Vagal Afib

[www.richardbogle.com]

I've been reading through some of the forum posts and found the term "vagal Afib." The article above explains it well, I think.

I had developed a very bad habit of going to bed, watching TV and having coffee and dessert every night. It was relaxing to me because my days are so stressful. I certainly stopped the coffee and dessert since my AF episode. Now I'm wondering if that practice actually caused my AF (or triggered it....not sure of the correct term).

Anyway, since my AF episode a month ago, I've done pretty well, except for worrying myself to death . There have been 2 occasions where I really thought I was going to have another one. Both times, I was laying in bed, and had eaten a late dinner. My heart started feeling "jumpy" and felt like I was skipping beats. I tried to remain calm, used a cold washcloth and both times it stopped within about 30 minutes.

Not even sure if it matters what type, but if I were to guess, I would call mine "vagal." What does seem to matter is that, from what I've read, beta blockers can make this type worse. The bb was prescribed for my HBP. Seems like another reason to ask doctor for a different type of med OR try to lower it naturally by some weight loss, magnesium, and exercise. I'm just hesitant to stop the medicine because I know HBP can cause Afib.

Thoughts?

ANd, sorry if I'm posting too much. This is all new and scary to me.

Vagal AF is characterized by evening/nighttime episodes only, typically lasting only a few hours and self-terminating. It is perhaps the common form in athletes or endurance exercisers. Many find that their rate while in AF isn’t even all that high (< 100 bpm), and they usually have lower than normal resting rates when in normal rhythm (< 60 bpm and often even < 50 bpm). It’s for these reasons that the beta blockers can be contraindicated, since they aren’t lowering such an elevated rate while in AF and will certainly make the patient feel VERY tired in normal rhythm. I’m speaking from personal experience here. The short time I was on betas I would spend most of the day, especially in the hours after a workout, with rates in the low 40’s. I would get tunnel vision while sitting in meetings and always wanted to just fall asleep.

As for the decision on whether to use a beta or not, I’d look at the following data:

What is the rate in AF?
What is the rate in NSR?
What is the resting BP?

That’s going to give you a much better risk/benefit analysis over just attempting to label AF as vagal or adrenergic based on internet reading. Many folks find they are mixed anyway, with both vagal and adrenergic triggers. Think of it this way - AF (absent structural heart disease) is happening because of some weird interaction between the autonomic nervous system and the atrial tissue. When biological things start to not work right, it’s rarely because one thing broke and simply needs replacing as if it were a cog in a machine. We’re more complicated than that.

Late, have you attempted to lower your BP by natural means? Or you may be eating/drinking/smelling something that causes your body to up BP?
Some years ago i had the problem and it turned out it was the thymol in my mouthwash. Stopped that and BP went back to normal.

Of course, if the problem is due to 'other' then diet, fasting, time restricted eating, exercise will certainly make a huge difference over time.

I don't know my rate while in AF. The trip to the ER was when I was diagnosed and knew NOTHING about Afib. When the fireman came out (we had called them earlier in the evening and they assured me I was having a panic attack), the little pulse thing they put on your finger went from 82 to 112 in about a second. Looking back, that was probably a sign it wasn't a panic attack.

Resting heart rate now - with the beta blockers - is about 54. Blood pressure averages 120/70.

Joe, i have tried at various times to address my BP, but nothing consistent. Obviously, I should have taken it more seriously. I think stress is the main factor and white coat plays a little part. It's hard to get a good reading on me. I'm determined to lose at least 20 pounds (my BMI is 29%) and exercise regularly on the treadmill.

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Joe
Late, have you attempted to lower your BP by natural means? Or you may be eating/drinking/smelling something that causes your body to up BP?
Some years ago i had the problem and it turned out it was the thymol in my mouthwash. Stopped that and BP went back to normal.

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Joe
Of course, if the problem is due to 'other' then diet, fasting, time restricted eating, exercise will certainly make a huge difference over time.

Intermittent fasting (18/6) helps.

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Catherine
Intermittent fasting (18/6) helps.

18/6?

So - only eating between say, 8AM - 2PM?

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katesshadow

18/6?

So - only eating between say, 8AM - 2PM?

Yep, or some variation of the timing.

Circadian rhythm is huge in many areas of health. Satchin Panda at the Salk Institute has done a lot of work in this area. Here is a presentation he made: <[www.youtube.com] He also has a book and has done many interviews.

As to white coat, do you take your own BP? I've had white coat for over 35 years. I can actually feel my heart rate and BP increase when in a doc's office and they bring the cuff over. Oddly, this doesn't happen when I give blood or when I take it myself.

Potassium to sodium ratio of >= 4 on intake can lower BP. Also higher insulin is bad. A very quick way to lower BP is to water fast someone for a few days. Insulin will drop and signal the kidney's to excrete sodium. High insulin signals sodium conservation.

As soon as they mention taking my BP, my rate rises. I don't know why. Years ago, it didn't bother me a bit. I do take my own BP. At my follow-up visit after my ER, I brought my monitor for them to make sure it was accurate, which it was. She still thought my rate was too high and now I am taking Norvasc and a combo bisoprolol/hctz.

I think I would have a hard time not eating after 2PM , but I do think it would benefit me to have early dinner.

No. Last meal/food at 7 pm....next meal at 11 am.

Technically, I only have two meals a day; a hefty breakfast/lunch around 11:30 am, which fills me up and a light dinner, as I am not too hungry.

No sugar (it’s a trigger) and lots of fruits and veggies. No animal products or dairy; Lots of Unrefined carbs, grainy breads, potatoes, brown rice.

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Catherine
No. Last meal/food at 7 pm....next meal at 11 am.

Technically, I only have two meals a day; a hefty breakfast/lunch around 11:30 am, which fills me up and a light dinner, as I am not too hungry.

No sugar (it’s a trigger) and lots of fruits and veggies. No animal products or dairy; Lots of Unrefined carbs, grainy breads, potatoes, brown rice.

Oh ok.....that sounds doable!

Kate, the bulk if your fast is when you’re asleep. My last Afib episode was Nov. 2 (4 hrs) then converted. This is the longest stretch for me and the only change is the fasting which I started mid-October.

Now, watch...I’ll Afib tonight.

The new year has not been good to me. It began (on the 1st) with a bout of Afib that lasted around 12 hours or so. Then, a couple days later and a couple days after that (now). I've tried all kinds of ways to stop it but nothing seems to work. Usually, I get bouts of Afib around 4 to 7 weeks apart. I haven't had then this close together for quite some time. I found the trigger and was able to stop it. I'm not sure what the trigger is with this bout. I had lost around 30 pounds over the past year and a half. I did it through what is termed the "longevity diet." It is nothing more than fasting 2 days a week. My fast days are Monday and Thursday. Not only have I lost weight but my BP dropped around 30 points as well (as taken at the doctor's office and I have white coat HBP). I generally exercise 5 to 6 days a week. But all of this has had no effect on the Afib. It's really frustrating. I'd like to find a surgeon who can remove the LAA. Seems this is the problem in a large percentage of Afibbers. [ [www.ahajournals.org] ] Thing is, when the bouts of Afib hit there is only arrhythmia and no real tachycardia. But going through this is so frustrating.

It's very unlikely that removing your LAA will stop your afib. It would protect you from strokes, but most likely your afib would continue. If you want to stop the afib you have three choices: drugs, ablation or a Maze procedure.

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alxndr01
I'd like to find a surgeon who can remove the LAA. Seems this is the problem in a large percentage of Afibbers. [ [www.ahajournals.org] ] .

The LAA May be involved in long-standing persistent afibber, but it’s less likely to be so in paroxysmal cases. I know we talk a lot about it here, because many of our seasoned posters have been down that road, but don’t let it taint your thinking that a first line procedure MUST include the LAA. Most likely, it won’t.

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Carey
If you want to stop the afib you have three choices: drugs, ablation or a Maze procedure.

For all of our newer readers, it bears repeating that a Maze procedure is really heavy duty stuff. It’s basically open heart surgery with a lengthy recovery time and also a frustratingly common side effect of flutter developing after the procedure, often requiring an ablation.

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wolfpack
The LAA May be involved in long-standing persistent afibber, but it’s less likely to be so in paroxysmal cases.

It's also very unlikely to be the sole source of afib for either category of patients. Stopping afib usually requires a PVI at a bare minimum.

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Carey

It's also very unlikely to be the sole source of afib for either category of patients. Stopping afib usually requires a PVI at a bare minimum.

Yes.

Stopping AF with ablation always starts with PVI and then goes “plus” if need be. Finding an EP who can handle the “plus” is key.

Carey knows this, just quoting for truth.

Any suggestions on how to stop an episode of vagal afib?

Vagal afib, if it's truly vagal afib, is triggered by vagal tone. It's the reaction of the autonomous nervous system to a resting attitude (body position) and, often, to digestion.
Vagal afib appears at rest and, most of the times, the afibber feels when he is in condition to have an afib attack (ectopics, for me).
Leaving the resting position and moving around may help preventing the attack.
When in afib, some vagal afibbers can get back to NSR with exercise. This does not work for me. But I've stopped some episodes just drinking a glass of water and gently moving around (and burping).
I may have afib some minutes after laying in bed for the night. I'm so used to short episodes that I know they'll stop spontaneously within 1 hour or two, but having to urinate every 20 min or so is really annoying...
I think it's highly individual, as always with afib. But if yours is vagal, leaving a resting position or attitude to start moving gently or exercising may likely help.

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silviageci
Any suggestions on how to stop an episode of vagal afib?

Things that are vagolytic. Exercise. But often that’s not really an option since vagal episodes happen in the evening or at night, and who wants to run a mile or two at 11PM?

What follows I DO NOT RECOMMEND, for the record. That being said, I did find in my own personal case that having a couple of beers in the evening would stop the episode. This was in conjunction with Propafenone. No white-coat anywhere on the planet will endorse this, mind you.

Vagal episodes often terminate on their own. Sunrise usually works. But if you can’t stand the night of fish-flopping in the chest, I can certainly understand that. I couldn’t.

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wolfpack

What follows I DO NOT RECOMMEND, for the record. That being said, I did find in my own personal case that having a couple of beers in the evening would stop the episode. This was in conjunction with Propafenone. No white-coat anywhere on the planet will endorse this, mind you.

On a French forum, someone wrote he could stop an afib episode drinking an Orval monk beer (it's low carb beer), but I would not recommend the method, even if it works, because it would have potential bad effects.

About exercise, leaving bed in the middle of the night to go out running or biking isn't what one would likely enjoy, but there are other exercises we can make in bed, alone or with a (compassionate) partner, that seem to be effective to stop vagal afib. Of course, being in afib does not bring much greatest desire for this than for the running option.