Vagus Nerve Stimulation

I have a variety of HR issues, essential hypertension, sinus node dysfunction, dyslipidemia and atrial flutter.  I received my pace maker in January 2019 and it works great.  Didn't know at the time it does nothing for flutter and tackycardia (sp).  I am lucky I don't have symptions often.  Have only had systems twice, overall fear/janxiety and high HR.  Have had some success with practicing some vegus  nerve stimulation, deep breaths,  ice pack on face.  Would like to know if has been successful for anyone else.  Also, found that my flutter is almost constant!  don't know what to do about it yet.  Had Dr. appt recently and he said if I was confortable with everything we could wait another 3 months, use the Holter monitor again and discuss further treatments?  Maybe a 2nd ablation?  How does anyone feel about multiple ablations?  I love this forum, thanks for all the feedback.


Multiple ablations?

by AgentX86 - 2019-10-30 22:47:06

Sure, multiple ablations aren't unusual but make sure you go to the best.  Anyone touching you should have thousands under the belt.  There is a big difference between practitioners.

That said, I've had three failed ablations for atypical (left atrial) flutter, caused by a Maze gone very wrong.  I finally got relief after an AV ablation and PM. I'm still in permanent flutter but I don't notice it because it doesn't telegraph through to my ventricles.

Constant AFlutter is not good for you...

by crustyg - 2019-10-31 02:39:40

Back in the day before targeted ablations were routine, patients who suffered frequent SVT due to WPW were taught various ways of stimulating the vagus - forced Valsava, carotid sinus massage, forehead ice-packs.

Depending on your AV conduction, longish periods of atrial flutter can be quite serious: a) if you can achieve 1:1 AV conduction then you can easily drive your ventricles at 230-250bpm - this *can* be sudden cardiac death territory due to VF, b) you run the risk of developing the cardiomyopathy of prolonged tachycardia - basically it can damage your heart muscle.  AgentX86 can afford to be relaxed *because* the flutter electrical activity doesn't make it to the ventricles.

I would be very nervous about prolonged periods of AFlut and start pushing for an ablation to fix them - assuming that your EP doc has some sensible ideas about the precise source of the flutter.  Commonly it's cavo-tricuspid isthmus (typical), but not always (atypical).


by IAN MC - 2019-10-31 06:17:55

If I were you I would ask for more information on the exact nature of your atrial flutter and most importantly what sort of success rates your EP would expect.

As you probably know , atrial flutter can be " typical"  or " atypical " depending on the location and pattern of the rogue electrical circuit. The way they respond to ablations can differ enormously.

I had " typical" atrial flutter and my EP really sold me on  an ablation .It was a no-brainer as he claimed success rates of well over 95% with a risk of it returning at under 5% .

 Sure enough, it was highly successful for me 8yrs ago. and having an ablation was such  a good decision.

 Since then I have had normal sinus rhythm and came off blood-thinners immediately.  .  But you do need to :-

i )  ascertain the type of flutter you have and                

ii )  do lots of research to find the very best EP in your area  ( as Agent said ,their levels of skill do vary )

Best of luck



by Gemita - 2019-10-31 07:50:48

Hello Rebeccaanne, have found responses to your post really helpful.  

For me vagus nerve maneuvers can be very hit and miss and cannot be relied on to terminate my arrhythmias.  Ice wont do it for me - it triggers an arrhythmia.  I find "positional changes" like standing from lying can often terminate an arrhythmia, whereas bending forward can often trigger tachycardia, but we are all so different.  I do believe though that because of the proximity of our oesophagus to our hearts, swallowing and digestion problems can trigger arrhythmias in many.  Swallowing is a strong trigger for my several arrhythmias.  

What to do about Atrial Flutter ?  I would ask for some long term monitoring to give your doctors as much information as possible about the nature of your Flutter before coming to an informed decision.  Then, if heart rates are high and cannot be controlled with medication, I would definitely consider an ablation.  Atrial Flutter may be easier to fix than Atrial Fibrillation, depending on the type of Flutter you have, so why not try to eliminate it ?  Of course it depends on your age and other health conditions because both of these will determine how safe an ablation for you is likely to be and the risks involved.  One ablation will carry a certain % risk and any subsequent ablation will increase that % risk for a complication, so we have to weigh this up when we consider multiple ablations.

I note your doctor suggested that if you were comfortable with everything you could wait another 3 months before coming to a decision.  This would suggest to me that your Atrial Flutter is being controlled (at least the speed of the arrhythmia since you say you do not have symptoms ?). I would not be happy to be in constant Flutter, but that is only my humble opinion.  Finally I hope your hypertension/hyperlipidemia is being firmly controlled since both will make an arrhythmia more likely to occur.  Good luck 

Crusty is exactly right (others are also)

by AgentX86 - 2019-10-31 21:56:49

I just wanted to make it clear that I didn't intend to minimize the danger of extended periods of flutter or any tachycardia.  I had the AV/His ablation because everything else failed (made the situation worse, really).  In my case the flutter didn't cause tachycardia (very slow AV conduction - rates around 90-100bpm), rather an unacceptable symptomatic arrhythmia caused by constantly varying 3:1, 4:1, 5:1 AV conduction.

I can "relax" now because my PM is doing all the work but my atria are just in the way (complete AV dyssynchrony).

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