Vagally Mediated Atrial Fibrillation and PVC's

[Dave0341]

I am 28 years old and otherwise a healthy individual.  Last April I woke up one day with what I believe to have been atrial fibrillation, but by the time the EMT's arrived, I had converted.  The doctor's at the hospital told me not to sweat it.  I then had about two more episodes of atrial fibrillation after binge drinking the night before, but converted on my own.  I did not think there was much of a problem until about a month and a half ago when I started to get PVC's every night.  Then about a week after they began, I woke up with my heart wildly out of control.  The EMT's came and hooked me up on a 12 lead and determined that I had a heart rate of about 280 bpm and that I was in atrial fibrillation along with Vtach and PVC's.  I went to the hospital and stayed about 4 days.  They thought maybe WPW, but my echo and stress test were negative for the delta wave or any other problems.  I had an EP study performed, whereby my elecrophysiologist concluded atrial fibrillation.  However, I think this conclusion was based on the notion that they were unable to reproduce my arrhythmia, so AFib was the default answer.  I have been doing extensive research and thought my arrhythmias were related to GERD because I had noticed my PVC's were worse after acid reflux.  It got to the point that every time I would lay down, I would have constant PVC's.  On Thanksgiving I had bad heartburn, one alcoholic beverage, and atrial fibrillation the next morning.  I had gone on a GERD friendly diet waiting to see the physician, and I magically felt a lot better.  However, a few days later I started having PVC's at night again, but this time it was not when I laid down, but rather after I had slept for awhile.  I had a barium swallow, which came back negative for GERD, but positive for duodenitis.  Feeling lost as to my problem, I came across information about vagally mediated atrial fibrillation, which seemed to make the most sense.  I believe my duodenitis to be caused by an over-secretion of stomach acid due to the vagus nerve, which is why the test was negative as to GERD.  I am also male, young, otherwise healthy heart, former military and athlete.  I now have PVC's, which occur after about every 5-7 hours of sleep.  I can I get up for a few hours and then go back to bed (assuming my vagal tone is not so high) and I can sleep without palpitations.  I feel my heart rate is not as consistent anymore as it used to be.  My resting rate is about 75-85 bpm, but goes up to about 120 or 130 when I stand up and walk around.  So my questions are: (1) does this sound like vagally mediated atrial fibrillation and PVC's? (2) is an ablation a viable option for vagally mediated atrial fibrillation? (3) are there any tests that can be performed to check the function of the vagus nerve? (4) Should I also see a neurologist, and if so are there any subspecialties to look for that focus on the vagus nerve?  
I should note that I am seeing my electrophysiologist this week, and I am scheduled to see a gastroenterologist sometime soon.  I am on diltiazem, but I only take as needed to convert out of AFib.  However, I have taken the dilitiazem hoping it would help with the PVC's, but it did not seem to make a difference, and maybe even made them worse.

[ArthurGibs]

Vagal tone can be reduce by taking propantheline bromide. This can substantially help vagal afib. See: http://beatloneafib.blogspot.com/

[Dave0341]

I have considered sleep apnea as a cause, but in my case I feel that if I did have sleep apnea, it would most likely be the constructive variant particularly because I do not have any of the anatomical characteristics that would point to OSA.  However, I do not seem to have many of the symptoms that go along with sleep apnea, for instance I do not snore, I typically feel well rested when I sleep the requisite hours, I rarely wake up at night, I do not wake up gasping for air, and I do not have morning headaches.  I will certainly speak to my doctor about this possibility though, thank you.

[CrohnieToo]

This may seem a far out stretch - but have you given any thought to obstructive sleep apnea? You don't have to be old and/or fat to have OSA. Altho snoring is common you don't even have to snore to have OSA altho it is a strong indicator.

OSA is an anatomical problem. Cause is often too large tongue, too long uvula, parrot mouth, short neck, thick neck, receding chin, etc. Something causes the throat to close off or partially close during sleep and/or while supine.

OSA is related to MANY health problems: GERD, silent reflux, hypertension, stroke, heart attack, diabetis, nocturia, kidney failure, etc, etc. etc.

[is_something_wrong]

A vagally mediated arrhythmia is usually an arrhythmia that occurs when the heart rate is slow.

An example:

It's common to have PVCs and PACs when your heart rate is slow, and you have a certain "anxious" feeling in the body. What may happen is that the vagus nerve is active, and it's somehow directly connected to the sinus node (vagal stimulation may instantly affect the sinus node). Adrenaline is, on the other hand, still stimulating the heart tissue, making it irritable, and when the sinus node isn't similary affected by this, lots of ectopics are triggered.

The wider this "gap" between adrenaline and heart rate is, the higher chance of an (usually benign) arrhythmia.

Bradycardia-induced A-fib may occur if several atrial spots suddenly decide to take over the pacemaking function when your heart rate is low. It's usually terminating itself when the sinus node takes over or the adrenaline levels reduces. If this happens often, the doctor should rule out the condition "sinus node dysfunction" a.k.a tachy-brady syndrome and sick sinus syndrome (SSS).

Short runs of atrial fibrillation is a common atrial arrhythmia, along with short runs of atrial tachycardia and other supraventricular arrhythmias. It's often misdiagnosed as "several PACs" and vice versa. They are often triggered by stress and adrenaline surges. What is important to rule out, is any causes for the arrhythmia, such as structural changes in the atria, valve dysfunctions, cardiomyopathy and high blood pressure.

Keep in touch with your cardiologist, and I hope this was somewhat helpful :)

[itdood]

If it is vagally mediated, I think the only option to treat it would be to avoid situations that create more vagal tone.

Keep in mind that "vagally mediated" doesn't mean the vagal tone causes the a-fib per se.  It means that increased vagal tone sent a signal to your heart to relax and for some reason your atria went into fibrillation.  Ultimately it's your heart muscles that cause the fibrillation, no the vagal tone.  You probably have the same vagal tone as everyone else.  For some reason your heart is prone to afib at slower rates.

If you get an EP study done hopefully they can isolate the spot that is causing it.

I swore up and down that my PVCs were caused by digestive issues.  I went as far as to have a complete endoscopy of my upper GI and a colonoscopy.  Everything there was perfect.

Keep searching though, you will eventually navigate your way to some answers.