Vagus Nerve and Arrhythmia

[Robb S]

I am quite certain that my periodic arrhythmia is caused by my vagus nerve getting stimulated in my abdomen region.  The reason that I believe this is because the arrhythmias can be triggered not only by spicy foods or reflux but also by working my abdominal muscles in the wrong way.  Raking leaves, swinging an axe, jogging and even stretching has started episodes of arrhythmia.  My GP has run me through the basic tests and deemed the condition non-life threatening.  When I mentioned the possibility of the vagus nerve as the cause he had no ideas as to what to do for diagnosis.  He has prescribed a beta blocker which has had minimal effect.  I can control the problem if I am careful to avoid eating things or doing things that bring the problem on but I lead a pretty active life and when an episode comes on I just have to sit down and rest.  A couple more things, my father had a similar condition when he was about my age (51).  His eventually went away by itself.  Also, when the episodes begin I usually feel pulsing or pressure in the area about 3" above my navel.  I believe that this is the vagus nerve firing.

So my question is how can I help my GP to order appropriate testing or send me to the right specialist?  Would a neurologist be knowledgable?  No doubt drugs would be an option for treatment, any other options?

[Michael J. McWilliams, M.D.]

So my question is how can I help my GP to order appropriate testing or send me to the right specialist?

There are no tests to order.  Vagal induced arrhythmias are suspected based on history but as of now cannot be proven with tests.  Triggers are usually right as you start fall asleep, stimulated by swallowing, etc.

Would a neurologist be knowledgable?

the most knowledgeable would probably be an electrophysiologist, but again, if there is no test to prove it, we can only suspect this to be the case. Things like exercise, jogging, raking, swing an axe, etc are not consistent with vagal induced arrhythmias.  It is usually swallowing and arrhythmias right before you fall asleep.

No doubt drugs would be an option for treatment, any other options?

Vagal induced arrhythmias can be treated with disopyrimide, but this is not a commonly used medication.  It also depends on what the arrhythmia is, how frequent, and how symptomatic you are.  The only other therapy would be an ablation that would remove the vagal inputs, but this is usually only done with atrial fibrillation after medical therapy has failed.

I hope this helps.  Thanks for posting.

[Robb S]

Thanks for the quick reply.  Unfortunately you didn't have the 'magic bullet' cure for me:)

I never had the arrhythmia start from swallowing or at bedtime.  I believe that the vagus nerve runs down across the stomach so I am suprised that stomach and abdomen issues are not in the list of  triggers.  My father was told that his arrythmia was vagus nerve triggered but I don't remember what conditions brought his on.  My father-in-law has irregular beats after eating too much.  I've read many cases on the internet about stomach conditions that trigger arrhythmia.  If my condition isn't related to the vagus nerve then there has to be another path from stomach/abdomen to the heart.  It sounds like the best treatment for now is the avoidance of my trigger conditions.

[Michael J. McWilliams, M.D.]

unfortunately, yes.  what is the arrhythmia?


unfortunately there is a lot in this field that we are still learning.

[StephPT]

The doctor is right about the usual triggers for vagus nerve involvement, and the recommendation for Norpace (disopyrimide), although this drug did nothing for me.  vagally mediated arrhythmias are usually made worse (or i should say more symptomatic, as they are still "benign") by beta blockers.

I was fortunate enough to find an EP who was willing to ablate my case (even though it wasn't a true "A-fib") by focusing on the vagal inputs in the left atrium.

If you GP isn't giving you the right answers, trying a cardiologist, or, as the doctor recommmended, an EP would be the next step.  Saying you are going to "avoid the triggers" sounds easy, but it may not be feasible.

Good luck!

Steph

[Michael J. McWilliams, M.D.]

Steph,
What arrhythmia did you have?  What type of ablation was done?
Just curious.

[StephPT]

Dr. McWilliams,

I am one of the lucky (and rare) few who has had a swallowing-induced tachycardia.  It presented as an atrial tach/atrial flutter (non-sustained, 2-20 beats, rate ~180-220) EVERY time i swallowed food or beverage, and if i burped (reverse esophageal pressure).  It was not mechanical in nature (we did barium under fluoro during the procedure and my focus was nowhere near my esophagus), and it was not resolved with ANY type of medication (one would think the norpace would work.  I did refuse Amiodorone and Betapace...I'm only 34 y.o.).  Ablation attempts were unsuccessful by my local docs, as they sedated me...no swallow, no arrhythmia.

I had the privilege of traveling to OUMC (twice).  They were willing to let me drink sprite on the table to induce my own arrhythmia for mapping (after 9 hours and 64 oz. of sprite, all i can say is thank goodness for foleys!!). First ablation was focal in the left atrium and we thought we got it, as i swallowed for 30 minutes post procedure with no arrhythmia, but 4 hours later, it came back.  6 months later, went back for another attempt, and this time, they did a PVI to the right superior and inferior pulmonary veins AND a ganglionated nerve plexi ablation times 2.  I have been arrhythmia-free for 19 months, and i'm so glad i had it done.

Although they say curiosity killed the cat, i'm happy to share my story with you, as it certainly isn't the norm.  When i went to Oklahoma, even THAT team (and as you know, they aren't your average group out there) wasn't willing to let me drink on the table until i showed them what i could do on EKG.  It was a learning experience for everyone!

Hope that answers your questions,
Steph

[scouser costa rica]

Do you have GERDS (acid reflux)? Some panels believe that this can produce vagal sourced LAF.

[reets80302]

Bingo.....If I run, eat, or move heavy stuff I get flutters. This all came on after a nasty stomach bug I had from consuming bad creek water. I took a bunch of harsh meds to clear out any and all parasites but since I have had these persistant flutters. This vagus nerve connection is very interesting. I have had nearly every cardio  and gastro test available and all say I'm OK, BUT, I know what I am feeling (flutters) are just not right. My family doc is looking more towards that this is an anxiety issue and suggestiong SSRIs. Ughh, this is so very frustrating. I just want to feel normal and do the things I love = run, eat, work hard in my yard without the flutters and fear of dropping dead.

I guess the next time I meet with my gastro doc I will mention the vegus nerve idea. I feel like I am in a medical maze,

[fwilson]

This is a bit off topic, but years ago I suffered form a severe viral infection that I believe injured my vagus nerve.

I have lousy blood pressure and heart rate control now, a deviated uvula, easily tired voice, gastric dysmotility....the list goes on and on.

However, no doc is willing to give the diagnosis of vagus nerve damage.  Do any of you know of any specific vagus nerve imaging tests that are avaliable?

[StephPT]

To the best of my knowledge, there is no imaging test that detects nerve damage.  Nerve damage is frequently diagnosed by symptoms within the nerve's distribution.  peripheral motor nerves can be examined with EMG/NCV studies, but this is not possible with something like the vagus nerve.

I'm sorry to hear of your frustrations with the medical profession.  what types of docs have you seen?  And, what would change in the course of your treatment if you DID find someone to say that is what's wrong with you?  Aside from piece of mind (as i'm sure you have run into a doc or two that tried to tell you that you were nuts), i'm not sure there is much to be done.

I hope this helped.
steph

[fwilson]

Hi Steph,

Yes, I know you cannot do standard EMG/NCV studies on the vagus, however I think imaging studies to look for obvious lesions should be possible.  Its not THAT small.

Piece of mind should not be underrated, however there are pratical concerns to firming up elusive diagnoses that many physicians do not see.

First and foremost is the need to stop seeing MORE physicians.  Once a diagnosis is firmed up, and it is clear not much can be done, much lower frequency of follow up is needed than the constant seeking of new opinions to explain a symtpom set.  This can translate into thousands of dollars not wasted on healthcare.

Second is the ability to particiapte in research and treatments however primitive at this stage for said malady.

Third is the ability to achieve a certain level of care in emergency situations.  When going to the ER extremely ill and being asked your past medical history, having to explain, "I've been very ill for 7 years with ...something." , generally is not helpful to the physician or to the patient's level of care.

[scouser costa rica]

Try afibbers.org. Lot of interesting info.
                                                 Regards Ian

[spacefan]

I have been diagnosed with a small duodinal ulcer and a high H. Pilori
bacteria count and have some arrythmia. Two EKGS one by my DO and the other by a cardiologist indicate that I have PVCs. I have gas with the PVCs sometimes, and they seem to start after I eat. When I take Pepcid, It seems to quiet them for awhile. I am also on a lowl dose of beta-blocker.
My question -- can the ulcer and or the H. Pilori trigger the PVCs and could teh vagus nerve be involved.
Thanks for your help, as I'm really getting bummed out, since neither
doctor seems to  acknowlwdge that such a relationship exists.

[scouser costa rica]

If I have A-Fib in the morning,light exercise,controlled by my Polar monitor usually stops it after about 10 mins. In the afternoon when exercise is not possible I chew ice and drink ice cold water which brings my HR down to within normal limits alhough not back to NSR.
                                        Regards Ian

[Mawa]

There is a connection,  I am no doctor but my problem always occurred after i eat spicy food, even in small amounts.

However the way this connection takes place is not well understood yet.

I have been having Heart PVC for over a year now, at the begining i started to feel stomach discomfort after dinner, but at that time i was not sure they were related.

Doctors have done some tests to my heart, Blood tests, Chest X-Ray, EKG, ECG ,Holter 24 hour, Stress Test, all came back good, with the Holter indicating the PVC and a sinus bradicardia during deep sleep.

Every time i eat i feel the stomach very upset with a lot of gas and the heart palpitations start to occur. most of the time, always at night, but sometimes when my stomach is not feeling well during the day the PVC's appear also.

The doctors then went to check my stomach by Endoscopy and Biopsy and  found i have a chronic Gastritis with presence of Helicobacter.

They told me the stress and stomach are somehow playing a role in the PVC's ,

1- excess of gas and acid irritate the esophagus which lies immediately next to the heart.

2- The Doctor also told me that vagus nerve is the parasympathetic nerve that goes from the brain to the right atrium of the heart, it also innervates the stomach  This nerve is also affected by stomach and stress disorders,  and it could affect the normal heart rhythm , although the way this happens is not well understood yet.

I have started the treatment and i can say that i feel better, somedays i have no palpitations, the other day i felt so good i forgot about the problem and  i accidentally skip a meal and later eat something spicy then i felt the PVC again.  

the treatment was antibiotic for the Helicobacter and Omeprazol
also eat more often , at least 6 times a day, but in small amounts.
avoid coffee, alcohol, do exercise, and avoid spicy foods like curry and things like that,