Re: Vagus nerve and afib triggers

[Guest guest]

My experience from my cardio is that the longer in afib the more chance of

stroke, so my cardio only waits 24 hours.

Barb

[Guest guest]

In a message dated 6/6/01 7:01:19 PM Pacific Daylight Time, diann@...

writes:

<< So I am hanging around my

house hoping this episode stops soon. >>

This may not be true of everyone, but I find that I am more likely to convert

from afib to sinus when I am busily involved in the normal activities of my

not-so normal life. I have never been cardioverted electrically in eighteen

years of afib, and have never even been in a hospital for afib. In January I

did go to an emergency room while in afib, but I went because my dog

accidentally put her paw in my left eye and scratched it, not because of the

afib. While I was waiting to be seen by the doctor, I spontaneously

converted to sinus even under all the stress of eye pain and worrying about

damage to the eye. By the time the nurse took my blood pressure and pulse,

both were normal In the beginning of my afib episodes eighteen years ago, I

would sit around my house, anxiously waiting to return to normal even while I

was anticipating death at any moment. (I didn't know then that the problem

was afib; I didn't even know of the existence of afib as a medical problem.)

Now I just go on with my life, taking my pulse occasionally to see if I am

back in sinus yet..

[Guest guest]

Diann Payne wrote

>He says the trigger for afib is an ectopic beat coming at a particular point

>in the heartbeat cycle. There is no way of knowing when that will happen.

>It is a random thing.

>

>Re the vagus nerve and afib, he said very little is actually understood

>about that relationship. But he thinks that afib episodes triggered by

>cold drinks are still about an ectopic beat happening at the wrong moment.

AIUI, ectopic beats are entirely normal - even folks with entirely

normal hearts get them. I also had this confirmed just this last Monday

by my new Cardio. What differs is how the heart reacts to the ectopics.

If the heart tissues are prone to AF for whatever _other_ reason then an

ectopic can set off AF (e.g. if at the wrong point in the cycle). If

there are no ectopics, then the likelihood of AF is, supposedly, zero (I

don't quite believe this myself). But because if there are no ectopics

there is no AF dose NOT mean, IMHO, that ectopics are the CAUSE of AF -

another trigger, if I can borrow the Dr's terminology.

[i know this wisdom is the current one - that stopping ectopics stops AF

therefore that's what the cause is, but I'm afraid I don't buy it. It

seems odd to try and prevent a normal happening from occurring.

Although of course if it works (and it does seem to) that does not mean

I wouldn't opt for it if I ever got to that stage(!) ]

Vagal overstimulation will release extra neurotransmitters at the SA

node and will set up the conditions for an ectopic to kick AF off.

Re. not much understood about the vagus and AF, I am not sure Professors

Coumel and Camm would agree with that. Search Medline for those two

authors:

" (Coumel [au] OR Camm [au]) AND (vagal OR vagus OR vagotonic OR

autonomic) "

and you'll get a whole bunch of stuff. Coumel originally defined the

vagal AF condition, and Camm wrote the chapter in 2nd Edn which replaced

Coumel's 1st Edn one on it in Falk - " AF - Mechanisms and Management "

Best of health to all,

Vicky

" Science may be described as the art of systematic over-simplification "

- Karl Popper

" All truth goes through three stages: first it is ridiculed, then it is

violently

opposed, finally it is accepted as self evident. " - Schopenhauer

" Wisdom is the quality that keeps you from getting into situations where we

need it " - Doug Larsen

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

- - - - - - - - - -

[Guest guest]

Starfi6314@... wrote

>I find that I am more likely to convert

>from afib to sinus when I am busily involved in the normal activities of my

>not-so normal life.

Classic vagal, sounds like. Before I knew about raising the heart rate

I wondered why the occasional bit of activity would pop me back into

sinus, but now it is clear.

Best of health to all,

Vicky

" Science may be described as the art of systematic over-simplification "

- Karl Popper

" All truth goes through three stages: first it is ridiculed, then it is

violently

opposed, finally it is accepted as self evident. " - Schopenhauer

" Wisdom is the quality that keeps you from getting into situations where we

need it " - Doug Larsen

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

- - - - - - - - - -

[Guest guest]

Hi Diane,

I am sorry to hear you having these problems, it does not seem to

get any better for us old timers with AF.

( I refer to old timer re the AF).

Ectopics beats this is what I have gleamed from various drs I have

met. These are the beats that feel like you have missed a beat. They occur

in a normal heart between 50 and 80 beats a day, for some reason they make

our Hearts go into AF. Why this happens to some and not other is not known.

There is some evidence that there are nerves in our Atria that are exposed

and giving of these extra beats to the ATRIA causing AF.

The MAZE and the ablation cuts of these beats an isolates the ATRIA. The

MAZE being more effective at doing this.

I to am going into AF nearly every day now even after increasing the

Dofetilde to 500mg x 2 per day.

I am hopeful that I will have another ablation either in the UK or France.

I have an appointment on the 7th July so I will keep you all informed.

Regards

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[Guest guest]

> This may not be true of everyone, but I find that I am more likely

to convert

> from afib to sinus when I am busily involved in the normal

activities of my

> not-so normal life.

Trying to do anything that involves physical effort makes my heart

stuff worse and when I persisted in the early days at the advice of

my former internist, I put myself into tachycardia. My best bet for

converting is to lay down and try to relax.

I wonder if this is an adregenic(sp?) vs. vagal difference?

[Guest guest]

>He says the trigger for afib is an ectopic beat coming at a

particular point

> >in the heartbeat cycle. ...

> I also had this confirmed just this last Monday

> by my new Cardio. What differs is how the heart reacts to the

ectopics.

> If the heart tissues are prone to AF for whatever _other_ reason

then an

> ectopic can set off AF (e.g. if at the wrong point in the cycle

Can someone say more about this point in the cycle thing? What does

an extra beat have to do with the atria going nuts? Thanks.

[Guest guest]

>Trying to do anything that involves physical effort makes my heart

>stuff worse and when I persisted in the early days at the advice of

>my former internist, I put myself into tachycardia. My best bet for

>converting is to lay down and try to relax.

>

>I wonder if this is an adregenic(sp?) vs. vagal difference?

Hi Trudy , I don't think this is the case. I also am pretty much bed bound when

I'm in AF. If I exert myself my heart rate can rapidly hit the 200 bpm mark and

things get pretty uncomfortable.

I almost always going into AF when I'm resting in the late evening or when I'm

asleep (only 3 or 4 occasions out of the last 50 episodes has my AF been

'exercise induced' and even some of these are debatable whether I was on my way

back down to rest)

My attacks normally last around 24 hours and I have discovered that when things

have calmed down a bit - around 5-10 hours into AF I can get up without putting

my heart under too much stress. Sometimes I get it wrong an my heart starts

racing- most time I can walk or sit up without too much discomfort. I've also

discovered there is a chance about 18 hours in that exercise or a large meal

will bring me out of AF.(I'm still at the anecdotal stage though and this may be

just coincidence but, given other peoples experience, I think there is something

in it)

cheers

--

D

[Guest guest]

>I to am going into AF nearly every day now even after increasing the

>Dofetilde to 500mg x 2 per day.

>I am hopeful that I will have another ablation either in the UK or France.

>

>I have an appointment on the 7th July so I will keep you all informed.

>

>Regards

>

Hi , really sorry you are having problems.

If you go for a third ablation is it likely that the EP study will find new

places or do you think they will say some of the ablated places are still

generating the ectopics. I'm a little concerned that, if this is a moving

problem, they will ablate a 'fresh' area but the ectopics will then move to

another location. I'm thinking of the 'meandering' reentry nature of AF. I

really don't want to stress you out further and I really don't know much about

ablation but it may be something to consider.

all the best

--

D

[Guest guest]

trudyjh@... wrote

>Trying to do anything that involves physical effort makes my heart

>stuff worse and when I persisted in the early days at the advice of

>my former internist, I put myself into tachycardia. My best bet for

>converting is to lay down and try to relax.

>

>I wonder if this is an adregenic(sp?) vs. vagal difference?

Definitely. Speeding the heart up can stop vagal attacks, but will make

adrenergic attacks worse. However, it is said that there is no such

thing as a purely vagal or purely adrenergic AF. What seems to matter

is the balance of the vagal and cardiac nerve impulses, but a trend can

often be found. I discuss my understanding of this on my website (see

links page)

Best of health to all,

Vicky

" Science may be described as the art of systematic over-simplification "

- Karl Popper

" All truth goes through three stages: first it is ridiculed, then it is

violently

opposed, finally it is accepted as self evident. " - Schopenhauer

" Wisdom is the quality that keeps you from getting into situations where we

need it " - Doug Larsen

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

- - - - - - - - - -

[Guest guest]

trudyjh@... wrote

>Can someone say more about this point in the cycle thing? What does

>an extra beat have to do with the atria going nuts? Thanks.

AIUI, the normal SA node impulses spread around the atria, make them

contract, then mostly die out, except those which reach the AV node,

which kick the ventricles off. By getting a beat at the wrong time,

re-entry can occur, which is that a path back to the SA node is created

and kicks it off again. Not really sure, but it's something like this.

Best of health to all,

Vicky

" Science may be described as the art of systematic over-simplification "

- Karl Popper

" All truth goes through three stages: first it is ridiculed, then it is

violently

opposed, finally it is accepted as self evident. " - Schopenhauer

" Wisdom is the quality that keeps you from getting into situations where we

need it " - Doug Larsen

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

- - - - - - - - - -

[Guest guest]

>Can someone say more about this point in the cycle thing? What does

>an extra beat have to do with the atria going nuts?

Hi Trudy - I'll have a go at what I think it's about (but anybody feel free to

tell me if I'm talking rubbish)

I'm hopping you've seen the classic normal heart beat ECG

(see http://www.rnceus.com/ekg/ekgframe.html for an example)

its split into P QRS T

P is the atria doing their thing, QRS is the ventricles doing their thing, T is

the ventricles re-polarising/relaxing. There's a gap between T and P before the

process starts again, the ventricles are filling passively here so I think this

is quite an important phase even though nothing much is happening on the ECG,

this is also the longest period in the cycle unless you a running like the

clappers

As far as I understand it... an ectopic beat will be a contraction which starts

out side of this normal cycle. It can originate anywhere in the heart, including

the SA node which is the normal place. A lot of the research at the moment

reckons that the ectopic beats often originate where the pulmonary veins enter

the atrium (which is why this is often the place to be ablated). As far as I am

aware nobody has the faintest idea why an ectopic happens - I think figuring

out why cells decide to fire at some random place will go a long way to figuring

out what's up with us. The heart has some amazing backup systems -

if certain cells don't receive an impulse after a certain time they decide the

SA node must have gone to sleep so they decide to fire so that the heart keeps

on working - fantastic! If some of these backup systems are faulty could they

decide to fire when there is no need - hence an ectopic beat?

Why do some ectopics just give a jump and some throw you into AF? I think this

is all to do with timing. If you are unlucky enough to get an ectopic at the

wrong place in your cycle the firing can be self sustaining (see previous posts

on the re-entry nature of AF). (my own experience is that I will get several

rapid ectopics before popping into AF so it may be this which is unusual - I can

probably deal with a single ectopic out of place but several in quick succession

will throw me into AF) I also believe the reason why some of us go into AF when

others don't is to do with how quickly/slowly it takes individual heart muscles

to rest before they are ready to fire again. A lot of the drugs we take try to

lengthen the refractory (resting) period before the cell is ready to fire again.

I think it's only a fairly recently they discovered that cardioversion can be a

problem if they zap at the wrong time in the cycle. The cardioverters these days

will watch your ECG and make sure they zap you in the safe zone. (see

http://www.mikecowley.co.uk/markhammerschmidt/ArrhythmiaReview.htm)

cheers

--

D

[Guest guest]

Trying to do anything that involves physical effort makes my heart

stuff worse and when I persisted in the early days at the advice of

my former internist, I put myself into tachycardia. My best bet for

converting is to lay down and try to relax.

I wonder if this is an adregenic(sp?) vs. vagal difference? Trudy

It's just the opposite with me -- I'm fine when I'm up and about, exercising,

working etc. But as soon as I relax and slow down, my heart does all kinds of

wierd stuff (but not always afib, thank goodness). Classic vagal. Sandy

[Guest guest]

Driscoll Driscoll wrote :

>Hi Trudy , I don't think this is the case. I also am pretty much bed

>bound when I'm in AF. If I exert myself my heart rate can rapidly hit

>the 200 bpm mark and things get pretty uncomfortable.

>

>I almost always going into AF when I'm resting in the late evening or

>when I'm asleep (only 3 or 4 occasions out of the last 50 episodes has

>my AF been 'exercise induced' and even some of these are debatable

>whether I was on my way back down to rest)

,

sounds like you have vagal aspects to yours - but once a vagal fibber is

actually in AF, then there probably ain't quite the difference between

the two forms, and they both involve rapid heart rate and feeling

knackered (ancient English term, for those on the left side of the pond)

However, I know your thyroid situation is difficult, so I wonder how

closely you will follow to either of the subtypes. Just my 8.4¢ worth.

(gee what an exchange rate - do we really NEED the Euro?)

Best of health to all,

Vicky

" Science may be described as the art of systematic over-simplification "

- Karl Popper

" All truth goes through three stages: first it is ridiculed, then it is

violently

opposed, finally it is accepted as self evident. " - Schopenhauer

" Wisdom is the quality that keeps you from getting into situations where we

need it " - Doug Larsen

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

- - - - - - - - - -

[Guest guest]

>Definitely. Speeding the heart up can stop vagal attacks, but will make

>adrenergic attacks worse. However, it is said that there is no such

>thing as a purely vagal or purely adrenergic AF. What seems to matter

>is the balance of the vagal and cardiac nerve impulses, but a trend can

>often be found. I discuss my understanding of this on my website (see

>links page)

Hi Vicky, our emails to Trudy past in the post so I didn't see yours until I had

sent mine.

I've always considered how we get into AF and what happens once we are there to

be two separate problems (and how we return to NSR is another). Do you think

your vagal over-activity continues when you are in AF? I've always thought my

body goes into a completely different survival mode once I've got into AF -

maybe it tries to squirt some adrenaline at the problem to see if can fix it!

All of my AFs start off with a fast rate (170+) - it's often several hours

before the rate will sit below 120 for any length of time. I'm still pretty sure

that I go into most AFs via a vagal trigger though. (I have never been formally

diagnosed with vagal AF but I, and my cardiologist to a lesser extent, believe

vagal activity is a large component of my problem)

P.S.

sorry, but I voted by post a few days ago, I ignore their ramblings though

cheers

--

D

[Guest guest]

Thanks for the note ,

I am having a bad day today. My heart is beating funny and I am not sure

what it is. I am really cold as well but I think that is the Dofetilide or

at least I hape so.

I hope because of the way the AF has returned is a gradual fashion over the

last week. It has returned in a very aggressive way. This would give a clue

that it's coming from the Pulmonary veins. That's what I was informed in

France. They found that tow of my Pulmonary veins had permanent AF inside

then. I was intrigue by this as the AF would only ignite the Atria at

certain times.

As you know I had them all ablated then would I hope indicate that one of

the scars has healed or broken up. I find it hard to understand that three

days after the ablation they put me on an exercise bike for 15 mins and all

was ok.

That's why I think it's a scar healing or broken up. If it does prove to be

a new focal point then I will have to reappraise the situation and maybe

consider the Maze option.

Perhaps I am kidding my self but one has to have hope to keep going other

wise I would become a depressant and watch the infernal TV for most of the

time.

Quoting another Favorite film of mine,(you can guess what I have been doing

while of work)

Hope is a wonderful thing. Like all good things, Good things never die.

I suggest that the First Saturday in July would be a great day for holding a

Partners , carers day for AF suffers. I only pray that AF hold off for most

of us and we are able to give some joy back to the people that look after

us.

Regards

C

did you see the news I posted what did you think??

Re: Vagus nerve and afib triggers

>I to am going into AF nearly every day now even after increasing

the

>Dofetilde to 500mg x 2 per day.

>I am hopeful that I will have another ablation either in the UK or

France.

>

>I have an appointment on the 7th July so I will keep you all

informed.

>

>Regards

>

Hi , really sorry you are having problems.

If you go for a third ablation is it likely that the EP study will

find new

places or do you think they will say some of the ablated places are

still

generating the ectopics. I'm a little concerned that, if this is a

moving

problem, they will ablate a 'fresh' area but the ectopics will then

move to

another location. I'm thinking of the 'meandering' reentry nature of

AF. I

really don't want to stress you out further and I really don't know

much about

ablation but it may be something to consider.

all the best

--

D

Web Page http://groups.yahoo.com/group/AFIBsupport

For more information: http://www.dialsolutions.com/af

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[Guest guest]

> did you see the news I posted what did you think??

If it's the same thing as I read some time back (or talked about with you??) it

sounds like a more accurate way of mapping/ablating an area. I think they can

temporarily freeze an area to see if it's the right spot, if they decide it's

the wrong area once it's thawed the cells go back to working normally. If they

decide it's worth ablating they turn the temperature down a bit more and this

knocks the cells out for good. Seems a pretty neat idea to me!

cheers

--

D

[Guest guest]

>However, I know your thyroid situation is difficult, so I wonder how

>closely you will follow to either of the subtypes. Just my 8.4 worth.

>(gee what an exchange rate - do we really NEED the Euro?)

Hi Vicky, your email won the race again

My symptoms have been pretty much the same pre and post amiodarone (though I was

going into AF more frequently after amiodarone until they sorted my thyroid

levels out). I know it's not black and white when it comes to vagal/adregenic

but it does seem most of mine start off with a slow heart rate BEFORE AF kicks

in.

Cheers

I'm all for missing the Euro out and switching straight to the dollar either

that or moving on to the Star Trek point of view! and maybe a medical tricorder

is what we all need

--

D

[Guest guest]

Driscoll Driscoll wrote :

>how we return to NSR is another).

understatment !

>Do you think

>your vagal over-activity continues when you are in AF?

I think it does, but it certainly also seems to get mixed up with all

sorts of other stuff. Once I'm actually in AF, exercise and stuff isn't

nearly as effective in bringing me out as it is in stopping me getting

there in the 1st place at the PAC's stage. However, sorting out my

digestion is /always/ a success, so there's clearly still a vagal

action.

Best of health to all,

Vicky

" Science may be described as the art of systematic over-simplification "

- Karl Popper

" All truth goes through three stages: first it is ridiculed, then it is

violently

opposed, finally it is accepted as self evident. " - Schopenhauer

" Wisdom is the quality that keeps you from getting into situations where we

need it " - Doug Larsen

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

- - - - - - - - - -

[Guest guest]

Codling, Codling, wrote :

>It has returned in a very aggressive way.

Sorry to hear all this, . Fingers crossed for you.

Best of health to all,

Vicky

[Guest guest]

Vicki and ,

Thank you for your explanations. Amazing what understanding can be

brought about by having someone put it into plain English.

I should have read that links page and copied it before I went to see

the cardiologist. I would have had more of a starting point for

discussion. I'm sure he didn't mean than nothing was known, just not

enough.

Regards,

Diann P.

[Guest guest]

diann@... wrote :

>I'm sure he didn't mean than nothing was known, just not

>enough.

I'd second that! (overnight attack :-( ) OK now though.

Best of health to all,

Vicky

" Science may be described as the art of systematic over-simplification "

- Karl Popper

" All truth goes through three stages: first it is ridiculed, then it is

violently

opposed, finally it is accepted as self evident. " - Schopenhauer

" Wisdom is the quality that keeps you from getting into situations where we

need it " - Doug Larsen

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

- - - - - - - - - -

[Guest guest]

- Good for you for not letting afib take over your life.

[Guest guest]

Vicky - How true that each one of us can figure out how to help ourselves.

My afib is caused by a problem in the back portion of my mitral valve where

the leaflets don't properly close (little bit of regurgitation from badly

prolapsed valve). So, to be expected, my af pops up when I'm laying on my

back, and since it is also vagally induced, it occurs when I go to sleep.

This is also classic vagal af. Unfortunately, mine, while not occurring too

often, was persistent, meaning that it would not clear up on its own.

I now recognize some of the prodrome of my af, namely that it is pretty

apt to occur after physically working too hard for too many hours - so that

my heart rate and blood pressure go way, way down afterwards - not uncommon

to have a blood pressure then of 98/68. Then my heart starts skipping a beat

or two. This is the prodrome. Then, before my heart goes into afib, I take

one to two hundred of the Norpace (depedning on how I judge the severity of

the impending sleep-induced afib). The Norpace (disopyramide) blocks the

action of Choline which is secreted by the vagus nerve. I also take 1/2 tab

(half the ordinary dose) of a new CNS drug (developed for narcolepsy and no,

it does not keep me awake). This drug is called Provigil. This combination

generally keeps me out of AF. However, I am also now learning about some of

the not so conscious choices I make which have affects on my heart - This is

also improving my heart function. Dorean

[Guest guest]

> overnight attack :-( ) OK now though.

Vicky,

Glad to hear the attack stopped!

Regards,

Diann P.