adrenergic vs vagotonic: ablation outcomes

One cardiologist (not an EP) that I spoke told me that vagotonic-triggered afib tended to have less favorable ablation outcomes than does afib caused by andrenergic triggers.

I have been unable to find PubMed or other papers to support or refute his claim.

My appointments with the experts (ie, EP's) are still several weeks/months away, so in the meantime I thought I'd see if the more technically oriented members of the afib forum (Shannon, Researcher, etc) had any thoughts on this...?

Thanks in advance,
-Ted

Ted, Beyond what is available in the public domain (see references in write up below), I don't have any insights into what the cardiologist that you talked to sees in his experience. The studies are pretty dated and observational.

[a-fib.com]

Hi Ted - Logic would point to the fact that for those who are Sympathetic dominant and unless that unremitting 'fight or flight' mode is tamped down more toward neutral, it would be more difficult to sustain a successful ablation in those patients given the toll sympathetic dominance takes on the body. That would would include dysfunction in the HPAA and the very high potential for adrenal burnout (and all that ensues) due to excess and prolonged cortisol production which can mean a difficult and time-consuming road back to health, especially when definitive, restorative measures aren't utilized.

Whereas, those prone to Parasympathic dominance, just have to step up certain basic habits to keep the tone more toward neutral or even a bit toward 'hyper' if warranted.

My personal experience as a mostly vagal afibber of 8 years duration prior to the first (Natale) ablation, is that lasted for 11 years.

Jackie

I seem to recall Natale being quoted that once you are in afib, afib is afib & it really didn't matter.

I'm also guessing the stats may be different for someone with 8,000+ ablations under their belt.

From 11 years of observation here, many (but not all) afibbers with adrenergic triggers have comorbidities. I observed this is much less likely for those with vagal triggers. If the afibber didn't address the root cause of the comorbidity, I'd think this would lower the likelyhood of long term success.

George

The top ablationists hardly make these distinctions anymore. They acknowledge the vagal and adrenergic influences., of course, but they see AFIB largely as a progressive condition in which a milieu of influences continue to morph and evolve as it progresses over time toward and increasingly persistent nature. Most people, even if starting out solely vagal like I did, wind up with a goo mix of vagal and adrenergic.

Certainly, as our site has emphasized from the beginning there is a very real and demonstrable practical benefit in identifying and labeling AFIB as vagally mediated or adrenergic ally mediated in the early years in particular as knowing these tendencies during the early to middle years of progression are often very usefully in identifying triggers to avoid and specific cardiac and AAR drugs to avoid as well or take as well.

But as time goes on, though there are exceptions of course as in everything, these distinctions tend to lose their meaning such as, often the term Lone AFIB, may have had descriptive relevance early on, but in many cases underlying CVD cofactor evidence that in many cases may have still be there in the beginning but was occult meaning that the markers or symptoms were just too subtle to detect by previous generation diagnostic equipment and understanding.

Once you hit 24/7 persistent AFIB, there is usually enough blend of adrenergic and vagal influences ( though not always) and enough even subtle evidence of cardiovascular changes to the heart and vascular system too that we would be hard pressed to classify it strictly as 'Lone AFIB' anymore ... even when it may have seemed to fit that bill well early on.

Just look at these terms as practical descriptions sign posts and guidelines along the way of the long and winding AFIB journey we are all on, rather than as some kind of absolute classifications that forever define the nature of your particular AFIB..... at a certain point in the progression, there is usually just ... AFIB ... plain, but not so simple, with a host of influences and impacts on our bodies, minds and lives.

Shannon



Edited 1 time(s). Last edit at 11/21/2015 03:25PM by Shannon.

Thanks all.

I especially liked Jackie's reply (ablation fixed vagal afib for 11 years), as it is the most encouraging. Of course it's just 1 data point, but it's a good one.