Timing & type of AF

I would be grateful to know if anyone has their AF at night or late afternoon, not necessarily while lying down or just at bedtime, and if they feel their AF is adrenergic rather than vagal even though their episodes are not during the daytime.

There are several indicators given so that you can diagnose which kind of AF you have, and I would just like to know if many of you find it common to have the episodes more in the late afternoon/early evening than during the day. If you have adrenergic type, are you only having episodes during the day? This is important to me because if I have vagal AF, the beta blockers are contraindicated. I fit some of the profile for vagal, but perhaps more for the adrenergic, other than having my episodes around dinner time, wine, and digesting a meal.

If you definitely feel you have vagal afib, do you fit the profile perfectly, as in being male, between 40 and 50, and an athlete of the type that runs marathons with episodes occurring weekly? Perhaps they do not occur as often as weekly? Or would you even be in your 60s, or female? Do they happen after eating or drinking any alcohol? Do they mostly happen at bedtime rather than after dinner?

Thank you for describing your profile and if you feel you are of the vagal, adrenergic or mixed type. I realize some people don’t care which type they are; nevertheless, it would be helpful to me if those of you interested could describe yourselves.

Madeline,

My triggers are mostly vagal. I'm 63, male, and had my first episode at 49. I was a delayed vagal response to a training run on a 14,000' mountain. I woke up with it and did no realize I had it till I took my blood pressure with a manual cuff. I didn't do this frequently, but had "white coat hypertension" for ~25 years at that point. My pulse sounded wierd. I slapped on an exercise heart rate monitor and my heart rate would elevate with a little exertion. Like 150 for walking up stairs. I drove myself to the ER. For six or so weeks, I would have episodes that commonly came on in the early morning (3AM) every 10-14 days. They would convert with exercise or by themselves in 6-9 hours.

I then had an episode that would not convert. The EP wanted me to stay out of rhythm. I proposed he convert me and that I would keep myself in rhythm with electrolytes. I also asked for a script for flecainide to be used on demand if I went out of rhythm. He agreed. I converted the 2.5 month episode with flec and have successfully followed my protocol since, with the addition of detraining from endurance training/competitions (though I maintain excellent fitness). My primary electrolyte supplement is magnesium to bowel tolerance.

Had a stretch 6 or so years ago going through a divorce. Turns out I was stress eating wheels of brie. Took me 18 months to figure out the calcium in the brie was a bad actor for me. I thought it was stress. To your question, I had some episodes that were more adrenergic during this time. I've also had some during the middle of the day, when I did not take magnesium the day before.

In general, my control is excellent, especially when I don't push myself to the max. Can do long duration activities at modest intesnsity or short duration at very high intensity. Just not both together. Also as long as I take my mag, which is a very high priority for me.

There seems to be a hierarchy.

If I follow my plan well, I don't get afib (can easily go 6 months to 2 years or more without an episode).

If I'm a little off - like pushing myself too hard, a vagal episode may occur.

If I'm farther off - forget mag, then an episode can occur, most likely, but not always vagal.

If I'm off on the calcium (too much) then any kind of episode can happen.

George



Edited 1 time(s). Last edit at 12/03/2018 11:18AM by GeorgeN.

I was 40, male, fit, and running 35-40 miles/week when my AF started. It was always at night either right before bed or in my sleep. Laying my left side was pretty much an “on switch” for it. It always converted in the morning either by itself or with a little bit of exercise. Alcohol never triggered it. Oddly enough, I found that 2 beers would actually terminate an evening episode for me. Try telling the doctors that!

Ablated in 2015, about 6 months after diagnosis. Was AF free until April of this year when I had a breakthrough episode that in retrospect I attribute to oversupplementing iodine. Reduced that and haven’t had anything since. Still get occasional PACs that correlate spot on with hydration levels as I still run and live in NC where it can be hot as a blast furnace in the summertime.

Thanks to both of you Wolfpack and George for replying. I am beginning to see that I probably do not have vagal afib as mine is mostly in the early evening after dinner and or wine & other triggers at other times as well. But not usually at bedtime, not lasting long, not terminated by exercise. I take iodine Iodoral 12.5 mg every morning with my thyroid medicine. I used to take a lot but this has been my dose for some time. I have exercised a lot for years and the doctors are usually surprised because my pulse rate and blood pressure are high at Dr. visits tho BP fine at home. My pulse rate always seems to run a little higher than the norm of 72 which is another reason I am thinking I am not vagal AF as I seem to have more symptoms that lead towards the sympathetic nervous system/ adrenergic. I have never been a runner; brisk walking is my thing. I love yoga, stretching & strengthening, Pilates and other forms of mostly not heavy aerobic exercise. So I guess that’s why my pulse is not necessarily low like an athlete.

I had first begun to think I was vagal because of the episodes happening around digestion and in the evening, but the early evening. Also because I am a pretty big exerciser though as I described above not heavily aerobic. Of course I am not a male and my afib only start at the age of 68. But I know one cannot meet every single marker for every category so that is why I have bit confused.