Adrenergic atrial fibrillation

The Vagus nerve and Beta-Adrenergic receptors in the myocardium are what are sensitive to, or triggering of, AF. So far, you have what is called 'paroxysmal' AF that comes and goes, usually with some kind of about 20 known stimuli, or triggers. They include alcohol, too little sleep, too much caffeine, exercise that raised the HR above, say, 140 for more than a few continuous minutes, GERD, vomiting, belching, too little serum levels of potassium and/or magnesium, and so on....

You should be on a Direct Oral Anti-coagulant or DOAC, such as Xarelto or Eliquis, that latter of which I and most other AF patients have been prescribed. Aspirin is better than nothing, but in the case of the risk for AF sufferers, a DOAC is strongly recommended because it's a better 'fit'. You might also need to be on a beta-blocker or on a calcium channel blocker, whatever a competent authority determines you need for your particular body's responses. Those drugs reduce the frequency of heart beats during rest, but only a little if the dosage is correct. When you go into AF, they keep the rate low so that you don't go into heart failure inside of a few weeks. Heart failure and cardiac 'remodeling' are the risks in AF, but only once the risk of stroke is dealt with, and that is via the DOAC I mentioned. If the heart is left in AF, it begins to adjust by 'remodeling' itself, and at that the treatment is either more complicated or impossible. This is why you should deal with AF as soon as possible. It prevents atrial enlargement, part of the remodeling process. Atrial enlargement begets two problems: inner endothelial stretching, which leads to fibrosis and more AF (!), and/or mitral valve prolapse, which can be fixed, but not while you're fibrillating...so get the fibrillation under control early!!!

This is a singular journey....for you. You must learn what works and what doesn't at keeping your AF at bay. We can share stories, share apparent commonalities, commiserate...and generally 'be there' for each other, but each patient must ascertain for themselves what keeps their heart in blissful NSR (normal sinus rhythm) most or all of the time.

Two more points: AF is a progressive electrical disorder of the heart. Secondly, it ain't gonna kill you. It might make you anxious, you might lose sleep, and when it is going on it feels terrible, but if it's held at bay 95% of the time, you can live a long life with atrial fibrillation. But do, please, consider the mechanical fix called 'catheter ablation'. They work most of the time (first attempts have about a 25% failure rate, but about the worst that happens as a result is that you go into flutter, or develop many PACs (premature atrial complexes or contractions), or you just remain in paroxysmal AF. A second attempt, usually four to six months later, has a much better probability of stopping the electrical circuitry that promotes AF in the left atrial endothelium and substrate). Introduce yourself to a really good, highly skilled, widely regarded, electrophysiologist as soon as you can and get in line for a catheter ablation at the first intuition that your heart is beginning to fibrillate a bit more often. This might be inside of six months (for you, remember, not for everyone), or you might be okay, as I was, for about three years. Eventually, I couldn't wait to get ablated because my heart began to come on like gangbusters over the spring in 2022.

Good luck. It's not a death sentence, but it's also not something you want to put your head under your pillow about.

Thank you very much for your reply. This is extremely helpful. I have spent the last few days pretty upset by the diagnosis but the issues have been ongoing for a few months now so I am happy the cause was finally determined. Now I just need to deal with the cause.

@clwalker24 how often and how long are your afib episodes? I have had episodes once or twice a year for 10 years now and am still not on meds, though I have "pill in the pocket" diltiazem and Eliquis to use as needed (have only used the diltiazem once and have never used the Eliquis though I am sure I will, short term, after an episode). I have no illusions about what the future may hold but just saying, not all of us have to immediately go on meds. That said, @gloaming has a lot of expertise.

You might be interested in the book "The Afib Cure" by two cardiologists. Hokey title but lots of good info.

Thank you for the reply. Generally the episodes while I am playing tennis and then start to subside after I stop. Initially I thought it was the altitude (I live in NM) or just getting old and out of shape but turns out to be more than that. Thank you for the book recommendation..I will take a look.

Most of my episodes are related to position or to lifting. Lifting shifts things around internally and some have suggested that that puts pressure on the vagus nerve. It sounds like tennis is a very specific trigger related to position or motion as well as exertion and heat.

Heat is an important factor too. My daughter nearly faints in the heat and her heart is being evaluated. It dilates blood vessels and may lower blood sugar, which I guess would make the heart work faster while at the same time you are exerting yourself. This happens to her while just walking and she vomits too.

My afib has not progressed in 10 years. I think I am lucky and am sure it will at some point. I drink low sodium V-8 and take magnesium (as I said) and eat early. I hope you can avoid medications and ablation (for now) by avoiding triggers. What happens if you stop playing tennis? How about pickleball!

@gloaming provides an excellent list of possible triggers and I would add lifting or tennis. and exertion in hot weather! Gas/belching also can trigger me probably also due to pressure on the vagus nerve. I stopped one episode with Gas-X!

Have you had a stress test? It would seem that might clarify things along with a patch monitor for a few weeks and an echocardiogram.

There is a difference between triggers of vagotonic and adrenergic Afib events. They also may respond differently to ablations. Literature studies in NIH data base PUB MED https://pubmed.ncbi.nlm.nih.gov and Google Scholar may help you find studies that show the efficacy of ablation and or drugs on adrenergic Afib vs Vagotonic. Adrenergic Afib is particularly set off by exercise and higher heart rates and is a result of fibrous.
See "Elevated β1-Adrenergic Receptor Autoantibody Levels Increase Atrial Fibrillation Susceptibility by Promoting Atrial Fibrosis"
https://shorturl.at/x65K2
Vagotonic is set off by stimulation of the vagus nerve often positional. A good EP cardiologist should be able to explain the differences of the 2 and what if any outcome differences there might be to an ablation. Drug therapy, often Sotalol is used to keep the HR lower thus reducing Afib triggers. The down side is that it is harder to get in a good work out with Sotalol because it suppresses HR. Also you have to monitor yourself when exercising. An example of this is my brother who at 81 walks 4 miles/day and lift weights but sometimes he pushes too hard and it will trigger Afib. He has used it successful for about 4 years but recently has had a couple of longer Afib events suggesting that the drug is becoming less helpful.
I myself very recently underwent a 2nd ablation after my first ablation 5 1/2 years ago was showing signs of increased Afib events usually lasting < 36 hours. In the first 4 years after the 1st ablation I had 3 episodes. Then last fall I started having them on average monthly.

Thank you for the very informative response. Very helpful.

I have both adrenergenic and vagotonic. I remember reading that beta blockers were not good for one of those but cannot remember which!

Again @clwalker24 it seems the most reasonable step is to stop playing tennis, at least for awhile, and see if you have any afib. It would be a shame to go on meds or have an ablation if that is the only trigger. I have been told that each episode paves the way for more so I would stop tennis asap. Sorry!