Patients over the years have described a clear association between certain foods and triggering of Atrial Fibrillation (AF). The most unusual case I have encountered is the case of the man who reliably triggered AF when eating takeaway Thai, but not Japanese, Italian, or any other type of food. Other
more common triggers include Alcohol, any large meals causing bloating, fizzy drinks, spicy foods, and large carbohydrate meals.
Why does food trigger Atrial Fibrillation?
It is thought that all heart rhythm abnormalities, including AF, atrial flutter, supraventricular tachycardia (SVT), and ventricular tachycardia (VT) require a trigger to kick off arrhythmia and substrate to maintain it. This trigger is thought to be the autonomic nervous system in the majority of patients. The gut is sometimes considered the second brain as it houses so many neurons (nerve cells) which it obviously requires to coordinate the fine peristaltic contractions which push good in a coordinated way in one direction.
These nerves are concentrated in groups termed Plexi (or plexuses) which both have sensory and motor functions. The sensory nerves take information from the gut and send it up to the brain and the motor fibers take signals from the brain into the gut to cause the gut to contract.
When a large bonus of food (or indeed a certain type of food) enters the gut, this may cause a stretch in the lining of the esophagus, stomach, or other intestinal organs downstream (small bowel). This stretching leads to activation of the nervous system, which in turns sends a signal upwards to the
brain to signal the start of the digestion process.
However, these signals traveling in the nerves from the gut to the brain also enter into the heart’s nervous system, sending strong signals also into the heart. The strong nerve firing which originates in the gut then causes the heart’s nervous system to be activated, which then leads to AF being triggered.
What is the vagus nerve and why is the vagus nerve so important in triggering atrial fibrillation? The vagus is the nerve that governs the ”rest and digest” phenomenon. This is in direct contrast to the sympathetic nervous system, responsible for the flight or fright response, which is adrenaline mediated.
The vagus is a large nerve that innervates the gut and heart, as well as many other organs in the body. Immediately after a meal, the vagus nerve is activated and exerts its effect both on the gut (initiating peristalsis). However, the vagus also innervates the heart, and any activity within the cardiac vagus may lead specifically to pulmonary vein firing, triggering rapid ectopic beats which cause AF.
Does everyone get AF triggered by food?
No. AF is not always triggered by vagal activation. Although autonomic activation is thought to trigger AF in most cases, autonomic activation is not commonly triggered by food. Other autonomic imbalance states include stress, anxiety, caffeine, alcohol, emotional stress may also trigger AF. The
important things are to recognize your triggers and to try to avoid these triggers.
Can AF occur without triggers?
Sometimes, AF is only ever triggered by specific circumstances, including food, but in time, AF may progress such that it becomes more prevalent, sometimes initiating even without obvious triggers. In these instances, AF is likely to have progressed to a form that may need to be treated more aggressively. This is usually with the initiation of a drug, which could be a pill in the pocket strategy, to be taken only after the onset of AF, or a regular drug. For more treatment for AF, click on
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