Does anyone know the connection between heart flutters (PAC's) and the vagus ner!

Does anyone know the connection between heart flutters (PAC's) and the vagus nerve?

I heard that acid reflux and stomach upset can trigger the vagus nerve, causing what feels like heart spasms/flutters or PAC's. I experience these quite a lot, sometimes in runs for hours and days. Usually when I have the flutters it feels like it is triggered after a big meal, and feel like I have a lot of gas and need to burp a lot. Sometimes they happen when my stomach muscles are tense or are puttng pressure on my chest, maybe due to eating a large meal (not necessarily due to anxiety or stress, in fact, it usually happens when I am quite relaxed). Since hearing about this possible connection, I've tried taking antacids and anti-gas medications, but it hasn't worked. Has anyone experience these, and is there anything else I can try to relieve/prevent them?

3 weeks ago
Note: I have had EKG's, echocardiograms and also wore a holter monitor. The echocardiogram was fairly normal, and with the other tests, some showed PVC's, and some showed PAC's, but never to the extent that I was actually feeling them. Every doctor I've been evaluated by says that there is nothing that they find wrong-- this is what makes me think the problem is gastrointestinal in nature.

PAC's, or premature atrial contractions, are one specific cause, among several, of the 'heart fluttering' you're describing, so the first question is whether that really is the cause of your symptom - and the only way to know is to be on some kind of heart monitor while having the symptom. Believe me, there's no way for patients to distinguish between different causes of palpitations by their symptoms. That said, there is indeed a connection between firing of the vagus nerve and premature atrial contractions, paroxysmal atrial tachycardia (whole bunch of PAC's in a row) and paroxysmal atrial fibrillation (PAF); the pulmonary vein foci that are the underlying cause in most people are irritated by vagal firing. Frankly, your symptoms sound more like paroxysmal atrial fibrillation, since they last for hours and days.

There are almost always multiple causes for PAF; and appropriate evaluation includes an echocardiogram to check for structural heart disease as well as blood tests to look for thyroid disease, anemia, or kidney disease. Since it's a marker for coronary disease, if you're of an age where that might be an issue, a stress test is appropriate as well. Being overweight and having sleep apnea can be significant contributors in lots of people, so weight loss and treatment of sleep apnea (with a CPAP mask) can help. Blood pressure needs to be controlled to reduce stress on the wall of the heart, diabetes should be treated, and excessive alcohol use (as well as, probably, smoking) should be stopped, since they contribute to the symptoms.

If you've (a) documented the cause of the symptoms as PAC's or PAF and (b) treated the treatable causes and still have symptoms, then there are a variety of medicines that can help. I doubt antacids will help much, since your trigger sounds more like stomach distention than excessive acid. If you're at high enough risk for stroke (ask your doctor) you should be on a blood thinner called warfarin, although that does nothing for symptoms. There are then a long list of medicines that can be tried, ranging from the safe but not particularly effective (beta blockers and calcium channel blockers) to the less safe but more effective antiarrhythmic drugs like flecainide, sotalol, or amiodarone. There's a specific medicine called disopyramide that's particularly effective in truly vagally mediated atrial fibrillation, but the side effect profile is often difficult to tolerate, and it's not used that often. If symptoms are disabling despite medical therapy, there are invasive catheter-based treatments; however, these are not without risk and don't always work perfectly.