Question on vagally mediated AFib

How do you know if your AFib is vagally mediated or not?

Also, once someone is in AFib what are the best methods for getting out of it besides meds and breathing exercises?.

TIA- Dina

See the definitions here.

As far a exercise goes, I think of vagal afib triggers as being delayed, as in after you've quit exercising. In my case, when I used to do long duration strenuous races, it might even be a several day delay. I think of adrenergic triggers as occurring during exercise. Like my friend who was hunting and killed a deer. In trying to pack it out, the exertion triggered an episode.

Vagal afib typically occurs at rest, after meals, while sleeping & etc.

None of this is cut and dried and afib can have a mind of its own. Some folks with vagal afib can use exercise to convert episodes. Some with adrenergic afib triggers can use vagal maneuvers to stop episodes (strongly suggest not trying carotid massage as it can be dangerous).

I have used exhaled breath holds (completely exhale, then hold your breath out as long as possible - I've pushed this for several minutes), increasing CO2 with breathing into a bag, cold water immersion (has risks if you don't regularly do this), inversion, exercise (has risk, I've pushed my heart rate to 225 BPM with flecainide on board combining exhaled breath holds with exercise like jump rope or push ups and had to invert or sit in cold water to slow the rate & then convert), I don't recommend what I do unless you are physically well and know how your body will respond. Though you didn't want meds, I've used a loading dose (max 300 mg if over 154 #'s/70 kg, 200 mg if less) of flecainide on demand for 18 years to convert per this paper. I've also done all of the non med stuff to aid the flec if it didn't work fast enough (took over two hours). I generally chew the med to get it into my system faster.

In my experience, the non-med stuff works better if you try it immediately after an episode starts, like seconds. I've found if I get my electrolytes right, then I'm much less likely to have an episode show up with an undefined or unusual trigger (my usual trigger is exercise). For example, when I was consuming more calcium in 2012 and didn't realize it was an issue, immediately after an orgasm could be a trigger. I could commonly feel the pre afib ectopics starting & if I immediately got to a vertical position, I could stop the episode. An episode in Jan 2021 was converted in about 3 minutes by immediately doing an exhaled breath hold. I captured the episode on heart rate and SpO2 monitors and their data are shown here.

Early in my afib career, I could go for a run, bike ride & etc and convert. This ability generally went away after my 2.5 month episode in the first 4 months of afib, at least unless I had flecainide on board.

I basically have vagally mediated Afib though I don't think it is always cut and dried and most of us are probably ab bit of both. I can sometimes convert with a big dose of potassium, say a large can of low sodium V8 (low sodium because it substitutes potassium for some of the salt). Of course, if you take a large dose of potassium you need to balance it with magnesium. It is safer to take food-sourced potassium than pill form (at least most doctors tell us this).

I can also sometimes convert with a burst of aerobic exercise, like jogging in place. Most of these conversion tricks work best right at the beginning of an episode.

Thanks GeorgeN for posting the definition. With that definition, my husband's current AFib episode appears to be Adrenergic not Vagal. Up until now he's always had episodes at night and medicine and breathing by themselves seemed to be enough to resolve the episode. However this episode which happened during the day after some emotional stress has continued on and does not respond to the breathing and meds. Any ideas ?

Emotional stress is a trigger for many patients. And, as AFib begets AFib, what you described is the next step :more AFib, harder to stop. Time to see the EP.

What is an EP?

Electro Physiologist. He's the specialist who cares about "electrical" issues in the heart.

I’m getting flutter so frequently when either sitting on a couch slouching (not 90 degrees straight back against the back of the couch) or laying in a hospital bed that is not either fully reclined horizontally flat. Yesterday and today I was on a gurney in the ER’s hallway and found each time I wasn’t either perfectly laying flat or sitting up as straight as I could, I went into flutter or whatever tachycardia of the day it was. It wasn’t 1:1 (ventricular and atrial chambers beating exactly the same number) because I quickly converted by my pacemaker to 55hr. Metronics has a burst therapy of pacing down to my set lowest hr (mine is set to 55) whenever it’s a 2:1 (or is it 1:2?) ratio. I can’t believe I’m writing this but my pacemaker has been very successful except when I recently had covid and a 16 hour tachycardia that didn’t convert even by sitting up straight like a board. So I think I am vagal because swatting or bending over or slouching will trigger an episode. At least now I know how to try to convert by sitting perfectly straight and doing breathing exercises to slow down my breathing. It’s a fine line of not breathing enough and getting dizzy so I wear an oximeter (thanks Carey for your Amazon suggestion) to make sure it’s over 90.



Edited 1 time(s). Last edit at 08/31/2022 08:01AM by susan.d.

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Dina Yaffa
Any ideas ?

Some with adrenergic afib triggers can use vagal maneuvers to stop episodes (strongly suggest not trying #6 carotid massage as it can be dangerous).

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Dina Yaffa

Also, once someone is in AFib what are the best methods for getting out of it besides meds and breathing exercises?.

TIA- Dina

Are you familiar with an outpatient procedure called an electrocardioversion? As a last resort, that is surest way of ending AFIB, but the AFIB may return.

I was cardioverted last September. It didn't work. They upped my dose of metoprolol and sent me home to rest.

I do agree that one's posture, one's adrenergic response to mental stressors, even acidy belches, can set me off, and that's the Vagus working. What works for me, mostly, is simply pacing up and down a hallway, or going for a walk. It can't be anything more than a saunter, but that works about 80% of the time.

Slouching at the computer is BAD!!