Differential Diagnosis for Vagal Atrial Fibrillation

The symptoms described, such as a trembling sensation or an "earthquake in body-like sensation" before falling asleep for 15-25 seconds, could be indicative of several conditions. Here's a breakdown of potential diagnoses:

• Single Most Likely Diagnosis

  • Vagal Atrial Fibrillation: This condition is characterized by an irregular and often rapid heart rhythm that can be triggered by vagal stimulation, such as before sleep. The symptoms described could align with the onset of vagal atrial fibrillation, especially if the individual experiences palpitations or irregular heartbeats during these episodes.

• Other Likely Diagnoses

  • Anxiety or Panic Attack: The trembling sensation and body-like earthquake feeling could be symptoms of an anxiety or panic attack, which can occur at any time, including before sleep.
  • Hypnagogic Jerks: These are sudden, brief contractions of the body that occur when a person is transitioning from wakefulness to sleep. They can feel like an earthquake or a trembling sensation and are very common.
  • Sleep Myoclonus: Similar to hypnagogic jerks, sleep myoclonus involves sudden muscle contractions as one falls asleep, which could be mistaken for a cardiac issue due to the sensation of trembling.

• Do Not Miss Diagnoses

  • Cardiac Arrhythmias (other than atrial fibrillation): Conditions like ventricular tachycardia or supraventricular tachycardia could present with similar symptoms and are critical to diagnose due to their potential severity.
  • Seizure Disorders: Although less likely, certain types of seizures could manifest with similar sensations, especially if they involve the temporal lobe or other areas that could affect body perception and heart rate.
  • Pulmonary Embolism or Other Acute Cardiopulmonary Conditions: While the symptoms might not perfectly align, any condition that could lead to sudden death or severe morbidity should be considered, even if the likelihood is low based on the description.

• Rare Diagnoses

  • Neurocardiogenic Syncope: This condition involves a sudden loss of consciousness due to a reflex of the involuntary nervous system that affects heart rate and blood pressure, potentially causing a brief, trembling-like sensation before fainting.
  • Migraine Variants: Certain types of migraines can cause strange sensations in the body, including trembling or earthquake-like feelings, though these are typically accompanied by headache or other migraine symptoms.
  • Autonomic Dysfunction: Disorders affecting the autonomic nervous system, such as postural orthostatic tachycardia syndrome (POTS), could potentially cause a variety of symptoms including palpitations, tremors, and other sensations that might be confused with vagal atrial fibrillation.