vagally mediated arrhythmias

[LynnSB]

Would you be so kind as to describe a little how vagal tone influences heart arrhythmias?

I was told being deconditioned could contribute to this sort of vagally mediated ectopic activity -- do you agree? And so does it follow that exercise ( which most of us palp frightened folks have a phobia of) could actually reduce ectopic activity over time?

Is there a connection to certain body movements ( like reaching up or down, turning your head, squatting down) that are linked to a greater frequency of irregular beats and vagal tone?

thanks.

Lynn

[Cleveland Clinic]

Lynn,

Vagal tone refers the effects of the autonomic nervous systems effect on the resting heart rate.  Just as there are many triggers for fibrillation and arrhythmias, the sympathetic and parasympathetic nervous systems can both initiate arrthymias. In pure form, these triggers as the sole cause of fibrillation are probably not common and usually represent a constellation of symptoms.

Specifically the vagus nerve inervates the heart and is responsible for controlling the resting heart rate. Increases in vagal tone cause a slowing of the heart rate.  

Decondtioning in itself is not rally relatated, and you might be referring to the syndrome of low heart rate lone atrial fibrillation which tend to occur in older ex-atheletes.

There really isnt any type of stong connection between body movements and arryhtmia initiation..

good luck

[Squimsy]

I'm glad somebody got a question posted about vagal tone.  I see so many threads that make reference to how the vagus can cause palpitations, or even A-Fib, but they never go on to say what you can do to lessen its influence.

I look forward to the doctors reply.

[LynnSB]

PS. I was told by a cardiologist that SSRIs could help with dysautonomia from deconditioning and might help premature beats. Do you agree? Any research on this you are aware of?

Thanks again.

Lynn

[LynnSB]

I'm SO ANNOYED.. ok.. this is so (*#&^@  typical. I just went to a meeting.. I had to walk a couple of blocks. I felt calm. Fine. About 3/4 of the way there, felt a feeling of being not "quite right", as if my heart had skipped a beat.. then it happened again. Went to the meeting. Felt fine. Calm.. easy... calmly listening and shook my head "yes".. blipblipblip -- felt like a couple of fast beats.. felt sort of very momentarily lightheaded but can't tell for sure it is anxiety/upset over the blip or what.  Few more minutes pass.. yes, I shake my head for "yes" again in agreement and the same thing happened... walking back to my car , no more blips.. get in my car, reach for the parking ticket in my glove compartment -- major heart "blip", feels like it stops for a moment.. and so on and so on.

I had an ablation on Sept. 15th. at a 4 week follow up with my cardiologist, he said my EKG was "perfect" and seemed to think no way could the ablation not have worked but he said I had "ambient" pacs and maybe being out of condition ( due to heart fears) was playing a role via dysautonomia and vagal tone.

I don't know any more. I'm just so depressed.. as I wrote this, a few more "blips".. I am so disappointed... no way will anyone put another monitor on me any time soon. I had 2 month long monitors pre-ablation. I see my cardiologist at the end of Jan.

I'm just so discouraged.thanks for letting me rant.

Lynn

[LynnSB]

>>They might desensitise your ectopics beats and you might not be aware of them , as they tend to have a numbing effect on the body as whole, that is why they are prescribed alot for PVCs , along with beta blockers.
<<

Yep, but only in part.. what I'm talking about is therapeutic usage for dysautonomia, POTS, etc.. which my cardiologist (and chairman of the dept. of medicine )thinks they can help treat.  He told me of a couple of dramatic cases where they helped folks who were actually passing out  from BP drops, etc.

But I don't have any firm research on this although I do know the national dysautonomia group mentions it. A lot of the older anti-depressants had pro-arrhytmic effects, actually. So  SSRIs  ( although can cause palps in some) are a welcome help for some as they can be used with less arrhythmia side effects usually for treating arrhythmia related anxiety/depression.. but my interest is in whether they actually have an effect on vagal tone or another pathway that could be beneficial to helping reduce ectopic activity.

[KarenSA]

Hi.  I have noticed that on a 'bad day' when my heart seems to be more sensitive, if I bend down and lean forward at the same time I will get a couplet and sometimes total confusion like the PVC's and the AVNRT run together.  I play golf and with the action of the golf swing, my AVNRT runs and I get short of breath.  I am finding it very difficult to play now as even if it is not life threatening, I keep feeling I have to wait for it to settle before I take the next swing.  Also, on some of the bad days, just breathing in very deeply can bring on a few PVC's.  Then on the good days, I can do all these things with absolutely no impact on heart rhythm at all (except the golf, that swing seems to be a real trigger).  Before my rhythm disturbances started more seriously at age 32 just after my first baby, I could play golf both days of a weekend, all day and not even know I had a heart in my chest!
Karen

[LynnSB]

>>I understand what you are saying , but What works for some might not works for others. I am sure some persons diagnosed with dysautonomia and POTS might do well on SSRIs, on others it probably has no effect at all. Like I said with medicines it is all trial and error. What works for Jim , might not work for Jane even though they have been diagnosed with same problem.<<

Absolutely -- hence the worsening of my symptoms and actually bringing ON my atrial tachycardia when I took beta blockers.


>>About them increasing or decreasing vagal tone, or reducing ectopics, I don't think this is the case, it is the numbing effect that they have that only appears to reduce them, therefore persons are able to resume normal activities because of the unawareness, it is the awareness that cause symptoms.<<


I hear you but , again, I was quoting a nationally known cardiologist ( i don't want to post his name but I assure you the Cleveland Clinic folks would know who he is) and scientist/heart researcher who says, in fact, that SSRIs CAN help dysautonomia and reduce ectopy in some people. And he was talking about demonstrable physiological differences ( tilt table testing, BP differences, etc) . Of course, I'm not saying this is for all people and I don't understand the theoretical mechanism to explain this.


>>They key to function normally is to reduce symptoms, even if the problem is still present, especially if it is not malignancy and pose no threat to life.<,

sure, but if there's a way to reduce symptoms by reducing the physiological process causing the symptoms, if possible, then that's best, in my opinion..

[LynnSB]

Well, from what I can see, SSRIs are being used to treat orthotatic hypotension and some dysautonomia and there is a vaso-vagal factor here SOOOOOo, I'm still curious about how and why that might mean they can help some people's palps (again, not talking about making people numb to them).  I'm assuming it's because palps can be caused by autonomic disorders? Vagal tone with too much sympathetic tone?

here's a little info I found:

Selective Serotonin Reuptake Inhibitors (SSRI's) are sometimes used to treat those with autonomic disorders. Studies have shown that some patients with autonomic disorders may have disturbances in central serotonin production and regulation (Grubb & Karas, 1998). SSRI treatment can supress the sympathetic nervous system (Shores, Pascualy, Lewis, Flatness & Veith, 2001). Venlafaxine is particuarly effective, possibly due to it's actions on norepinephrine as well as serotonin. It has been reported that SSRI's are effective in treating the chest pain that is associated with dysautonomia (Low, 2000).

from NY Medical center web site:

Effective treatment for chronic orthostatic intolerance is being developed but will depend on specific etiologies as these are discovered. For the moment we continue to use some of the medications outlined in the vasovagal section. Of these florinef and midodrine seem to be most effective with an emerging use of SSRI’s. Beta-blockers and clonidine are rarely tolerated and may point to a very different origin for COI from syncope.   Recently, selective serotonin reuptake inhibitors have been used to good effect in a variety of orthostatic disabilities. These seem to interfere with hypotensive responses at a central level. Grubb and associates have demonstrated efficacy of sertraline and fluoxetine in a series of controlled studies (31). The studies  were performed after careful psychiatric screening had ruled out significant depression. Personal experience bears this out and the SSRI’s remain a useful medication for many forms of orthostatic intolerance.

[LynnSB]

>>Hope you the relief you so desperately need
Hank.<<

oh, I'm not desperate.. I WAS 20 years ago when I was told it was all "stress" and "panic" which I knew wasn't true.
I'm frustrated , not desperate.

Sure, I supposed SSRIs could cause some people to "relax" and make palps less or less noticeable. But I don't think that is what the researchers are talking about at all. I think it is perhaps the modulation of various neurochemicals and how this effects the autonomic nervous system that might help -- IF they help. Unfortunately, SSRIs, like prozac, can cause some people to feel very agitated and anxious and even cause palps.

It is all a very complicated subject which I certainly don't claim to understand.. so that's  one reason why I posted here. Maybe someone else has some actual data about mechanisms contributing to vagally mediated arrhythmias and the possible therapeutic value ( not just the "feel better psychologically" value) of SSRIs.

Thanks for your comments.

[wmac]

quick question, regarding ef. So if a person has a low ef is that when one would go into sustained v-tach? And when they have a good ef like you and me they dont worry about going into sustained v-tach, is this correct?
wmac

[arthur]

It's all too easy to obsess about palps and keep wondering where they are coming from and keep thinking that there's something the EP missed or didn't explain...

The reality is that everybody has skipped beats.  The reality is that they come from islands of electrically-active cardiac tissue imbedded in normal cardiac muscle (again, everybody has these).  And, the reality is that their signals cause the skips.  In some folks, because of the location of such islands or their size or their activity, they can lead to more disturbing and potentially dangerous arrhythmias.  The degree to which their signalling reaches the normal pacemaker circuitry is governed in large part by the state of one's nervous system (a separate electrical system), in particular, the nervous system near and surrounding the heart.  Ergo, anxiety can lead to increased skips...not because your nerves are acting up, but because your autonomic nervous system is fired up, and provides an easier pathway for those cardiac islands to send off their signals.

The vagal (nervous system directly behind the heart) connection is simple enough.  A high vagal tone is one mechanism that the body uses to slow the beat of the heart.  Current thinking is that the slower the beat, the more likely an abberant electrical signal (like from a focus) will interfere with the next beat.

If you have the occassional skip, or like me, can have hundreds/thousands a day, just thinking about them will turn up that ole autonomic nervous system, giving the electrical noise generated by those cardiac islands (foci) a much easier path out and into your pacemaker system.  

Bottom line, if you've been diagnosed with a structurally normal heart, and the EP has declared your palps as benign, Ye gods! Stop Fretting, you're only making things worse.  Having said that..it did take me a solid year of calming myself down to stop thinking about them (excepting right now, of course).  The result was dramatic...from feeling every beat and every skip, I can now claim to be (almost) entirely ignorant of my heart beat. Of course, if you've raised your anxiety level enough, you'll be too paranoic to embrace such ignorance.  In my case, it has given me my life back.

-Arthur

[Momto3]

What a terrific message!! I couldn't agree more. It took me a little longer than 1 year, but in 1998, after a very compassionate doctor convinced me that the pvcs truly were benign, I took "heart" and moved on. It was kinda strange cuz I never worried too much about them except for when other doctors/nurses would listen to me heart. They would get that crinkled up look in their brows and say, "that's strange", "have you had this checked", etc... Then, I would begin to wonder all over again.  It would happen EVERY time I went to a doctor, lab, etc. In 1998, I was experiencing a "major storm" of pvcs and I was referred to an EP.  Decided to put my faith in God and the EP who studies this stuff EVERY day!! After 5 great years, still with thousands of daily pvcs, an ablation was recommended....Long story, but the short of it is: Had 2 ablations this year and I am doing great!  So many times we only get to hear the bad stuff on these boards...Thought I'd let others know, when ablations are recommended, they can be very successful! HERE HERE!! By the way, chocolate is wonderful....I may even indulge myself in a Pepsi :) (haven't had a Pepsi in probably 10 years...lol). For now, to those of you who have pvcs, pacs, have the standard tests to rule out anything serious, and trust the good doctors. If you cannot talk with your doctor, find another one...There are MANY, MANY wonderful doctors out there. Happy Holidays everyone!

[Ryman]

Hi Arthur. I'm now 11 weeks post ablation. Earlier when I read one of your comments I really couldn't relate. My symptoms were so frequent and I was so sensitive. Since then a few things happened. I believe the biggest one is that I saw my cardiologist who did some test and gave me really great feedback. This really calmed me down quite a bit. In addition I started taking aspirin again and exercising. I'm not sure if any one of these things or the combination is responsible, but I'm feeling much better. I have to believe that what you said is a big part of it. Being able to mentally calm myself down and accept that I'm in no danger, along with the assurance that my general heart function is o.k. really seems to have made a difference. Unfortunately, one has to come to that point on their own time in there own way. Even still, an episode of palps could potentially send me back into that vicious cycle of worry, but I'm doing my best and feeling it's positive effects. For me the catalyst was seeing my cardiologist and having all of my fears and questions addressed. I guess it's a matter of figuring out what your fears are and address them and hopefully accepting them. I was always what I believed to be a strong person and never felt any physical reaction to stress, but now know how powerful it is and how it can manifest itself physically.

[TITUS]

I have had experience with arrhythmia for twenty years.  Yes, sudden movements, especially turning and putting pressure on the area of your abdomen which your vagal nerve runs through can definately cause PVCs.  Also acid reflux can cause PVCs.

It took many years to convince my doctors but knowing this has helped many of their patients.

kim

[CJW III]

Hi I have chronic A-Fib. Beta blockers bring me down to 120BPM.
Irregular, sometimes while exercising it seems to even out to regular rhythm, but not for long. I told doctors this, but they tell me it's fooling me. Heart sppeds up when I rest and when don't eat for awhile. What's the name of your EP, and where did you get the ablation? Thanks, Joseph.

[Momto3]

My doctor is in Cleveland at MetroHealth Medical Center. There are several EPs there, as well as at the CCF.  My ablation was not for a-fib, but for persistent pvcs.  I do not know the success rates at Metro for a-fib ablations, but as for me, I'm quite happy : )