Cardiologists/EPs that recognize/treat VAGAL AF?

I suspect i might have vagal AF. But, from what I've seen, most cardiologists/eps in the US don't recognize Vagal AF. Have you found anyone who do, and treats it effectively?

Also, does vagal AF only describe the onset of AF? In other words, once you are IN AF, could I take something like metoprolol to slow down the heart rate? (I've read metoprolol shouldn't be used with vagal AF. But, what about if the episode has already started?)

Thanks!

It's not that US doctors don't recognize vagal afib; it's just that it's not all that important of a distinction. I know people here like to talk about it as if it's a separate form of afib. It is not. The only difference between vagal afib and adrenergic afib are the things that tend to trigger it, just as you said. But once triggered, the two are IDENTICAL diseases. There is no reason to treat them differently. And there is no valid reason to avoid beta blockers with "vagal afib." You absolutely can and should take something to slow your heart rate and metoprolol is a good choice.

Thanks Carey. I've read in multiple articles online that beta-blockers should be avoided with vagal AF.

For example...

Article 1: Drugs which block the sympathetic nervous system commonly used in the management of AF such as beta blockers and digoxin should be avoided. Alternative drugs such as those which reduce vagal tone should theoretically be effective. These drugs include flecainide, quinidine, and disopyramide.

Article 2: For example, beta-blockers usually don’t work well with Vagal A-Fib or the antiarrhythmic 1C meds. Flecainide seems to work better for Vagal A-Fib than propafenone. (Though it’s difficult to generalize about A-Fib treatments, because each person reacts so individually.)

I'm just trying to sift thru the loads of info online. But, I do appreciate your insight Carey!

Those are two opinions with nothing to back them up, and Steve Ryan isn't even a (medical) doctor. I'm no fan of Ryan and his site. The reason you don't find much information about this is because it's not particularly important in the management of afib. Once afib begins, what triggered it is utterly irrelevant. What's important is that keeping your heart rate down will prevent heart enlargement and heart failure and beta blockers do a good job of that. So do calcium channel blockers (diltiazem). Whether it's vagal or not just doesn't matter.

Thank you so much Carey!

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cirenepurzalot
I suspect i might have vagal AF. But, from what I've seen, most cardiologists/eps in the US don't recognize Vagal AF. Have you found anyone who do, and treats it effectively?

Also, does vagal AF only describe the onset of AF? In other words, once you are IN AF, could I take something like metoprolol to slow down the heart rate? (I've read metoprolol shouldn't be used with vagal AF. But, what about if the episode has already started?)

Thanks!

Once an AFIB episode starts, then the decision to take a Beta-Blocker or Calcium Channel Blocker, should be based on how high your Heart rate is (rate-control). Once you convert back to NSR, then get off of these Drugs, if you think you have Vagally-Mediated AFIB.

Thanks! I appreciate the advice.

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Carey
And there is no valid reason to avoid beta blockers with "vagal afib."

The one I can think of is a lowered heart rate while in NSR if a patient is taking betas chronically as opposed to PIP. This was my experience early on in my AF saga. The daily use of metoprolol gave rise to low NSR rates (40 bpm) which made it tough to focus at work during the day. I also experienced daytime AF episodes whereas prior to starting daily metoprolol they were strictly nighttime affairs. Now, that’s not going to be the case with everyone for sure, but if I were a patient with high vagal tone (athlete) and experienced AF I would very much push for a PIP approach to the betas.

That being said, the betas won’t hurt you. Worst case is you feel like a slug.

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wolfpack
That being said, the betas won’t hurt you. Worst case is you feel like a slug.

Apparently beta blockers (and other anti-hypertensives) are ototoxic to some degree or another. I learned this because I have tinnitus from a car airbag deployment and this is discussed in the tinnitus world. I've never taken a BB, so no issue for me. I would certainly do something to reduce my afib heart rate to <100 if my afib lasted very long and this would be a reason to use the meds PIP, not chronically. However, if you have any hearing loss, this is something to consider. Look into which meds are the least ototoxic.

When I first got AF my regular doctor prescribed a Beta Blocker (Atenolol) which I took for a while, it made me very tried. I don't remember how long I took this drug but when I would go out of AF to NSR my heart beat would almost flat line for a few seconds and I would almost black out. This was caught when I happened to be in my Doctors office. I got an EP and he immediately had me get a pacemaker, I was in his office one day and saw my chart in which he had written that he believed that my first degree heart block was caused by the beta blocker. I will say that my heart rate never went really high, so it was a wrong drug for me. But I don't agree with you Betas can't hurt you.

Liz



Edited 1 time(s). Last edit at 01/31/2020 09:52PM by Elizabeth.