Atrial Fibrillation patients often have loads of “Why?” and “How?” questions. Here are answers to the most frequently asked questions by patients and their families. (Click on the question to jump to the answer.)
5. “What is the difference between “Adrenergic” and “Vagal” Atrial Fibrillation? How can I tell if I have one or the other? Does it really matter? Does Pulmonary Vein Ablation (Isolation) work for Adrenergic and/or Vagal A-Fib?“
14. “I have paroxysmal A-Fib with “pauses” at the end of an event. Will they stop if my A-Fib is cured? My cardiologist recommends a pacemaker. I am willing, but want to learn more about these pauses first.”
16. “I am 69 years old, in permanent A-Fib for 15 years, but non-symptomatic. My left atrium is over 55mm and several cardioversions have failed. My EP won’t even try a catheter ablation. I exercise regularly and have met some self-imposed extreme goals. What more can I do? NEW!
Last updated: Friday, December 9, 2016
5. “What is the difference between “Adrenergic” and “Vagal” Atrial Fibrillation? How can I tell if I have one or the other? Does it really matter? Does Pulmonary Vein Ablation (Isolation) work for Adrenergic and/or Vagal A-Fib?”
If your A-Fib is normally triggered by exercise, stress, stimulants, exertion, etc., then you may have what doctors call ‘Adrenergically-Mediated’ A-Fib. People with structural heart disease seem more prone to Adrenergic A-Fib. The Adrenal (Adrenergic) Glands sit above the kidneys and produce the hormone epinephrine (adrenaline) in response to stress, which causes an increase in heart rate and blood pressure. This adrenaline stimulates what is called the ‘Sympathetic Nervous System’ to speed up the heart and constrict the blood vessels.
But if your A-Fib occurs at night, after a meal, when resting after exercising, or when you have digestive problems, then you may have ‘Vagally-Mediated’ A-Fib. The Vagus Nerve, in contrast, controls the abdomen and is part of the Parasympathetic Nervous System that tends to slow the heart and dilate blood vessels.
Adrenergic and Vagotonic forms of paroxysmal A-Fib are uncommon.
The majority of patients with paroxysmal A-Fib do not have a clear autonomic pattern. Those with Lone A-Fib (no other related medical condition) seem more prone to Vagal A-Fib. (Many people have a mix of both Adrenergic and Vagal A-Fib.) (Perhaps A-Fib begins as a nervous system problem, then becomes a heart problem after the arrhythmia is established.)
What does this mean to you? It might be helpful to determine if you have one or the other so that you can better identify what triggers your A-Fib, and because the treatments are often different for each.
For example, beta-blockers usually don’t work well with Vagal A-Fib or the antiarrhythmic 1C meds. Flecainide seems to work better for Vagal A-Fib than propafenone. (Though it’s difficult to generalize about A-Fib treatments, because each person reacts so individually.)
Pulmonary Vein Ablation: It seems that both Adrenergic and Vagal A-Fib are ‘focal’ in origin (come from specific points or spots in the heart), and are treatable with Pulmonary Vein Ablation (Isolation) procedures.