Andrenergic-Neurogenic Atrial Fibrilation/ Vagus

[kvpg217]

I was diagnosed last September with Paroxsymal A-Fib but as I began to look more into the various types of A-Fib I came across a type that deals with the Vagus nerve. It is amazing what organs and body the ganglia of the vagus nerve lead. I noticed it goes into the teeth, the intestines and the bladder if I can remember correctly. I find I get the a-fib at the same time (end of day after stress levels have been up.."adrenal") also during intestinal disturbances(meal or digestion probs-neurogenic).
I have always had that fight or flight response due to basically an anxiety disorder I have had for awhile(adrenal).
Q.
Will an ablation procedure take care of this type of Neurogenic-Andrenergic stimulation that may be causing the a-fib eventhough afib is thought to come from the pulmonary veins? or Should i find a way to contain the anxiety which may be exacerbating the a-fib before i decide on the ablation?

Thanks
Kevin

[StephPT]

You are right to question if the treatment for vagal A-fib is different than that of regular.  A lot of times, what is used for regular A-fib will make vagal stuff WORSE, which can help in the differentiation (but make one rather miserable in the process).  For example, beta blockers are often attempted to control heart rate, but in vagal A-fib, it will make the arrhythmia more pronounced.  I know this from personal experience.

Although i did NOT have vagal A-fib, i had a vagally mediated form of SVT that happened EVERY time I swallowed food, beverage, or even burped (a reverse in esophageal tone).  It was definitely vagal in nature, and was either an A-tach or an A-flutter, depending on the day.  No one locally could fix the problem becuase during most EP studies, they put you to sleep.  If i was sleeping, i wasn't swallowing.

I was referred to Oklahoma University Physician Warren Jackman for an ablation.  He is one of the best in the world, and is well-known for his ability to fix problems at which others have failed.  He specializes in A-fib ablation.  What is interesting about his technique (and why the 2nd trip out was successful for me, because he treated me exactly like an A-fib case) is that he not only performs the standard PVI (pulmonary vein isolation), but he also seeks out the ganglionated nerve plexi of the vagus nerve that innnervate the heart, and ablates those, too.  He was also daring enough to keep me awake and let me swallow on the EP table to induce my own arrhythmia while they mapped it's location (risky business because of the chance of aspiration once they DO sedate you...and you do want to be sedated during the ablating part.  trust me on this one.  i was awake the first time, and it feels like a hot poker going into your chest).  Needless to say, he is a very dynamic EP, and i am so pleased with the results.

I guess my point is, you want to make sure that whoever you are dealing with is able to differentiate between the two (vagal vs. non-vagal), as the treatment can be different.

Good luck getting the beast under control.

steph

[Forum-M.D.-MJM]

Hi Kevin,

Vagus' (as in 'vagabond') is Latin for 'wandering'.  The nerve 'wanders' through out the body and was given it's name accordingly.

Vagal atrial fibrillation tends to associated with actions that stimulate the vagus nerve like afib as you are falling asleep, swallowing, ice cream, relaxing, etc.  Fight or flight type stimlulation is more common in non vagal atrial fibrillation, that is unless you are almost fainting with your fight or flight response.  

I agree that if 'stres' stimuli tend to initiate you afib, stress control is the first route to pursue.  The second step in treating symptomatic atrial fibrillation is a trial of anti arrhythmic medications.  If these two options are not successful, ablation is a valid next step.

I hope this answers your question.  Thanks for posting.