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Thread: Post Aortic Valve Replacement Arrhythmias

  1. #1
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    Default Post Aortic Valve Replacement Arrhythmias

    In my research for my upcoming AVR I have discovered many cases of arrhythmias, especially A-Fib, that has occurred as a result of valve replacement. Cleveland Clinic responded to my inquiry stating "Atrial fibrillation is a common arrhythmia after heart surgery and can prolong hospitalization. It is usually triggered by the healing process after heart surgery". I know that all arrhythmias cause anxiety, risk, and the need for additional medications for control. My question is how can one minimize the chance of this happening? Is one type of tissue valve more apt to cause it than another? Does the quality of the surgery have an effect on the likelihood of a resulting arrhythmia? Does A-Fib go away as the recovery progresses or can it be an on-going condition? Personally, I can feel every beat and off-beat of my heart. I want to avoid any long term arrhythmias if at all possible.

    THANK YOU ALL for the time and energy that you put into this forum. The information is invaluable and extremely helpful. The love & caring that you all give so freely is truly inspiring. I know that your prayers play a huge part in the healing process for everyone. My time is coming and I will be sure to take advantage of all your love.

  2. #2
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    I too can feel every single beat or off beat and going into a-fib was horrible for me. I only went in once after surgery and it has been controlled since. I don't have any answers for you except to say that over the last few months that I have been here most everyone has gone into a-fib after surgery, some have done it more than once...but most, are like me(I think) and manage to stay out.

    I have a mech valve in the Mitral position.


    Mileena

  3. #3
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    Luck of the draw to a large degree, I think!

    I went into A-Fib very shortly after they wheeled me from the OR into CICU. I certainly don't remember it. They controlled it with some Amiodarone (or however you spell it) for a day, maybe just a few hours. Never had A-Fib again (knock on wood).

    As for those benign arythmmias, well, they come and go for me. The first 4 months post op the were pounding hard and annoying, so beta blockers were prescribed and did the trick. I always say that my heart was doing a "happy dance"!! Eventually I weaned myself (with permission from docs) off the beta blockers. Now I have episodes from time to time, but not too serious.

    Look. Things may change for you. You can't control this, like as you may. All the best of everything may not be enough to keep you from having to live with some changes. You have to let go a little, here. In the letting go, I think we honestly allow a more positive result.

    Regardless of what occurs in your personal journey; the best thing will be waking up and knowing that you get to continue the journey. This fact will become ever more meaningful to you the more post surgery you get.

    Keep on fact gathering though!! Your questions help everyone!

    Best wishes.

    Marguerite
    AVR 4/18/06, age 52. Bovine tissue. CE Perimount RSR Model 2800. 23 mm. BAV diagnosed age 27(1981). Moderate stenosis (1.0 cm) 9/03; severe stenosis (.7cm) 12/05, Aortic measure at surgery 4/06, critical (.53 cm)

  4. #4
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    Default Post op Arrhythmias

    Take heart....sorry.....the arryhthmias that occur after heart surgery occur because the heart has undergone surgery, NOT because of anything you did or can do. You can probably minimize the number of occurences, which, as I'm sure you've read and will read in subsequent posts, are a normal part of the healing process, by keeping yourself adequately hydrated. Drink lots of water.

    But I need to address something you said: "I know that all arrhythmias cause anxiety, risk, and the need for additional medications for control. " Actually, most of them don't do any of the above. There is an increased risk of stroke with A-fib, but it's not true that all arrhythmias cause anxiety. I admit, it can be a bit worrisome to see your heart rate beating out an abnormal rhythm, but it's like flying. Some people get anxious and some people don't. If you keep in mind that abnormal rhythms during the first 6 mths (usually on a declining scale) are normal, there is no reason for you to be anxious nor is there a need for medication for your anxiety. If you need it, of course, you can always ask the docs for a prescription for it. I had a whole bottle of Alprazolam (Xanax) in my medicine cabinet and never felt the need to take any (although, I did a couple times the week before my surgery) and I had numerous bouts of A-fib (very short periods and under 100 BPM), in the first few weeks post op.

    Yes, you will undoubtedly be on a beta blocker to help keep your heart rate a little slower and to help it stay more regular. And here's the bonus: most, if not all, beta blockers also significantly reduce anxiety. Quite effectively, I might add. You'll be fine. You only need to be concerned if the irregular beats don't subside after several hours or if they are really fast, like 110 - 120+. My numbers may be off a bit, but they're in the right vicinity. Most hospitals and/or surgical groups provide guidance on what constitutes an emergency and what warrants a call to your doctor. It wouldn't hurt to ask for this information now for your own stress relief.

    You may also receive another medication to more specifically keep your heart rhythm regular Amiodarone is a commonly prescribed one. Another, Coumadin (Warfarin) will likely be given as an anticoagulant, which reduces the risk of having a stroke caused by clot formations.

    Another med you'll likely get is an Angiotensin Converting Enzyme (ACE) inhiibter or Angiotensin Receptor Blocker (ARB) for helping to keep your blood pressure low to ease your heart's workload and aid it in the healing process.

    Not to make light of aortic valve replacement surgery, but to a great extent, the medical professionals have it pretty well covered. The more you read these forums and posts, you'll see that the vast majority of us, especially those of us who have just needed an AVR (and perhaps a Maze procedure) rarely have complications. Typically, the healthier your are going into it, the quicker you bounce back.

    Yes, arrhythmias can be an ongoing occurrence. But millions of non-heart patients get them. Most people just aren't as cardiac-aware as we are, understandably. I often get them more for several hours after really hard cardiovascular workouts . Not A-fib, but Premature Atrial Contractions (PACs) and a rare run of tachycardia (anywhere from 5 - 12 beats). This is normal. I haven't been on beta blockers or anit-coagulants for well over a year and my docs are perfectly OK with that. If you get a tissue valve you shouldn't need anticoag. therapy but you'll need another AVR at some point. If you go mechanical, you may hear your valve more than with tissue, you will need anticoag. therapy (see On-x as a poss. future exception), but you shouldn't have to get it replaced ever again. No guarantees on anything, but that's the general expectation.

    My bottom line message to you is, definitely continue to educate yourself, but please don't sweat the arrhythmias that, yes, you will most likely experience. The ones that occur as a result of the heart being messed with in such a major way, are almost always well controlled, minor and will drop off in frequency quite noticeably after the first few weeks post-op.

    Meanwhile, the wonderful VR family will be here to help you through the tough spots...before and after your surgery!
    AVR - Medtronics 29mm
    porcine valve and partial Maze
    9/12/08 at Fairfax Hospital/Dr. Alan Speir[SIZE="2"][/SIZE]

  5. #5
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    Quote Originally Posted by 2leafer View Post
    In my research for my upcoming AVR I have discovered many cases of arrhythmias, especially A-Fib, that has occurred as a result of valve replacement. Cleveland Clinic responded to my inquiry stating "Atrial fibrillation is a common arrhythmia after heart surgery and can prolong hospitalization. It is usually triggered by the healing process after heart surgery". I know that all arrhythmias cause anxiety, risk, and the need for additional medications for control. My question is how can one minimize the chance of this happening? Is one type of tissue valve more apt to cause it than another? Does the quality of the surgery have an effect on the likelihood of a resulting arrhythmia? Does A-Fib go away as the recovery progresses or can it be an on-going condition? Personally, I can feel every beat and off-beat of my heart. I want to avoid any long term arrhythmias if at all possible.

    THANK YOU ALL for the time and energy that you put into this forum. The information is invaluable and extremely helpful. The love & caring that you all give so freely is truly inspiring. I know that your prayers play a huge part in the healing process for everyone. My time is coming and I will be sure to take advantage of all your love.
    I don't think there is anything you can do before surgery to minimize an arrhythmia after surgery. I've not heard or read anything about a particular valve triggering them. The spots for the heart's conduction system can get annoyed by being handled during surgery, and cause the irregular beats after surgery -- that's how it was explained to me. Most people don't even experience them.

    Not all arrhythmias cause anxiety, risk or the need for medication. A fair amount are benign and need no treatment, and we all experience irregular beats from time to time, not just valve or other heart patients.

    The majority of the arrhythmias after valve surgery occur within a few days when you're still in the hospital and being monitored and will have a quick response and you'll be given medication if needed. I had an interesting bout, but it all worked out fine.
    Luana

  6. #6
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    Partial excerpt:
    Quote Originally Posted by 2leafer View Post
    My question is how can one minimize the chance of this happening? Is one type of tissue valve more apt to cause it than another? Does the quality of the surgery have an effect on the likelihood of a resulting arrhythmia? Does A-Fib go away as the recovery progresses or can it be an on-going condition? Personally, I can feel every beat and off-beat of my heart. I want to avoid any long term arrhythmias if at all possible.
    I had the same questions because I had a few incidents of tachycardia over the years prior to my AVR and I wanted to know if I was at greater risk for A-fib after surgery. If so then that would suggest I would then be on coumadin and may as well get a mechanical valve. My surgeon did not think those prior events would lead to a higher probability of getting permanent A-fib. I believe my pre-surgery tachycardia was related to my heart compensating for its BAV defect.

    It's the surgery and not valve type that MAY cause arrhythmia. Arrhythmias often happen after OHS and from the literature I read that most do go away. Mine did. But it was a major pain when I had it. My opinion is that to avoid possible tachycardia you should be extra careful while healing for say 3 months or so and avoid stress, alcohol, caffeine and other stimulants. Then gradually add those vices back into your routine as you see fit. For the first 3-months or so you will hear and feel every little nuance of your heart and it could take several months before everything (physical and mental) settles down back to normal.
    John
    Coarctation of aorta repaired in 1966 @ 11
    AVR (bovine-pericardial valve) and aortic reduction in 2008 @ 53 ~ Cleveland Clinic

  7. #7
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    Quote Originally Posted by 2leafer View Post
    In my research for my upcoming AVR I have discovered many cases of arrhythmias, especially A-Fib, that has occurred as a result of valve replacement. Cleveland Clinic responded to my inquiry stating "Atrial fibrillation is a common arrhythmia after heart surgery and can prolong hospitalization. It is usually triggered by the healing process after heart surgery". I know that all arrhythmias cause anxiety, risk, and the need for additional medications for control. My question is how can one minimize the chance of this happening? Is one type of tissue valve more apt to cause it than another? Does the quality of the surgery have an effect on the likelihood of a resulting arrhythmia? Does A-Fib go away as the recovery progresses or can it be an on-going condition? Personally, I can feel every beat and off-beat of my heart. I want to avoid any long term arrhythmias if at all possible...
    I believe that I once read that how much of the heart, or possibly where the heart is cut, can make a difference. Maybe talk to your surgeon and find out their experience and stats in that regard.

    Mineral imbalance can make a difference. And there are plenty of heart medications that can contribute to mineral imbalances also, even after some time of taking the medication with no apparent side effects, namely cumulative effect.

    Remember also that some arrhythmias are considered benign, although they may be uncomfortable. Allergies and various foods can apparently contribute to some "benign" arrhythmias.
    Repaired coarctation of the aorta and replaced bicuspid aortic valve
    Forum Rules: "...Any and all medical opinions expressed in this forum are the personal opinions of individuals. No person should at anytime act on the information contained herein without the express consent of your own physician..."

  8. #8
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    Quote Originally Posted by Marguerite53 View Post
    Luck of the draw to a large degree, I think!

    Marguerite
    I think this is pretty much the truth. Most of us experienced Afib after surgery, but some did not. For me, it hit me 6 weeks out of surgery and lasted for 3 days. There is nothing you can do about it. It will either happen or it won't, but either way, if it does occur, it will be treated.

  9. #9
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    May 2008
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    yep ross you hit it on the nail,
    had avr replacement feb 2008 tissue valve fitted have got a nice porky pig one so no bacon for me ha ha,on hbp tabs and beta blockers,

  10. #10
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    Jun 2009
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    Yes A-fib for 3 days in ICU. Treated with amiodarone and it went away...
    Johan
    Diagnosed with heart murmer at age of 6. AVR 1 July 2009 at age 66. Carpentier-Edwards Perimount Magna Thermafix Model 3000TFX/21mm plus 1 CABG. Christiaan Barnard Memorial Private Hospital in Cape Town, South Africa. Surgeon Dr Otto Thaning.

  11. #11
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    I went into AFib about 1.5 weeks out of surgery, after I was home, and stayed in AFib for 8 full weeks while on Amioderone and Coumadin prior to Cardioversion. The Amioderone hurt my Thyroid gland, now I'm Hypothyroid which, if not treated at the correct rate of supplementary hormones, causes *irregular heartbeats*, usually for me PVCs. Sigh.

    Luck of the draw (or lack thereof) it is.... IMHO

    Yet, when it's all said and done, here I am, happy to be here and happy to be well again.

    I wish you all the best in your surgery and recovery.

    Ruth
    Mitral Valve Repair - 1/9/07
    Washington Hospital Center
    Right Thoracotomy
    Post Op A-Fib - Cardioversion 3/15/07
    Hypothyroid now likely due to Amioderone
    Rheumatic Fever 1971 age 12

  12. #12
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    I am 5 weeks post-op after aortic valve replacement and mitral valve repair. A week or so prior to surgery I was started on metoprolol, which I understand was to minimize the possibility of Afib. I am still on it, don't know how long I will need it. I have had no instances of irregular heartbeats (at least that I am aware of!)

  13. #13
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    I am a newb here with my first post. I had MVR 5 weeks ago, and also have a dilated left ventricle. I went into a-fig on my third week for 8 days, and they started my on Amioderone 800mg, 400mg down to 200mg. The afib stopped the next day after starting, but that is a fast self cardioversion from what I am told. I still get spells of slow pounding beats that last a few minutes, but they pass.

    I am still not sure what to expect going forward, but I do hope they go away with healing and excersize. When I go into afib I get so dizzy I nearly fall down. Wheni am in rythm, I feel like I can run a marathon,,, well, all most.

    One cool thing, because I can hear my heart tick, taking my heart rate is easy.

  14. #14
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    It is scar tissue from cutting into the heart that can cause an interference in the electrical activity conduction, or arrhythmia. The type of valve has no effect since all require cutting heart tissue. The highest chance of an arrhythmia occurs soon after surgery when the heart is healing, but can happen at any time in the life of a heart valve patient. There is very little we can do to prevent how our hearts react, just be sure to keep an open dialogue with your physician and they can medically treat whatever pops up.

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