Change of Position driving onset of Afib activity

Hi folks. In my never ending quest to determine what could be a trigger to my bouts with the beast, I've kept a strict journal of what I was doing before, during and after each event to see if I can get any commonality. I won't bore anyone with the details, as we all have our own battle raging. I've only had 5 full on episodes of afib. I'm 48, and regularly exercise. My question revolves around positioning, and more to the point, transitioning between different positions. For example:

All of my afib attacks have occurred when I was lying down (sleeping, napping, resting) and the moved to activity (getting up, walking around) and then again, moving to rest. Lying in bed, getting up to use the bathroom, coming back and lying down in bed. Bam. All episodes follow this pattern. Lately, I've had very brief events of the same afib-like activity that lasted no more than 15 seconds before converting back to NSR, and these occurred with me sitting or laying for a brief time and then standing up, moving about for a few seconds and then pausing.

Its almost like some sort of orthostatic hypotension type thing, without the blood pressure (though I have no idea what my blood pressure is during those events). I do not experience any other symptoms other than the dreaded heart flipping about (no shortness of breath, no dizzy feelings, etc).

is this a problem with the sinus node, or perhaps the sinus node is functioning normal, but some cells in the heart aren't responding well to the command to change pace?

Acid reflux (relaxed LES) when changing position can do it.

Perhaps, but I'd be very surprised if that is what it is here. I have never had (other than the occasional indigestion) any symptoms of acid reflux. I don't have it at night or during the day.

Ghost, I have had 3 AF episodes and everyone of them happened as you described. All revolving around bed, waking, falling asleep, turning over, etc. Now the last year.....nothing.....nada....zilch.....Ive gone to bed, and turned and fallen asleep , etc.....and not one episode. So, the quest for the elusive trigger is sometimes worth giving up...maybe? I think sometimes trying to find the trigger can really stress a person out.

Linda

I'm almost always likely to get a couple of ectopics when I lie down again in bed after having got up to go pee in the night.



Edited 1 time(s). Last edit at 02/12/2020 12:19PM by mwcf.

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lds001
Ghost, I have had 3 AF episodes and everyone of them happened as you described. All revolving around bed, waking, falling asleep, turning over, etc. Now the last year.....nothing.....nada....zilch.....Ive gone to bed, and turned and fallen asleep , etc.....and not one episode. So, the quest for the elusive trigger is sometimes worth giving up...maybe? I think sometimes trying to find the trigger can really stress a person out.

Linda

There's no question it is stressing me out (I want to put a pic of Kramer from Seinfeld going "oh, I'm stressed!"). But the constant quest for understanding of the beast is what allows us to deal with it. Or some of us, anyway.

Most of my 300+ episodes came this way too.
I agree with Carola about acid reflux. Mine is discrete, without any burning sensation. But I'm sure it plays its role.
Like you, Ghost, I'm taking notes and notes... Even if I take care staying away from conditions favouring afib, afib may come anyway.
I've noticed quick changes in body position (sitting or laying down, standing up, leaning forward...) may bring ectopics and then afib. It's the most sensible early in the morning after leaving bed. And at night, I've better laying down slowly on my bed. It seems my vagus nerve is easily irritated those ways... and during the first hour after meal too.
I see we're several in the same boat.

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Pompon
Most of my 300+ episodes came this way too.
I agree with Carola about acid reflux. Mine is discrete, without any burning sensation. But I'm sure it plays its role.
Like you, Ghost, I'm taking notes and notes... Even if I take care staying away from conditions favouring afib, afib may come anyway.
I've noticed quick changes in body position (sitting or laying down, standing up, leaning forward...) may bring ectopics and then afib. It's the most sensible early in the morning after leaving bed. And at night, I've better laying down slowly on my bed. It seems my vagus nerve is easily irritated those ways... and during the first hour after meal too.
I see we're several in the same boat.

And you think this has more to do with acid reflux affecting the Vagus nerve? You don't think it is some sort of orthostatic hypotension or something of the sort where the sinus node kicks into high gear, and the heart follows the instructions but some cells overreact?

I have no medical knowledge on any of this, just trying to follow logic. And I did stay at a Holiday Inn Express last night.

Vagal afibbers are used to have ectopics or afib mainly at rest or when making some movements. They rarely have problems while exercising, provided they don't start abruptly. That's what we have in common, as vagal afibbers. We have an irritable vagus nerve. For some, it's a family affair, genetics being a root cause.

What we have in common too, of course, is our vagus nerve, which is amazingly long, running in two main trunks between our neck and our bowels. Then, it may get irritated as well by our throat, lungs, esophagus, stomach, liver, bowels... Add to that our brain, stress and adrenaline level... I'm no scientist, it's complex. We are all different, but things being able to disturb our vagal tone have to be found among all those organs and states of mind.

For me, it's more linked to digestion than anything else. In the morning, in the first hour after leaving bed, orthostatic issues are much present. I've a weak LE sphincter, leaning forward soon after leaving bed makes me feel bad. It's the moment I clearly FEEL (empty) stomach reflux. Breakfast helps. It forces my weak valve to work.

Again, it's me. Your way to disturb your vagal tone may be quite different. Take notes. Don't wait. We are quickly forgetting things.
Good Luck!

Ghost,
I had the same positional problems with afib and pacs as you and many others. These are a couple of old posts of mine for your info. I would definitely suggest you see a Gastro and have a 24hr pH study and if you can wrangle it a 24hr Holter monitor at the same time. This would nail any relationship with reflux and afib/pacs. I had silent reflux and didn't know it.
Hope this helps.
Dean


With all the discussion on this board lately about the vagus nerve, esophagus and afib I thought it timely to detail my Barium meal test I had done in early 2002.
This is a section of the doctors report:

"There was no obstruction to the flow of the contrast to the stomach but there is slow clearing of both the barium and the barium impregnated marshmallow through the mid and distal oesophagus.
Initially on screening the stomach the configuration was normal. No mucosal abnormality was detected in the fundus, body and antrum. On lateral views, after moving the patient supine, prone and then back to erect, the configuration of the stomach altered with the antrum and duodenum on the erect view now lying above the level of the fundus (In other words I have a "wandering stomach"."

I have always believed that my esophagus has a faulty peristalsis action whereby the esophagus has to really work to force the food down to the stomach. On occasions I have had difficulty in swallowing. In my opinion, this coupled with my "wondering stomach" and LES giving me bad reflux is THE root cause of my afib. Faulty vagus nerve functioning.

The obvious question is what do I do about it?


Gastro then sent me for an endoscopy which indicated a loose LES then sent me for a 24hr pH study and esophageal motility study.

The 24hr pH study involved inserting a tube with a metal sensor on the end into my throat and positioned half way between my LES and mouth then connected to a Holter type recorder. Bloody awful for 24hrs!

During the 24 hours I noted when I laid on the couch the pH monitor went from a pH of 6 or 7 (neutral or normal) to 1 or 2 (acidic or reflux). Also when sleeping if I lay on my left side it did the same thing, down from 7 to 1 (reflux again). Also from 3am to 7am when sleeping it was again 1 or 2 (silent night time reflux).

So over the 24hrs every time I laid down or slept the pH dropped from 7 to 1 or 2 and I would have a run of ectopics (PAC's ect.) at the same time. So for me this indicated the “smoking gun” behind my ectopics and afib.

If I had a Holter monitor on at the same time as the 24hr pH study it would have confirmed the ectopics were triggered by the reflux.

So if your ectopics or AF are triggered when in a sleeping position or bending over then strongly suspect silent refux is behind it and have a Gastroenterologist check you out.

Dean, it's great information!
How do you deal with this LES and reflux, now?

Very interesting. I think my issue is more vagal as Pompon suggested. Right now, I'm doing the Steve Carr approach of limiting Ca intake and supplementing Vit D and K2-7 and, although it has only been a month or so, I've eliminated all ectopics completely, even when changing position.

Also, as Pompon indicated, I never had issues while exercising, provided I gradually increased activity and did just jump up and start running.