Nocturnal Patterns April 09, 2024 04:38AM |
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Hans Larsen
The findings that adrenergic afib is preceded by an increase in sympathetic activity while vagal afib is preceded by an increase in parasympathetic activity explains why adrenergic afibbers can sometimes ward off an episode by quickly chewing and swallowing part of an atenolol (Tenormin) or propranolol (Inderal) tablet. Taking these beta-blockers decreases adrenergic activity and shifts the balance back in favour of the vagal branch. Similarly, vagal afibbers have found that getting up and moving around when an episode seemed imminent can sometimes abort an episode. Physical activity increases adrenergic tone and thus shifts the balance away from vagal predominance. There are, of course, many other approaches to preventing episodes and these will be discussed in future chapters. First though, we will take a look at other atrial (supraventricular) arrhythmias that may accompany AF or be mistaken for AF.
Propafenone (Rythmol) and beta-blockers are not recommended for people with vagal LAF
Drugs in vagal LAF
Twenty-six of the 35 vagal afibbers (74%) were taking antiarrhythmics or other drugs to prevent further episodes. There is ample evidence that vagal afibbers should not take digoxin (Lanoxin), beta-blockers or antiarrhythmics with beta-blocking properties as these drugs will markedly worsen their condition[2,3]. Yet of the 26 vagal afibbers on drugs 14 (54%) were on a drug contraindicated for their condition. These people spent an average of 105 hours in fibrillation (over 6 months) as compared to 40 hours for the people on the drugs best suited for vagal LAF flecainide (Tambocor) and disopyramide (Norpace, Rythmodan). Even vagal afibbers taking no drugs at all spent less time (90 hours) in fibrillation than did the people who were on the wrong drugs. Vagal afibbers on flecainide did the best and spent only 23 hours in fibrillation and had an average of 6 episodes (average duration of 3 hours) over the 6 months. This compares to 6 episodes (average duration of 24 hours) for non-drug users and 24 episodes (average duration of 13 hours) for people on contraindicated drugs. There was no significant difference in age or time since diagnosis between the drug and non- drug groups.
For example, beta-blockers (atenolol, propranolol, metoprolol), which work directly to dampen adrenergic response, are definitely contraindicated for vagal origin LAF(3,4,5).
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GeorgeN
... while I get comfortable I do George's breathing routine.
As I've mentioned more than one breathing routine, I'm curious which one you are referring to?