A Guide to Atrial Fibrillation After Open Heart Surgery

Atrial fibrillation is the most common type of heartbeat irregularity. It causes your heart to beat chaotically. Instead of the usual steady rhythm, it may beat quickly for a few minutes or longer. Or, it may alternate among beating rapidly, then normally and then slowly. Atrial fibrillation is caused by an electrical problem in the atria, the heart’s top chambers.

There are approximately 2.3 million to 6.1 million people living with afib in the U.S., the Centers for Disease Control and Prevention reports. Having afib can put you at a higher risk for serious and sometimes life-threatening health problems such as:

Blood clots.

— Heart failure.


There’s another subset of patients who develop afib, often temporarily, after open heart surgery. Open heart surgery refers to surgeries in which a surgeon opens the chest to perform the surgery, says Dr. Sameer K. Mehta, a cardiologist and vascular surgeon with Denver Heart and director of cardiology and co-director of the Amputation Prevention Center at Rose Medical Center in Denver.

The most common types of open heart surgery are:

Coronary bypass surgery, also called CABG, is when a surgeon uses arteries or veins from other areas of your body to reroute the blood around any blocked heart arteries.

Aortic valve replacement, in which the aortic valve that helps to control blood flow to the heart is replaced.

— Mitral valve repair, which fixes narrowing or leakage of the heart’s mitral valve.

Atrial fibrillation after all types of heart surgeries occurs in as many as 20% to 60% of patients, according to a 2019 study in the journal Acta Anaesthesiologica Scandinavica.

Afib is the most common complication after heart surgery, according to the American Heart Association. Cardiologists estimate as many as a third to half of patients develop afib specifically after open heart surgery.

[READ: Heart Palpitations After Eating: When to Be Concerned.]

Why AFib Occurs After Open Heart Surgery

Doctors don’t always know why afib occurs after open heart surgery. It may have to do with inflammation in the heart. Nor can they always predict who will develop atrial fibrillation after heart surgery, but there appear to be a few risk factors:

— Being obese.

— Having a genetic disposition for atrial fibrillation.

— Having chronic obstructive pulmonary disease, or COPD.

— Having an electrolyte imbalance after surgery. This means that your body may not have its usual balance of calcium, magnesium, potassium and other minerals that help it to function properly.

— Having high blood pressure.

— Having surgery on a heart valve.

— Heart failure.

— Older age.

— Pneumonia that occurs after surgery.

— Preexisting thyroid problems.

Atrial fibrillation most commonly develops within seven days after open heart surgery, but there’s still a risk up to 90 days postoperatively, says Dr. Marc Miller, a cardiac electrophysiologist and an associate professor of medicine and cardiology with the Mount Sinai Hospital in New York.

Sometimes, it occurs just briefly after surgery, even just for a couple of hours or for a day. “By the time you tell the patient that they had afib, they are out of it,” says Dr. Leonard Pianko, a cardiologist with Aventura Cardiovascular Center in Aventura, Florida.

Even though afib after surgery can be temporary, it’s better to not have it at all because it’s associated with a greater risk for a longer hospital stay and more time in the intensive care unit. Atrial fibrillation also may increase the chance of kidney dysfunction, brain dysfunction or infection. Those are in addition to the increased risks for stroke and heart failure.

There are some patients who develop atrial fibrillation that doesn’t go away after open heart surgery, Mehta says.

If you have risk factors for afib or you already have afib, doctors will likely prescribe medicines or perform a procedure in advance or during open heart surgery to help lower the risk of postoperative afib, Mehta says.

[See: Best Exercises for Heart Disease Patients.]

Treatment for Atrial Fibrillation After Open Heart Surgery

If afib occurs after surgery, doctors will first make sure there aren’t other possible causes for an irregular heartbeat, such as bleeding or infection, Pianko says. If afib is present, doctors aim to get rid of it as soon as possible. That’s because the longer someone is in atrial fibrillation, the harder it can be to treat.

Atrial fibrillation after heart surgery can correct on its own, but that’s rare, says Dr. Suzanne Steinbaum, an American Heart Association volunteer medical expert based in New York City.

When it doesn’t, doctors can use several treatments for atrial fibrillation after open heart surgery. The exact treatment they use will depend on factors such as the patient’s health and the type of open heart surgery they had. Some treatments used for afib after open heart surgery include:

Blood thinners to help lower the risk for a dangerous blood clot, Pianko says. Common blood thinners include heparin or rivaroxaban. These types of medicine also are called anti-coagulants.

Anti-rhythmic drugs such as amiodarone to help restore the heart’s normal rhythm.

Beta blockers and calcium channel blockers that help control the heart rate.

Cardioversion, a type of shock therapy used to help the heart get back into a normal rhythm.

A cardiac ablation procedure, which involves the use of catheters that cause scars on the heart to help get rid of the heart’s faulty electrical signals.

In the majority of patients, one or more of these treatments will help them get out of an abnormal rhythm, Miller says. The important thing is to help a patient obtain a normal heart rhythm and rate, even if that means using medication over time.

[See: How to Avoid a Second Heart Attack.]

Patient Tips for Atrial Fibrillation After Open Heart Surgery

Although you can’t completely eliminate the risk for afib that occurs after open heart surgery, there are some things you can do to minimize your chances.

Most of these tips apply to the time period before surgery:

1. Maintain a healthy weight. If your open heart surgery isn’t an emergency surgery, ask your doctor if you can schedule it a few weeks away to give yourself time to lose weight if needed, Pianko advises. The healthier you are going into surgery, the better off you’ll be during the recovery period.

2. Quit smoking. Smoking can affect surgical outcomes.

3. Aim to lower your blood pressure, cholesterol and blood sugar before surgery if possible. These also can increase the risk for postoperative afib, Steinbaum says.

4. Get up and walk around when you can safely do so after surgery, Pianko advises. Of course, do this after you’ve been given the all clear by your doctor. Walking around after surgery helps to improve blood flow and lower your risk for blood clots.

5. Listen to any instructions from the doctor about afib. After you have open heart surgery, you likely will have to wear a heart monitor once you’re home, and your doctor may speak with you in advance about the signs and symptoms of afib.

6. Take any medications as prescribed by your doctor to help control your heart rate or rhythm, Steinbaum advises.

More from U.S. News

Best Exercises for Heart Disease Patients

6 Signs You’re Having a Heart Attack

Heart-Healthy Snacks

A Guide to Atrial Fibrillation After Open Heart Surgery originally appeared on usnews.com

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