Bradycardia and Afib

Hello, all. I am a first time poster, but have “lurked” around this site for some time. My question has to do with bradycardia and afib. First a short profile: I’m 65, not yet retired, live in Texas, always been active, lifelong jogger, bicycler, weight-trainer, etc. Oh, and I have sleep apnea – odd because I am not overweight – docs tell me it is not obstructive but “central” apnea. I use a CPAP.

I’ve had AFIB for at least 20 years. It is paroxysmal and for many years would spontaneously convert after 24-48 hours, or I could often convert it with strenuous exercise. I assume my afib is vagal, because in the early years it would come on only at night. Of course the beast has gotten worse as I have gotten older. Now I spend almost as much time in afib as in NSR. Luckily my AFIB is not terribly symptomatic, just annoying. I have been using Flec PIP for about 5 years, and its effectiveness seems to be diminishing too. I don’t seem to have any specific triggers, but after 2 or 3 days in NSR, I can feel my heart slowing down, ectopic beats (I assume that’s what they are) starting, and within a few hours, I’m back in afib. When I first convert to NSR, my heart rate is usually 55-60 bpm, which is comfortable. Then it gradually slows down till it’s in the low 40’s just before I go into afib.

Does anyone know the exact relationship between bradycardia and afib? Is there anything you can do for bradycardia other than a pacemaker? I have read that caffeine might help. Also I have read that an ablation typically “cures” bradycardia as well as the afib, but I’m not keen for either a pacer or an ablation.

Thanks in advance for your wisdom, Jim Bob

Hi Jim Bob, I'm not one of the resident experts but do share some of your history...for me, I'm 59 with 12+ years history as a paroxysmal vagal afibber. Sounds like your afib, like mine, is progressive with age as it tends to be. Your spending more and more time in afib versus NSR makes me wonder if some remodeling might not be taking place in your heart despite the fact that your episodes are more annoying than symptomatic. Might be a good time to get an echocardiogram, if you haven't already had one done, to check out the size of those atria among other things, because it can reach a point where afib begets afib due to changes in the heart itself.

As for the relationship between bradycardia (which I also had for many years and which also worsened) and afib, I'm sure others can comment at more length, but I do recall the reasoning from Hans Larsen's book that the body may treat bradycardia as a potentially serious condition and may respond to it with more adrenaline to quicken the pace. However, an adrenergic response with too abrupt a transition from a vagal state, especially if you have poor (high) vagal tone to begin with, can trigger an afib episode. For me, introducing sympathetic arousal (noradrenaline), regardless of the cause, in a dominant and dysfunctional parasympathetic (vagal) state, which I'm convinced I had/have, was a common and often repeated trigger I was unable to avoid. Also, too much time between beats allows more opportunity for premature beats (ectopics) to creep in and also lead to afib. OK, all that said by someone who only has a few pieces of the big picture.

I know you said you're not keen on ablation, and neither was I, but it reached the point where I had little choice. Others can comment whether a pacemaker is the better option versus ablation, or even whether there are other means of solving your bradycardia. Wishing you the best, and I'm sure you'll get some very valuable advice from others here. - Randy

Jim Bob - Hi and welcome... since you are athletic and undoubtedly tend to be in the parasympathetic mode much of the time, have you tried using Ginger?

Do a Search using the search feature on Ginger and read Colindo’s (Colin) posts on his success with reversing his AF with his Ginger regimen. Read through all but specifically, this link [www.afibbers.org]

And this particular post by Hans with the explanation of Ginger promoting sympathetic activity…getting you out of parasympathetic and a low heart rate.

Also, how's your potassium intake compared to sodium. Do you supplement with magnesium?

Jackie




Hans Larsen
Re: Is Ginger My Cure?
July 30, 2013

Colin,

Thank you for sharing your experience with ginger. It certainly looks promising. Just to make sure I have got your regimen correct: You take one 250 mg capsule of NOW Foods ginger root extract before each of your three main meals and one before bed. In addition you have found that one GingerForce capsule (New Chapter) works as a pill-in-the-pocket to terminate an afib episode. As your afib is of the vagal variety it makes sense that the 4 capsules of ginger root extract would help prevent episodes. However, your finding that one capsule of GingerForce is effective in halting an episode is most intriguing.

Ginger increases adrenergic (sympathetic) dominance and thus would increase heart rate rather than slow it down. Thus your finding is kind of counterintuitive considering that your heart rate may already be 120 bpm or more during afib. However, I believe there is evidence that the shift from afib to normal sinus rhythm (NSR) often, if not always, is preceeded by a period of sinus tachycardia. Perhaps ginger has the effect of putting the heart into tachycardia and from there the change to NSR is "easy". Any thoughts on this?

Hans

PS. GingerForce and the NOW Foods ginger root extract are both available in the afibbers.org vitamin shop [www.afibbers.org]

Jim Bob,

"Does anyone know the exact relationship between bradycardia and afib?" In layman's terms, each time the atrial cells contract, there is a "blanking period" where they don't fire on their own, "atrial effective refractory period" or AERP. When the heart rate is fast, a new beat happens before this period ends. When the heart rate slows down, then it is more likely that an errant "p" cell in the atria will fire on its own. This can lead to PAC's and afib. The AERP is also not constant. Autonomic nervous system changes can cause it to shorten. There are complex interactions here. I've noticed if my heart is "happy" then none of these autonomic nervous system changes make any difference and I'm "bulletproof" afib-wise. If my heart is "unhappy" then the reverse is true. For me, electrolytes make a huge difference in how happy my heart is. Magnesium, potassium and taurine help and too much calcium hurts. When my heart was "unhappy," ginger did make a difference in keeping it "happy." I used organic ginger spice and took it in both tablespoon and teaspoon quantities. My comments are in the archives starting around Nov 2012. Here is a search on this board on ginger <[www.afibbers.org]

Here is a search on the Conference Room and other areas on AERP for more detail <[tinyurl.com]

The other thing you can do is detrain a bit to get your resting heart rate up. I'd deemphasize endurance training and emphasize short duration high intensity weight lifting. Especially see the Body by Science protocol which seems to keep one fit enough but requires little time (but is not easy at all, if done properly). I think minimizing time exercising is a good thing, afibwise, especially in traditional endurance activities. Here is their book <[www.amazon.com] and they have a website, too: <[www.bodybyscience.net] If you Google author Doug McGuff, you can watch some of his presentations. I recommended this approach to another poster here and he's corresponded privately with me that it has helped.

George



Edited 1 time(s). Last edit at 02/14/2014 06:39PM by GeorgeN.

Great answers George and Randy,
And welcome Jim Bob

Also,in Jackies reference to ginger as a possible help where she quoted as Hans recall that AFIB tends to switch to sinus tachycardia or even atrial tachycardia just prior to conversion to NSR is very true to. Typically during an ablation the EP will notice AFIB convert first to tackycardia or flutter as an intermediary point on the way to the preferred endpoint of NSR.

Also, it's well known due to the reasons George and Randy discuss that Bradycardia sets up the tendency for the heart to try to kick start NSR again and it often overshoots into AFIB or flutter in the process. There is even a lousy condition called tachy-Brady syndrome in which the heart is now swinging back and forth between the two states while 'hunting' for NSR and can go on a miserably long time I know from experience Id rather have not had.

Shannon



Edited 1 time(s). Last edit at 02/17/2014 09:05PM by Shannon.

Thanks all for your responses. I will certainly follow up on the ginger protocol.

Regarding my supplements, I take taurine, arginine, fish oil, ginko, and baby aspirin. I try to keep potassium up with OJ, bananas and low-sodium V8, and mag with Waller Water.

Re the suggestion on de-training, I really don't actually train very much. I jog 2 miles most days and work our 2 or 3 times a week at the Y on weights. A few times a year, I'll run a 5k race just for motivation. My last one I did in 35 minutes, which is very slow for you serious runners. But I usually get a medal because not many guys my age want to get up on a 30 degree Saturday morning and huff and puff 3.1 miles. Luckily my wife is a triathaloner and even nuttier than I am.

Anyone have any comments on caffeine for bradycardia? I usually avoid caffeine like the plague because I am a bit high strung and I don't need any extra stimulation.

Jim Bob

Jogging has been shown to damage the muscles, the joints and the heart.

Look into brief sessions of interval training for fitness - and be careful about how much effort you put into the "all-out" parts. Build up slowly and never strain.