I have had vagally-mediated afib for about 10 years. I first noticed pac's in my 40's and then while playing golf one day the swinging of the club set off a bad episode of afib. Although it goes in cycles, there are many times when the afib was triggered by what I eat or drink. More often it would get set off by stretching or contracting my abs, like when lifting weights. I recently had an ablation done for the afib and the episodes are disappearing. My feeling is that my trigger is the vagus nerve getting irritated by a little reflux or by pressure exerted on it by my abs. I also went to a GI MD who was certain that my afib could not be caused by anything going on in my stomach. I would get your h pylori taken care of first- I remember reading that it can trigger afib. If you have even a little reflux get it under control. If episodes persist see an electrophysiologist. He will first try meds. If they don't help then you could try an ablation. The best hope is to control the trigger(s).
Regardless of the doctors opinion if you notice a pattern in yourself then likely there is a trigger involved. I would suggest cutting down on the size of your meal to see if that helps. Maybe eat more smaller meals so your full stomach doesn't put any pressure on any nerves. As well try to avoid spicy, sugary/carbohydrates and see if that helps. I think taking steps to try and clear up the h pylori will hopefully help but other than that maybe try some otc meds for the gerd and indigestion and see if that helps. Finally do your best to manage any stress in your life. Stress can be very subtle sometimes so just take some time to evaluate how you handle everyday situations and see if there is any tendency to stress. Take care and I do hope that your afib settles down.
Thanks so much Michelle for the advise. This is the best advise all day. My cardiologist was out of the office today. I will be checking up with them next week. This has been a crazy month. I have dealt with afbis before but not this frequent. My body is definitely changing. But I do have a lot of stresses this month. I will take your advise and try to be more stress free. :-)
and I will definitely cut down on the size of the meals as well.
It could be direction that's aggrevating the issue but IMHO I wouldn't think of the vagus nerve as a root cause. When you eat your body will send signals to the heart to speed up to support digestion.
The root cause of the afib is the heart muscle.
*direction should be: Digestion.
Thank you for responding. Yea I definitely believe its digestion thats aggravating the issue. Im just not sure why all of a sudden more now than ever. Maybe its age or stress related. Im just praying that the muscle hasn't gotten any weaker. My cardiologist told me the size has stayed the same and my levels look good. So I believe this to be a GI related problem thats causing my a fib to flare up. I'm trying to control them and have them stay at bay.
Thanks for responding Robb. My cardiologist concurs with the electrophysiologist. He wants to put me on the drug Norpace which is an older drug for controlling rhythm. He told me I'm not a candidate for an ablation yet. What makes you a candidate and what doesn't. Is it the amount of episodes, age and other risk factors? I have the script for Norpace but have not filled it yet. My Cardiologist told me to try to pace myself better by eating smaller meals and controlling the reflux and the GI told me its just a nervous stomach and didn't recommend any acid reducers. I took it upon myself to consult with a pharmacist and get their recommendation and they recommended prilosec right now. I also picked up myself Ginger Root which I heard helps to calm the vagus nerve during digestion. I'm going to see how it goes for the next couple weeks. I will be starting the H pylori medication right after the holidays. My GI told me the medication is going to make me a zombie. I don't want to feel like that this next month.
Sounds like a good plan. I drink ginger tea and eat a lot of ginger chews candy. I know that it is good for digestion but didn't know that it can help the vagus nerve too. As for what makes you a candidate for an ablation, there is a protocol in afib treatment that the doc's follow which calls for the meds as the first line treatment. If you don't respond to the different types of anti-arrhythmic drugs then your would be considered for an ablation. I have read that because the risks in the ablation procedure have been reduced due to new methods, some doc's are considering ablation the first line of treatment now. The success rate from meds is only around 50% whereas ablation success is 75%-80% according to my EP. Success meaning no afib lasting over 3 minutes.
I can tell you definitely that my afib is vagally mediated. Last December I had 2 back to back episodes (after nearly 2 years without an episode). The first was after eating a REALLY big meal and the second was right after I ate a salad and a cold drink. It turned out my thyroid was very low and that can cause an episode too. I am taking Norpace and it was what kept me in normal rhythm for the 2 years. After my December episodes, my Norpace was increased and I have been ok except for one time when I tried another med (Rhythmol) and it made me very sick. I went off the anti-arrhythmics and only took a beta blocker and was back in afib in about 3 weeks. So back to the Norpace which has kept me in normal rhythm since last December except for the Rhythmol incident in May, so 6 months now with no episodes. I have found lack of sleep, large meals, spicy food, stress, constipation, too much sugar all to be triggers for me. I use no caffeine at all -- not even chocolate:P I miss it, but it's not worth the whole trip to the hospital, getting zapped thing. I am going to the Cleveland Clinic in march for an opinion on an ablation. I believe the criteria is you have to fail 2 medications in order to have the insurance pay for an ablation. My EP sad I qualify, but another doctor told me it is reasonable to wait until this med fails. I take Atenolol (beta blocker), the Norpace and Xanax to help when my heart gets irritable or I am stressed. I hope some of this helps. Don't give up hope -- you are not alone and this can be managed. I am keeping you in my thoughts and prayers. Keep us posted on your progress.
Fellow Afiber -- Just wondering if you would share where you had your ablation done and how it went. I may be a candidate soon and want to find out all I can BEFORE I'm in a crisis situation. I am now not going back to normal rhythm without a electrocardioversion, which I would do nearly anything to avoid. I am stable now, but I know that an episode could happen next week or next year. I am so glad to hear that you had a successful ablation.
Sorry to hear that your episodes require cardioconversion. I have never had to go through that. I was in AF 25%-30% of the time before the ablation. Now after 7 weeks I am down to about 10%. What you should know is that it usually takes 3 months or longer to really know the degree of success of the procedure. So I have a ways to go yet but I am very encouraged. I had mine done by Dr. Sra at St.Lukes in Milwaukee. They are the top heart hospital in WI. Cleveland Clinic is very well spoken of as well. Mayo's would be another top clinic. I recommend that you have it done at a highly regarded heart hospital. I went into AF only 8 hrs after the procedure and was mostly in it for another 5 days. After the dr's nurse prescribed Metralol in addition to the Tikosyn that I started in the hospital, I began to get back to NSR. Since that first week my time in AF has been trending down gradually. I still get pac's but my heart is much more resistant to AF now. I read about a study that shows that subjects that were given anti-inflammatory meds immediately after the procedure had a 17% greater chance of long-term success. Something that you might want to ask about. Let me know if I can help with any other info.
Thanks so much Delta for responding. My episodes with the last two afibs i've had back to back were EXACTLY like yours. My first was with a large meal and the second with a cold drink. I've become more sensitive to them now and not sure why. However, this past month I've had a lot of stresses in my life with stuff at work, etc. and I've been sleep deprived and dealt with a bout of constipation. So I'm guessing those could be the culprits. My cardiologist did recommend Norpace. I'm just skeptical of going on it because I'm not to fond of medication. I do take 100mg twice a day of metoprolol. At this point I am debating on going on it now. I just have to fill the script and give it a try. I also might ask to see if they can look into xanax for me as well. Just to take the edge off. Having heart problems and exeperiencing a fib for th east 14 years has made me such a nervous person. Sometimes it effects my lifestyle and I hate it. :-/ Thanks so much for keeping me in your prayers. Godbless you. I will keep you in my prayers as well.
Thanks for the info. So do you expect to stay on Tikosyn or is that yet to be determined? I know many people can get off meds entirely after ablation and I am hopeful that I would be able to. Norpace is keeping me in normal rhythm but has some side effects -- nothing major -- but I would prefer to be off of it. Also, I have needed one increase in dose and expect that may continue. Higher doses = more side effects, another reason to consider ablation. I also believe that I can expect more afib from my ageing heart and it may be best to get the ablation sooner rather than later. Thanks again.
I would suggest sipping, not gulping, cold water or beverages. Also, carbonated drinks do not agree with me -- I believe because the carbonation builds up and pushes against the heart. Not sure, but know I am better off without it. I once went into afib after 2 pieces of sugar free chocolate and half a bottle of diet soda. Simple things that would not bother a person with a normal heart can put us into afib. It IS very nerve wracking and the Xanax allowed me to function in my very stressful job the last 2 years I worked. Meditation is a big help for me. I belong to a heart group at my cardio's practice and that has been a big help with information as well as emotional support. Are you on a blood thinner? I have been on Warfarin to prevent strokes for the past 3 years. Sending good thoughts and hope for good health your way . . .
BTW -- Not sure what the HCM cardiomyopathy is. How does it factor in to your afib?
BTW -- Not sure what the HCM cardiomyopathy is. How does it factor in to your afib?
Sorry, I failed to mention that after an ablation you will be on an anti-arrhythmic med for a few months. For most people the heart will be doing some strange things as the lesions heal and the idea is to keep it out of afib as much as possible during that time. Honestly, I don't think that the Tikosyn helped me as much as the Metropalol but I will stay on it until the EP says that I can stop. No doubt that there are some that need an anti-arrhythmic long-term afterwards to stay in NSR. You will also be on a blood thinner for about 3 months as a safety measure as things heal. You should probably have the ablation done sooner than later if you are over 60, as the risks go up slightly with age.
I was on a blood thinner for a few weeks after one of my arrhythmia's but many doctors now follow the CHADS2 score guidelines. Its a series of questions each one is a point. If you have a history of diabetes, hypertension, over the age of 75, have had a stroke before, etc. They take the points and if they add up over 2 then they look into putting you on a blood thinner to help reduce the risks of the side effects of stroke.
HCM is a condition where I have an enlarged heart. I have an obstruction on one side. It gives me an irregular heart beat because since one of the walls is thick, it becomes harder to push blood from and to the heart. I take metoprolol for my condition. But the side effect of having this condition is the arrhythmia's. Everything I do I have to do in moderation or with some caution. It puts a damper on my lifestyle because I do wish to do somethings in life that my other friends can do. But it is what it is. Everything happens for a reason. I always have to look at it, that their are people in the world with far worse problems and i'm blessed to only have these problems which can be controlled.
Sorry, my computer wasn't letting me post. I agree many things about heart issues are life changing if not life changing. I, too, am very grateful for the health I do have. Whenever I run across someone with worse issues, I am grateful to still be able to function, even if it is not in top form. My chads2 score was high enough for me to go on warfarin 2 years ago.
should have read, "if not life threatening, life changeing"
My symptoms are nearly identical to yours. What helped me was losing weight and exercising (specifically cardio, such as light to brisk walking 30 min/day, as opposed to resistance training). Fasting, such as skipping dinner, has made a big difference - helped reduce reflux and corresponding palpitations.
Some people have also had some relief with magnesium supplements and dietary enzymes to aid digestion.
I hope this helps. And if you try it for a few months and it works for you, please post again to provide feedback to the community. There appear to be a lot of people with similar symptoms out there that are not being adequately addressed by cardiologists.
Interesting you mention the vagus nerve. I've had a rough day with PACs/PVCs today, and I notice a lot of triggers that could be related to the vagus nerve. In my case I've observed certain positions trigger arrhythmia. Sitting upright after a meal is now a big no. It wasn't always like this, something has changed the past couple of months. Also, whenever I sing my heart begins skipping. Was singing today, and it caused them. They ended up lasting all day.
What else can cause positional induced arrhythmia if not the vagus nerve? I'm not convinced the professionals know what they're talking about half the time. They can't even tell me why these are happening, so I'm not convinced they know the cause.