Randy - "Vagally mediated AF" occurs when the vagus nerve neurotransmitter acetylcholine (ACh) inhibits sodium / potassium pumps activity to a point where cardiac muscle cells' voltage becomes too low to maintain adequate cell refractory duration. Two solutions: 1) stimulate Na/K pump activity so that ACh can't lower cell voltage too far. Do this nutritionally by assurinby Anonymous User - AFIBBERS FORUM
Hi Lisa, I tried this a while back- it made me feel slugish and did not reduce my afib frequency. I am mixed mostly vagal. If you are really vagal you need to try propantheline bromide. It really worked for me but I couldn't tolerate the blurred vision side effect. EBby E. B. - AFIBBERS FORUM
Ron, Though a med, if the non-med approach doesn't work, you might consider a vagolytic agent (eg, propantheline bromide, urecholine, tincture of belladonna). James A Reiffel MD in a paper entitled Have Sanctioned Algorithms Replaced Empiric Judgment in the Selection Process of Antiarrhythmic Drugs for the Therapy for Atrial Fibrillation? Wrote: There are some forms of paroxysmal AF that doby GeorgeN - AFIBBERS FORUM
Periodically the use of vagolytic meds, specifically Propantheline Bromide, has been suggested as a way to control vagal triggers for afib. Thought this paper might be of interest. I wonder if it could also have applicability for SSS? Increased vagal tone as an isolated finding in patients undergoing electrophysiological testing for recurrent syncope: response to long term anticholinergic agby GeorgeN - AFIBBERS FORUM
Calli, My experience is my resting HR is not correlated with taking Mg, K & taurine. Hopefully the metropolol is on-demand, when you are in afib. If you take it all the time, it would slow your HR down. As previously mentioned, a vagolytic such as propantheline bromide may be a reasonable bet to raise your HR. I'd certainly try this before I had a pacemaker implant. Georgeby GeorgeN - AFIBBERS FORUM
Hi Calli, Not inexpensive, but the Polar R to R recording monitors do a great job. These include the Polar rs800cx. I have the older S810 model. By the way, what is wrong with your finger and a second hand on a watch or clock? A 20 or 30 second reading works well for me. On many people, there is a pulse point just in front of the ear on a line starting just above the tragus (see ) and eby GeorgeN - AFIBBERS FORUM
Erling, I would agree this is an avenue that should be pursued. Additionally I would suggest that afibbers try the 12 Step Plan prior to initiating Propantheline Bromide (P. I would modify step 2 to include a 4:1 K:Na ratio. I would suggest a PB approach after step 9 for vagal afibbers. From what I can see, most problems with PB come from too large a dose. However, even a little may haveby GeorgeN - AFIBBERS FORUM
Hi Jill, Great news! My PB correspondent recently told me it also continues working without issue. To me, the concept of vagolytic drugs makes sense for vagal afibbers. Here is one list: Propantheline Bromide makes sense as, from my reading, it is the only one that does not pass the blood brain barrier. The late Dr. Coumel speaks to the concept here: "These theoretical notions hby GeorgeN - AFIBBERS FORUM
I don't post here very often, but I have been a "student" of this forum for a couple of years, trying to learn all I can. I greatly appreciate having access to all the knowledge and experience here. I have experienced afib since 2006, at first only one episode a year, then in 2010, 4 episodes about 3 months apart. I've been through 2 cardiologists and 2 EPs and numerous drby Jill - AFIBBERS FORUM
Lynn, Many thanks for the further posts. Interesting that alkaline tides occur early mornings when first up and around and after meals - these are the times that I get most ectopy (including bigeminy on the mornings up unti, about 10am or so). Maybe this is also why alkaline WW seems to make my ectopy worse - I'll have to try adding apple vinegar to it until it tests at say 6.0 before I usby Mike - AFIBBERS FORUM
*** Correction *** "How about using an home-model ECG to predict an episode, then taking a med if the ECG "predicts" afib. Maybe the risk period would be transient and you'd only need to take the med till it passed. " I meant: "How about using an home-model EEG to predict an episode, then taking a med if the EEG "predicts" afib. Maybe the risk period wouby GeorgeN - AFIBBERS FORUM
Hi Hans, I'm not sure I understand what this study did. Glycopyrrolate is a medication of the muscarinic anticholinergic group. It does not cross the blood brain barrier and as such it has no to few central effects. I guess since the glycopyrrolate is an anticholinergic, it would increase the sympathetic arm of the ANS. HR, Q, oxygen uptake, mean arterial pressure, and leg blood flow wereby GeorgeN - AFIBBERS FORUM
Monty, I'm no expert & have not needed to try it. It does look like it has promise. If you email me I can give you a contact for more information. The whole point of the anticholinergic approach is to change the autonomic nervous system to be a bit less vagal. Anticholinergic meds can have side effects. The effective dose is just below the dose that causes side effects, and this vaby GeorgeN - AFIBBERS FORUM
Montos, 1. Have you tried pill-in-pocket flecainide (on-demand)? 2. If your episodes are vagal, you could try an anticholinergic such as propantheline bromide. As it is prescription, it will require a cooperative physician. If interested, I can put you in contact with a correspondent who has been using this approach successfully for a year. Georgeby GeorgeN - AFIBBERS FORUM
Mike, One PB question I had relayed to Dr. Reiffel was about PB and dementia caused by anticholinergic meds. In theory, PB doesn't cross the blood brain barrier, so should not be an issue. However, since I have a mother with dementia, it would be a big negative if PB has a causative effect. I've not gotten a response. A google search certainly shows that choline can offset the mentby GeorgeN - AFIBBERS FORUM
Erling, Many thanks for the response. I only left PC off my list as I haven't seen him posting for some time now. I certainly haven't forgotten about him and often wonder how he's doing - I guess pretty well since he isn't posting here! I do miss his brain-cramping posts! I would particularly liked to see his input on the propantheline bromide discussion involving mainly Geoby Mike - AFIBBERS FORUM
"my resting heart rate averaged between 46 to 51 bpm, and hit lows of 36 bpm. During the day it averages 60bpm, unless i'm working out or something. I have a slow resting heart rate as I was kept fairly fit when i was younger, and try to do as much as I can for cardio nowa days as well." You may be interested in this: SESSION 64: Exercise and Afib (May 21 - June 15, 2008) You maby GeorgeN - AFIBBERS FORUM
This article gives a basis for the effectiveness of anticholinergic drugs, along with a discussion of vagal and adrenergic propensities for afib. Atropine is the only anticholinergic drug mentioned, and not mentioned as being prescribed for prevention, but it was studied. Atropine is derived from belladonna, one of the meds, along with Propantheline Bromide, talked about by Dr. Dr. Reiffel. Theby GeorgeN - AFIBBERS FORUM
Anticholinergic drugs were the first pharmacological agents used in the treatment of Parkinson's disease. There are reports of greater dementia in parkinson's patients treated with anticholinergic drugs "The sensitivity of demented Parkinsonians to anticholinergic drugs can be attributed to a cholinergic deficiency which has been detected in the cortex and hippocampus of Parkiby GeorgeN - AFIBBERS FORUM
Rod, Several questions: 1) what was the doseage of the pill, 2) did you notice any side effects, 3) what time of day did you take the pill, and 4) do you consider yourself a vagal afibber? Stugeron would potentially be useful for vagal afibbers. It would be in the same category as the anticholinergic drugs Propantheline Bromide, Urecholine and tincture of belladona. Atropine, referenced by Guby GeorgeN - AFIBBERS FORUM
Mike, From "The amplitude of respiratory sinus arrhythmia was quantified as the ratio of the longest to the shortest RR intervals in electrocardiograms recorded during deep inspirations and forced expirations in the supine position." I have a bit of a problem with this protocol. The emwave device (formerly known as FreezeFramer) is based upon consciously modifying this. I've played with itby GeorgeN - AFIBBERS FORUM
Mike, " was the answer you came up with PB for the above reasons" The answer is, I don't know yet. Obviously, Dr. R has had experience here. I want to know more. My mother has dementia, too - with no real family history. Her mother lived to be 103 without much dementia. My mother has had Waldenstrom's Macroglobulinemia, a lymphoma, for 12 years. Early on she thoughtby GeorgeN - AFIBBERS FORUM
George, Interesting form your references above to note from: That 'The mean resting vagal tone in diabetic patients was reduced by 40%'. PC always maintained that vagal AF was in some main ways the 'opposite' of diabetes. On another note, it is of obvious concern here that anticholinergic drugs can bring about dementia than might otherwise be the case: 'Findings fby Mike - AFIBBERS FORUM
Hunting around regarding atropine, which comes from belladona, I found this 52 year old paper. I found the bolded section interesting. 286 ASSOCIATION NoTEs Canad. M. A. J. Aug. 15, 1958, vol. 79 "It was found that small doses of atropine are purely parasympatholytic, while much higher doses are stimulants of the central nervous system leading to death in convulsions. The therapeutic saby GeorgeN - AFIBBERS FORUM
George, Not sure I'm ready to take the plunge, yet! I have an appointment later this month with my cardio, so I would appreciate the papers, so that he can take a look at them and give me his thoughts. Thanks so much for setting me straight and translating into the only language I can read :-) I'll be looking for the email. Regards, Lisaby lisa s - AFIBBERS FORUM
So the idea occurred to me, "What is the least toxic, effective, vagolytic agent? Some searches I've pursued on this path are below. No great answers yet - just rabbit trails to follow.by GeorgeN - AFIBBERS FORUM
Lisa, I would say that many antihistimines have anticholinergic properties, but not all anticholinergics are antihistimines. I do not believe that Propantheline Bromide is an antihistimine. I'm not sure of how it would interact with blood pressure. As I research this further, I would not wish to stray too far from what Dr. R. has used - Propantheline Bromide, Urecholine & Tinctureby GeorgeN - AFIBBERS FORUM
George, At first glance, it sounds like it may be very beneficial to vagal AFers (me, me, me). I do have one question right away: if I understand correctly, it is an antihistamine, and thus would be contraindicated for those with HBP. Do I have that right, or am I way off base? I am certainly no chemist or have any sort of science background beyond what it takes for an art degree, so I appreciaby lisa s - AFIBBERS FORUM
For this post, this definition will be useful: Muscarinic acetylcholine receptor Muscarinic receptors, or mAChRs, are G protein-coupled acetylcholine receptors found in the plasma membranes of certain neurons[1] and other cells. They play several roles, including acting as the main end-receptor stimulated by acetylcholine released from postganglionic fibers in the parasympathetic nervous systemby GeorgeN - AFIBBERS FORUM
Mike, One of my concerns in venturing too far from Dr. Reiffel's suggestions is the issue of anticholinergics and cognitive impairment. "Anticholinergic drugs block a nervous system neurotransmitter called acetylcholine. Those suffering from Alzheimer's disease typically have a marked shortage of acetylcholine." From: When I queried about this issue with respect to PB, tby GeorgeN - AFIBBERS FORUM