it from orbit. Because nothing, nothing, nothing is worth the constant stress and worry of "am I eating right, what if I drink this, ah no, I hope this isn't a trigger," on top of the stress of AF itself.

Hello Anne and welcome. As you can see by the responses thus far, there are a variety of influencing factors recognized in some afibbers, yet not others.

Commonly, though, all things considered, the consensus is fairly consistent regarding the dehydration factor and depletion of the core, essential electrolytes which need to be kept in balance as in proper ratios. As noted in George's response... too much calcium which dominates over magnesium is very common as is too much sodium which dominates over potassium. While small amounts of both sodium and calcium are cellular function requirements, many find cutting back dietary sources helps and also it's important not to supplement with calcium. That's true whether or not you are addressing arrhythmia issues.

Ultimately, optimizing continually intracellular stores of magnesium seem to make a huge difference for the majority of afibbers, although that varies in degrees of success depending on the health or viability status of the outer cell membrane where nutrient receptor sites are located. If the sites are damaged, then nutrients can't get in and often people say this or that nutrient didn't work, but it's really because the nutrient can't access the cell's interior. Therefore, a dietary assessment included in 'life-style risk factor assessment' which focuses on (as an example)... bad fat intake that would contribute to the cell membrane damage would be in order and; with time, as the renewal/replacement of the damaged outer cells takes place, then the various targeted nutrients finally do manage to get inside the cells where they can begin to make functional changes. Obviously, this doesn't happen overnight and is a lifelong commitment. Many aids to membrane replacement are available and are typically part of functional health recommendations.

In my many years participating here on the forum and helping others sort out various nutritional protocols that may be useful for their unique situation, I have seen most commonly that evaluations of the following areas are typically helpful.
Results vary upon age, other existing health issues, resistance to changing lifestyle risk factors and often, just personal discipline. Often, finding the source of 'silent inflammation' that is causing havoc is the culprit and only until that factor is discovered, does the arrhythmia change. A classic example is one afibber who had unknown H.pylori infection. Another might be a free-glutamate sensitivity.. from long-cooking of protein containing foods including the now-popular bone broth.

Important to know also, what depletes the all-important intracellular magnesium.... Big factors include... alcohol, stress, too much calcium intake either from food or supplements and empty food calories of processed foods that are devoid of most nutrients and contain many processing chemicals.

As indicated... some notice quickly, apparent triggers which is always great, but often, it's not all that obvious until you start to focus and record with a log about foods, events, exposure that can be recalled after the fact. A log helps.

The silent inflammation issue that keep the cellular mechanism including the 'electrical' activity stimulated is one that should be evaluated by lab testing because if you are high in those markers that indicate inflammation, then those remedial protocols need to be implemented and followed for life. Not just for AF but other adverse conditions as well.
Eliminating the damage from the oxidative stress factors which result in that silent inflammation which is excitatory to heart cells is also one of the fundamental issues. This comes up with heavy exercisers and endurance athletes and the data is there to support the underlying long-term damage that can manifest in a variety of health ailments including AF.

These are only a few of the many potential influences or underlying factors in various triggers and is far-reaching. Check at this link to read some of the past reports that many afibbers have found very useful in their situation. [www.afibbers.org]

Best to you,
Jackie

I agree with AB Page and Carey. Dehydration for sure.
219 afib episodes now (and still counting), the first in Nov 2015. Most of them of short duration (from some minutes to 2 hours) since my PVI in Sept 2016.
I'm used to write everything: hours, duration, meals, drugs and supplements, circumstances...
Most things I thought were triggers were likely not, but pure coincidences.

So, dehydration (from exercise, sickness, alcohol consumption...) is an identified trigger for me.

I'm suspicious about heat/cold situations, but it has to be checked another couple of times. Near my home, we have a supermarket with a "fresh zone" (for fruits and vegetables, cheese, meat...). They don't use refrigerators, but a cold room. It's really cold inside (around 5°C). Possibly a trigger, especially in summertime (I've started afib 3 times in this supermarket), but I'm not sure.

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JKAF


I did it. It kept a log of everything I did and everything I ate. For over two years, I thought I found correlations. But then a few weeks would pass, and the correlations would prove to be false. The cost? Hundreds of hours of work and years of anxiety over what I might eat or do.


I could have written the same thing!!! Tried and tried without success to determine what caused my arrhythmia......all without success. While initially my episodes were very infrequent and short in duration they were very debilitating. I was adamant in my position that any "heart surgery" was not an option I would consider. However, the frequency of the arrhythmia began to increase and I was prescribed daily anti-arrhythmic medication. I experienced just about every side-affect of the medication.

With the guidance of this group I went to see Natale. I hated the medication more than the thought of an ablation and ultimately had the procedure in March 2011. I have been issue free (and medication free) since.



Steve

Sure, all of the above, none of the above. Does that make sense?

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hwkmn05
Sure, all of the above, none of the above. Does that make sense?

Yes - it's called 'biochemical individuality'... However, there are some common traits that seem to be generally true for much of the AF population and once those are recognized or acknowledged, then it becomes the 'individual' factor.


J

80-90% of my 50 episodes came after withdrawal from Anti-Inflammatories. Mostly Steriods like Prednisone, although about 25% of these were from NSAID's I would be taking the Anti-Inflammatories intermittently, then after stopping them, about 2-8 days later, I would go into AFIB. Same thing happened after Steriod Injections into joints or my back for pain.

Triggers for me are definitely food...that is eating or drinking too fast or too much.Having GERD I think can make it more likely for me.
My gut seems to be tied to the majority of my episodes.
Others:
Not staying well hydrated'
Alcohol...altho a small glass of red can be ok sometimes.
Stress, physical or mental can kick it off. But on the other hand if I pace myself physically it's OK
Sleeping on my right side (waved off by a lot of people)

Wolfpack, how do you do that rythmic breathing?

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Catherine
Wolfpack, how do you do that rythmic breathing?

I have no idea. I just sort of invented it while driving the car as the episode started. Deep breaths in, slow out. The key at the time was not to get myself more worked up, because that just “locks in” the episode. Once nerves take over all is lost.

Wolfpack,

You mentioned that your afib episodes were preceeded by PACs - did you find there was anything you could do while experiencing the PACs which prevented an afib episode from coming on?

Regards

Anne

Hi Anne,

triggers for me (age 47, athlete, female, paroxysmal low rate AF episodes for last 17 years):
-going from zero to max intensity in exercise, with no prep / warm up. instant trigger
-lack of sleep
-stress, particularly the kind where i try to do too much, or am emotionally caught off guard/ get angry with someone . delayed trigger; the AF will come on sometimes days later, when 'all is fine" and my body feels 'safe'
Related to this is not 'looking out for me first; but trying to accommodate other people's priorities instead of my own.
-dehydration. instant trigger

If I feel susceptible, I am sure I've avoided episodes simply by lying down, doing a bit less. Like many here, working w my electrolytes/ chemistry, but a big part has been emotional management, and tuning into my macro (life) rhythms. For instance I can push myself harder physically if I am fully emotionally solid.

Regards,

Ruby
NSW, Oz

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AnneC
Wolfpack,

You mentioned that your afib episodes were preceeded by PACs - did you find there was anything you could do while experiencing the PACs which prevented an afib episode from coming on?

Regards

Anne

That was prior to my ablation. The "old normal", as I call it. The AF episodes were always preceded by PACs in increasing frequency. I could not do anything to stop the episode. It was a freight train rolling down the tracks.

The "new normal", which has happened twice now, is just immediate AF without any warning signs whatsoever. Take an odd step, swallow a drink - BOOM. AF. So that's depressing but so far its manageable and self converts so I'll use the time to strategize and set my game plan for further treatment. Hopefully things stay calm.

Anne,
My own afib episodes are now always preceded by PACs. They come mainly after meal, when I'm resting, laying in bed or sitting at my desk. I guess all those PACs are, in many cases, stomach (and GERD) related. Usually, standing and drinking some fresh water may help avoiding afib, but not always. In some cases, PACs precede a rhythmic chaos: PACs in clusters, runs of SVT, unsustained afib, short runs of atypical flutter...

Pompon... Have you tried using a digestive enzyme with your meals? Often, when there isn't adequate production of your own natural stomach acid (typically due to a vitamin deficiency), after meals, there will be some gas production because the stomach acid isn't there to break down the food elements properly. The gas expands the stomach tissue and that bloating can result in pressure/impingement on the Vagus nerve... which then can cause the PACs or outright Afib.

The typical medical solution to stomach issues is to prescribe a PPI or similar but that only compounds the problem because suppressing the stomach acid doesn't break down the food into usable nutritional components. I can share more if it sounds useful.

Jackie

Jackie, I'd been prescribed a PPI, but I stopped it after about ten months. It was bad for my stomach and bowels. I'm feeling better with probiotics, good food and no late meals. I've took some bitter plants with good results. My stomach acid level seems ok.
There's something strange with stomach bloating and PVCs, as they always come and go together, but I'm not sure that a digestion problem is the first culprit, because it's when my PVCs disappear that my stomach can relax.
Those things are really complicated and I'm scratching my head more than I probably should.
Afibbers are anxious people. Afib made me anxious. I wasn't some years ago.

Dehydration caused my first attack. I didn't understand what was going on (was on the Champs Elysee with friend) so just drank a couple of bottles of water since I was thirsty & it went away.

Since that I've found triggers to be:
Sleeping on left side
Caffeine (in drinks, not in chocolate)
Dehydration
And my favorite - no reason I can figure out at all.

Nancy

Pompon - I'm glad you are having some improvements with your positive changes.

Bloating and heart activity such as PACs or outright arrhythmia seem to go together. The stomach distension or bloating stretches tissue and irritates the Vagus nerve which then can result in the ectopy or AF. Bloating is often the result of undigested food (lack of natural digestive enzymes and stomach acid). The food remains in the stomach too long and starts to putrify... creates gas in the process and the bloating then causes the stomach distension. As that gradually dissipates, then (as you note...the relaxation starts to take place).

You may also be sensitive to a food or a food additive. The probiotics are a great addition as are your dietary changes but you still could have an obscure sensitivity that can be difficult to detect without specific testing.

I hope your progress continues so that you can continually be less anxious as that, in itself, can contribute to stomach issues.

Jackie

Jackie, I'm gradually taking more and more Mg. I've stopped flecainide and I'm feeling better. I keep it as PIP, of course, and I'm still taking 2.5mg bisoprolol in the evening. My nights are really better.
My main issue seems to come from my weak lower esophageal valve. I can easily have HR disorders soon after meal, especially if I've to sit at my desk. Sometimes, just drinking water can cause stomach discomfort. It's hard to understand. As you say, I may react to some kinds of food or additives. I've tried diets, but the results were poor. I noticed most diets have adverse effects that counterbalance their benefits.

Vomiting, dehydration and body position seem to be the main ones for me. Although, it seems that my stomach is also becoming an issue.

Thankfully, following my ablation with Dr Todd and his team in Liverpool that seems to be more a trigger for PACs but I imagine if any converted to ful af they would defo be real triggers.

MSG. Guaranteed AF within 2 hours. For example, 2015-17 I had 6 episodes of AF. 3 of them were after Chinese takeaway - I only had Chinese takeaway 3 times during 2015-17.