Cervical spine instability and neck pain as a cause of atrial fibrillation

Ross Hauser, MD

This article is part of a series of articles on how cardiovascular-type symptoms may be coming from a problem in the cervical spine, causing compression on the nerves, arteries, and veins that are all part of the cardiovascular system. This article will focus on atrial fibrillation, the vagus nerve, and cervical spine instability.

It is important to understand that atrial fibrillation can be caused by many health issues. Cervical spine instability may only be one possible explanation as to why seemingly healthy individuals, having been checked out by their cardiologist, have cardiovascular-type symptoms with no clear explanation.

An example case: This email has been edited.

I have a diagnosis of degenerative disc disease and compression at C2-C3 and C5-C6. I had nerve blocks that did not help. My symptoms are headaches, dizziness, bowel problems, weakness, tachycardia, bradycardia, and depression. Most recently, I had a cardiac ablation for my irregular heartbeat. There is no clear connection that my heart issues are being caused by my neck problems.

Explanation: Hauser’s Law, developed by Ross Hauser, MD., seeks to explain the cause of most chronic disabling symptoms. In Hauser’s Law, these symptoms of human diseases, when the cause remains elusive, are due to dynamic carotid sheath compression from ligamentous cervical instability. (Cervical spine instability causing nerve and blood vessel compression). This compression affects the vagus nerves and internal jugular veins and occurs primarily at the atlas (C1 vertebra). Most body symptoms and diseases occur because of vagus nerve dysfunction or degeneration, and brain symptoms and diseases are from internal jugular vein compression, resulting in high brain venous and cerebrospinal fluid pressures.

Cervical spine instability distorts messages from the heart to the brain and back again

Cervical spine instability creates autonomic myopathy or autonomic neuropathy, simply, nerve damage that blocks or interferes with the messages sent between the brain and the heart. Distortion, blocking, or interference in these heart function messages getting through can lead to a variety of serious symptoms, including atrial fibrillation and various heart arrhythmias. Diagnoses such as myocardial ischemia, angina, atrial fibrillation, ventricular tachycardia, mitral valve prolapse, postural orthostatic tachycardia syndrome (POTS), drop attacks, and life-threatening hypotensive episodes can be from autonomic failure, which can have a cervical structural etiology.

In November 2019, doctors in the United Kingdom, writing in the European Journal of Clinical Investigation (1) wrote: “There has been increasing evidence that abnormalities of the autonomic nervous system (ANS) that includes sympathetic, parasympathetic and intrinsic neural network (simply the ability to regulate heart function) are involved in the pathogenesis of atrial fibrillation . . .”

What these doctors were after, among other explanations, was an explanation as to why some patients with atrial fibrillation do not benefit from cardioversion (shocking the heart into rhythm) or ablation. The explanation is that in certain patients, it is not the heart, but the network, including the vagus nerve. For some patients, this may be a clue to the “mysterious heart condition” that no one can figure out.

A February 2023 study in the journal Frontiers in Cardiovascular Medicine (5) did point out that Heart rate variability, especially higher rMSSD (differences in rate within short-term and long-term periods), was closely related to recurrent atrial fibrillation following catheter ablation, highlighting the clinical importance of HRV in the prognosis of atrial fibrillation following catheter ablation.

Messaging miscommunication in the autonomic nervous system causes Atrial Fibrillation

A June 2020 paper in the Journal of Atrial Fibrillation (2) describes the difficulty in understanding lesser-known diagnoses of a racing heart and the problem of heart rate messaging miscommunication in the autonomic nervous system.

“The cardiovascular branch of the autonomic nervous system (ANS) is responsible for the regulation of heart rate, blood pressure, and maintaining homeostasis during physiological stress such as exercise and standing upright. The autonomic nervous system constantly controls the rate and force of heart contractions and the vascular tone with the aim to maintain sufficient tissue perfusion with oxygenated blood and secure venous return to the heart.” (In other words, the normal function of the heart, blood rich in oxygen travels the body, and it returns to the heart the oxygen-poor blood to send to the lungs to be re-oxygenated).

Vagal atrial fibrillation

A January 2024 paper in the Frontiers in Cardiovascular Medicine (3) offers a summary explanation of the two types of atrial fibrillation.

Adrenergic atrial fibrillation
Vagal atrial fibrillation

This paper from doctors at the University Hospitals Leuven in Belgium and the University of Calgary goes on: “While the existence of a vagal atrial fibrillation subtype (atrial fibrillation occurs when the vagus nerve is stimulated) cannot be denied, there is no universal definition of a vagal atrial fibrillation. This is mainly due to the fact that vagal and adrenergic atrial fibrillation subtypes (atrial fibrillation onset with mental or physical stress) represent the extremes of a spectrum where most of the patients will present with a mixed subtype. (The patients have atrial fibrillation, possibly due to a combination of vagus nerve stimulation and physical and mental stress). Therefore, it is important to note that the described characteristics are not definitive markers for either subtype, nor that there may be significant overlap. (The patient’s overlapping symptoms make it difficult to understand their situation.) Differentiation of vagal and adrenergic atrial fibrillation subtypes may have implications for the treatment options, as certain interventions have shown not to modify the autonomic innervation of the heart. (Treating symptoms of one subtype of atrial fibrillation may not help regulate the other symptoms caused by another subtype of atrial fibrillation.) Non-invasive methods for identifying patients with vagally-mediated atrial fibrillation, such as ambulatory HRV (monitoring the patient’s heart rate variability), may have the potential to guide ablation strategy. However, further research is needed to better understand the mechanisms underlying the relationship between autonomic tone and AF, and to validate the use of measures such as HRV, baroreflex sensitivity, or novel artificial intelligence algorithms (predictions of diagnosis and treatment outcomes), as a tool for patient selection.”

“The clinical characteristics of patients with vagal and adrenergic atrial fibrillation subtypes differ significantly. Patients with vagally-mediated atrial fibrillation are typically younger, more often male patients without structural heart disease, and in the absence of significant cardiovascular comorbidities. In contrast, adrenergic atrial fibrillation is believed to manifest in patients by a combination of triggers and atrial (heart muscle) remodeling due to underlying structural heart disease and risk factors such as arterial hypertension, diabetes, and heart failure.”

Here, we will focus on the vagus nerve or Vagal atrial fibrillation.

Now, let’s do a short summary and a video presentation with Ross Hauser, MD.

Summary of the learning points of this video

There are a lot of people who have unexplained dizziness, balance problems, blood pressure swings, arrhythmia, palpitations, OR their heart rate can go really low.
They go to a cardiologist or several cardiologists and other doctors and no one seems to know the cause of their heart problems.
We find that in a lot of these cases, the person is suffering from cervical instability, especially upper cervical instability.
The sensory nerves that tell the brain what’s going on, moment to moment, in regard to heart rate and blood pressure are carried by the vagus nerve and the glossopharyngeal nerve. If the messages that these sensory nerves need to deliver to the brain are blocked or impaired, the heart symptoms described can develop.

Cervical spondylosis and atrial fibrillation

A September 2018 paper in the Journal of Clinical Medicine (4) was among the first published papers to report an association between cervical spondylosis and arrhythmia. In this study of 22,236 cervical spondylosis patients (males, 42.6%; average age, 54.4 years) who were matched with 22,236 non-cervical spondylosis patients, the researchers found:

1441 events of arrhythmia in the cervical spondylosis patients and 537 events of arrhythmia in non-cervical spondylosis patients.
- The cervical spondylosis group was associated with a 310% increase in arrhythmia risk compared to patients without cervical spondylosis, especially atrial fibrillation, ventricular, and supraventricular tachycardia.

The researchers stated: “evidence has shown that cervical spondylosis can cause sympathetic nerve irritation and associated sympathetic symptoms, and instability at the C4–C5 intervertebral space is the most common type causing sympathetic symptoms. Recognized sympathetic symptoms of cervical spondylosis are vertigo, dizziness, tinnitus, headache, and palpitation.” Further: “One interesting finding of this study is that cervical spondylosis patients who had received rehabilitation or surgical decompression had a lower risk of arrhythmia events compared with those who had mild cervical spondylosis with no signs.” In other words, fixing the neck in selected patients results in a lower risk of arrhythmia.

Here are some videos that you might find helpful!

We hope you found this article informative and that it helped answer many of the questions you may have surrounding atrial fibrillation. Just like you, we want to make sure you are a good fit for our clinic prior to accepting your case. While our mission is to help as many people with chronic pain as we can, sadly, we cannot accept all cases. We have a multi-step process so our team can really get to know you and your case to ensure that it sounds like you are a good fit for the unique testing and treatments that we offer here. Please contact us

References

1 Khan AA, Lip GY, Shantsila A. Heart rate variability in atrial fibrillation: The balance between sympathetic and parasympathetic nervous system. European journal of clinical investigation. 2019 Nov;49(11):e13174. [Google Scholar]
2 Feigofsky S, Fedorowski A. Defining Cardiac Dysautonomia–Different Types, Overlap Syndromes; Case-based Presentations. Journal of Atrial Fibrillation. 2020 Jun;13(1). [Google Scholar]
3 Vandenberk B, Haemers P, Morillo C. The autonomic nervous system in atrial fibrillation—pathophysiology and non-invasive assessment. Frontiers in Cardiovascular Medicine. 2024 Jan 4;10:1327387. [Google Scholar]
4 Lin SY, Hsu WH, Lin CC, Lin CL, Tsai CH, Lin CH, Chen DC, Lin TC, Hsu CY, Kao CH. Association of arrhythmia in patients with cervical spondylosis: a nationwide population-based cohort study. Journal of Clinical Medicine. 2018 Aug 23;7(9):236. [Google Scholar]
5 Zhang E, Liang S, Sun T, Xu J, Lu F, Wu D, Zhang J, He L, Zhang F, Fan S, Ma W. Prognostic value of heart rate variability in atrial fibrillation recurrence following catheter ablation: a systematic review and meta-analysis. Frontiers in Cardiovascular Medicine. 2023 Feb 2;9:1048398. [Google Scholar]