AF Episodes at Rest

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For those of you who like me, have suffered AFib episodes only at night or while resting, I stumbled upon some information you may want to check out.  It' the Euro Heart Study.  In it, researchers found that vagal fibbers were more likely to progress to persistent Afib when treated with the wrong medication, namely beta-blockers.  Vagal afibbers seem to respond to Flecainide, brand name, Tambour.  It seems that most North American physicians are in denial that Vagal AFib plays a role.  I don't know about you but I am going to have a discussion with my cardiologist this week.

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  • Posted

    I saw some kind of such report the other day I was researching online. I had my episodes only at night while resting. When I lay down, I feel my every heart beat even thought I didn't want to pay attention to. I was prescribed metoprolol since diagnosed but can't tolerate it. So cut the pill to half, but still felt bad on it. So after couple months, I only take 1/4 pill of 25 mg a day, and my last visit to EP, he agreed that I can get off metoprolol. 

    EP said metoprolol doesn't prevent afib episode, it only slower heart rate during an afib episode. Then why do I want to take a pill on the days I didn't have afib? I just got rid of it four days so far and felt better at day time.

  • Posted

    Fascinating! Do you have a link to this study? I love reading about this stuff. I'm about to go on meds for A Fib and very concerned with what I will be taking.

    So, this study discusses vagal fibbers. Does it go into detail on that? I am getting A Fibs from trapped gas that is causing a vagal response. Doctor does NOT agree. 

    • Posted

      This is me exactly,if I have a bloated stomach or indegestion it interferes with my heart and I get fast runs and palps.
    • Posted

      Most vagal afibbers receive wrong medication

      MAASTRICHT, THE NETHERLANDS. There is still widespread denial among North American cardiologists as to the existence of vagally-mediated AF (atrial fibrillation) and a pronounced tendency to treat all AF patients the same. Hopefully, this will now change with the publication of the results of the Euro Heart Study. This study involved over 5000 AF patients treated in 182 hospitals in 25 different countries. 

      A total of 1517 of the patients experienced paroxysmal (intermittent) afib and was studied in detail. Among this group, 42% (640 patients) had a distinct, physician-verified, autonomic pattern as far as triggering an episode was concerned. Another 35% reported no clear trigger patterns, while in the remaining 23%; the physician did not verify the presence of triggers. The authors of the study classified the trigger pattern as vagal if episodes occurred after a meal or during the night, and as adrenergic if initiated by exercise or emotional stress. Afibbers with no clear trigger pattern were classified as mixed.

      Sixteen percent of the group had lone AF defined as afib without the presence of hypertension, coronary artery disease, or heart failure. Somewhat surprisingly, the researchers found no difference in the incidence of heart disease among vagal and adrenergic afibbers. Among the group with clearly defined trigger patterns, 18% were classified as vagal, 46% as adrenergic, and the remaining 36% as mixed. (NOTE: The distribution in our most recent LAF survey was 30% vagal, 6% adrenergic, and 64% mixed).

      The major conclusions reached from the study are as follows:

      Exercise and emotional stress were the most common triggers followed by electrolyte imbalances, and alcohol and caffeine consumption.The majority (72%) of vagal afibbers received non-recommended drugs (beta-blockers, sotalol, digoxin or propafenone) – 57% were prescribed beta-blockers or sotalol.Vagal afibbers who were prescribed non-recommended drugs were more likely to progress to persistent or permanent AF than were vagal afibbers prescribed recommended drugs (primarily flecainide). After 1 year of follow-up, 19% of vagal afibbers prescribed non-recommended drugs had developed persistent or permanent afib as compared to 0% in the group prescribed correct drugs.Among adrenergic afibbers, 20% did not receive the medication recommended in the 2006 ACC/AHS/ESC Guidelines for the Management of Atrial Fibrillation. However, there was no indication that the type of medication affected progression to persistent or permanent in this group.Quality of care would appear to vary considerably between the regions in Europe. In the Mediterranean region 41% of patients received the recommended treatment as compared to 20% in Central Europe, and only 19% in Western Europe. Similarly, in the Mediterranean region physicians verified the presence of triggers in 75% of cases as compared to 79% in Central Europe and only 46% in Western Europe. Editor’s comment: It would seem that afib care in Western Europe is substandard, but probably no worse than in North America.The authors point out that beta-blockers are often given in conjunction with class 1C antiarrhythmics (flecainide and propafenone) in order to prevent 1:1 conduction in the case of atrial flutter induced by the class 1C drug. They suggest that verapamil and diltiazem could be used as safer alternatives.

      The authors conclude, “Physicians do not seem to choose rhythm or rate control medication based upon autonomic trigger pattern of AF. However, the role of autonomic influences should be taken into consideration in order to achieve an optimal management of the disease as non-recommended treatment may result in aggravation of the arrhythmia.”

      de Vos, CB, et al. Autonomic trigger patterns and anti-arrhythmic treatment of paroxysmal atrial fibrillation: data from the Euro Heart Survey. European Heart Journal, Vol. 29, 2008, pp. 632-39

      Editor’s comment: Although not specifically directed at lone AF, this new European study is clearly a landmark and emphasizes the importance of determining trigger pattern (vagal, adrenergic or mixed) before prescribing medication for paroxysmal afibbers. It is interesting that our first LAF Survey (February 2001) revealed that 50% of vagal afibbers had been prescribed non-recommended drugs. This resulted in an average afib burden (# of episodes times their duration) more than twice as high than the burden among vagal afibbers taking flecainide or disopyramide. As far as propafenone (Rythmol) is concerned, the situation may not be as clear-cut as suggested in the Euro Heart Study. Some vagal afibbers have found this drug quite useful. Some fairly recent research have found that the degree of beta-blocking effect exhibited by propafenone depends markedly on how fast it is metabolized, so this may explain why it works for some vagal afibbers, while it is contraindicated in most others.

  • Posted

    Intersting I had a few episodes of Afib earlier this year either whilst asleep , or after getting up after resing (maybe Vagal ?) I took beta blocker which sort of controlled it, (did have more episodes) but had to come off as I became aware  I was on epipen and they cannot be combined.

    Now on Channel blocker which helped , but also on small dose of flecainide, and not had anyt afib for about 4 months

  • Posted

    Ask your  cardio if vagal AFib responds to ablation as there is a question over that.
    • Posted

      Thank you but I am not a candidate for an ablation at this point.  If the electrophysiologist doesn't isolate the correct tissue, it could lead to multiple ablations.

  • Posted

    Yet one more black mark against beta blockers! Life improved after I came off a beta blocker and used Flecainide. Beta blockers do seem to be a very crude cure with multiple side effectsQ
  • Posted

    So you have Paroxysmal AF. And are you taking anything for it at present.

    Flecainide is a scarier drug than Beta Blockers. I’ve heard of it being used an abortant for AF episodes. But i dont know whether it can be safely used as a prophylactic.

    • Posted

      Yes, I do.  I have been taking sotolol for 10 years, progressing up to 120 mg twice daily for the last four years.  I have had five confirmed Afib attacks in the past ten years.  I am not a candidate for ablation and I have talked to multiple patients who have had more than one ablation to correct the issue.  The sotolol makes me feel like I am in 4th gear all the time.
    • Posted

      When did you last have an episode?

      What other medical conditions do you have?

      If I were you I genuinely would stay on it - medicine regimes for AF can be a lot worse I promise you.

    • Posted

      My last episode was in August.  It was the first time I had had one since 2013.  I have no other conditions that I'm treated for.  The problem is that my insurance does not cover pre-existing conditions.  It was the only way I could afford the coverage.  So, I was out of pocket over 10K this summer for the ER visit.

    • Posted

      I had them cardiovert me this time to avoid being admitted.  I have never tried letting the AFib go back into rhythm on its own.  I am fearful of clots and possible strokes.  I tried a technique yesterday where I elevated my legs and blew into my hand (simulating blowing into an empty syringe).  I saw this on YouTube.  I felt out of rhythm even though I was only doing about 66 ppm but the pulse was rapid.  It abated in about 4 hours.
    • Posted

      Sometimes the Valsalva manoeuvre works.

      When are you next seeing your cardiologist?

      Whats your BMI?

    • Posted

      I have an appointment on Wednesday.  I can't remember my BMI but I am not in jeopardy there.  I weigh less than I ever have and have recently changed to a Vegan diet although I have cheated a few times.  My blood type is A+ and I am suppose to avoid red meat.  That's my greatest weakness.


    • Posted

      You could ask for a Flecainide "Pill in the Pocket" that you can take when you get episodes.

    • Posted

      I only take a baby aspirin daily.  I do not have permanent or consistent Afib.  I have been under the care of a great cardiologist for the last ten years and only recently switched because of a relocation.

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