I had a bovine aortic valve replacement in March 2018. Recovered pretty quickly and was back paddling an outrigger by late July. I did have an a-fib occurrence in July but recovered quickly. Doc put me on diltiazem. Did the full race season in 2019, and then the next two seasons were essentially cancelled because of covid, but I did train and coach novice and paddled a one-man. Then in 2021, I started racing again. But in August, a-fib came back and Doc put me on Xeralto. That December I had ablation for a-fib and a-flutter. Stayed on Xeralto for 6 more months, but no a-fib or a-flutter (I go to cardiologist every 3 months). Then last month they found a-fib and a-flutter again in a different part of my heart. Back on Xeralto and two ablations scheduled for this summer after race season. I am totally non-symptomatic and can race 12 miles on the open ocean. Anyone else have these occurrences after aortic heart valve replacement? I was pretty damned depressed when the a-fib and a-flutter came back. It probably means I will be on Xeralto for the rest of my life. (I am 74.)
A-Fib after Aortic Valve Replacement
- Thread starter Jerry D
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pellicle
Professional Dingbat, Guru and Merkintologist
Hi Jerry
sorry to read of your AF onset ...
However its not an uncommon occurrence AFAIK
I have had (12 years post surgery) an onset of Tacycardia, which I attribute to COVID. While it was "intermittent" I didn't worry to much about it (as I was already on warfarin due to picking a mech valve in my 3rd OHS). However were I not I'd likely have sought something out quickly because IMO this will (if not treated with medication) be an increase in morbidity for me.
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2734630
thus my advice is to always consider this when making a decision towards a bio-prosthetic if it is based on a dislike of being on anticoagulation therapy (ACT) rather than an actual medical "contra-indication" ... because you may just wind up on ACT and then that may make it all the more a regretful decision.
But at least you don't have to check INR ...
Best Wishes
sorry to read of your AF onset ...
However its not an uncommon occurrence AFAIK
I have had (12 years post surgery) an onset of Tacycardia, which I attribute to COVID. While it was "intermittent" I didn't worry to much about it (as I was already on warfarin due to picking a mech valve in my 3rd OHS). However were I not I'd likely have sought something out quickly because IMO this will (if not treated with medication) be an increase in morbidity for me.
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2734630
Atrial fibrillation is a common arrhythmia with a lifetime risk of 37% in individuals older than 55 years. Atrial fibrillation is also associated with significant cardiovascular morbidity and mortality. New-onset atrial fibrillation has been recognized as a common occurrence after noncardiac and cardiac surgery, such as aortic valve replacement (AVR).3-5
Several investigations have attempted to elucidate the incidence of atrial fibrillation after AVR. The incidence estimates of atrial fibrillation after transcatheter aortic valve implantation (TAVI) and surgical AVR have varied widely, ranging from 8% to 100%.6-9 New-onset atrial fibrillation after TAVI and AVR has also been associated with increased morbidity and mortality.10 Most investigations detailing new-onset atrial fibrillation after TAVI and AVR, however, are single-center series or post hoc analyses of clinical trials.
thus my advice is to always consider this when making a decision towards a bio-prosthetic if it is based on a dislike of being on anticoagulation therapy (ACT) rather than an actual medical "contra-indication" ... because you may just wind up on ACT and then that may make it all the more a regretful decision.
But at least you don't have to check INR ...
Best Wishes
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Hi Jerry. I'm a lifelong endurance runner and have had 2 valve (mitral) surgeries and 2 ablations (technically 3 as an ablation was also done during my first valve surgery.
- I routinely recommend older endurance athletes read "The Haywire Heart" by Case, Mandrola, & Zinn. As much as it still bothers me to acknowledge it, there's quite a bit of data indicating that longtime endurance athletes have an increased risk of arrhythmias. Unfortunately it is also (essentially) impossible to run a double blind, randomized, verification/refutation of this for the obvious (to the endurance athletes anyway!) reason. The reference book does have lots of easy to read information on arrythmias and what can be done about them.
- As Pellicle points out, there is plenty of evidence that AFIB incidence increases with age.
- Every surgical incision into the heart muscle is scarring it. Because cardiac tissue (unlike muscle tissue arranged in fibers with a common cell membrane) transmits it's electrical signals multi-directionally, every scar changes the electrical pathways in the heart. This is actually what ablations do as well. An ablation's scarring is intended to correct erroneous pathways but they don't always work and not always permanently. I have one friend who underwent 5 ablations for AFIB over about 36 mos. So - to me anyway - it makes sense that those of us who have undergone valve surgery have a greater chance of developing an arrythmia. Reading about the early Maze procedures on the outside of the heart and on the inside were educational for me.
So you have several factors that could all be playing a role (and of course there are many other factors as well; e.g. alcohol). Some good news is that it need not stop your activity. AFIB and/or preventative drugs may well impact performance but I (eventually) accepted that I was slowing down with age anyway! I still run 5 or 6 days a week and compete regularly.
fyi - my actual "order of operations" was AFIB ablation age 45, mitral repair age 49 (cryogenic ablation also performed), mitral replacement age 50, Aflutter ablation age 56. I went on warfarin in my early 40's after a blood clot so I never considered anything other than mechanical when the repair became problematic.
- I routinely recommend older endurance athletes read "The Haywire Heart" by Case, Mandrola, & Zinn. As much as it still bothers me to acknowledge it, there's quite a bit of data indicating that longtime endurance athletes have an increased risk of arrhythmias. Unfortunately it is also (essentially) impossible to run a double blind, randomized, verification/refutation of this for the obvious (to the endurance athletes anyway!) reason. The reference book does have lots of easy to read information on arrythmias and what can be done about them.
- As Pellicle points out, there is plenty of evidence that AFIB incidence increases with age.
- Every surgical incision into the heart muscle is scarring it. Because cardiac tissue (unlike muscle tissue arranged in fibers with a common cell membrane) transmits it's electrical signals multi-directionally, every scar changes the electrical pathways in the heart. This is actually what ablations do as well. An ablation's scarring is intended to correct erroneous pathways but they don't always work and not always permanently. I have one friend who underwent 5 ablations for AFIB over about 36 mos. So - to me anyway - it makes sense that those of us who have undergone valve surgery have a greater chance of developing an arrythmia. Reading about the early Maze procedures on the outside of the heart and on the inside were educational for me.
So you have several factors that could all be playing a role (and of course there are many other factors as well; e.g. alcohol). Some good news is that it need not stop your activity. AFIB and/or preventative drugs may well impact performance but I (eventually) accepted that I was slowing down with age anyway! I still run 5 or 6 days a week and compete regularly.
fyi - my actual "order of operations" was AFIB ablation age 45, mitral repair age 49 (cryogenic ablation also performed), mitral replacement age 50, Aflutter ablation age 56. I went on warfarin in my early 40's after a blood clot so I never considered anything other than mechanical when the repair became problematic.
Thank you for your responses. Very helpful.
Gail in Ca
Well-known member
My chronic a-fib started 3 yrs after my 3rd surgery. The cardio version worked for 2 yrs. my a-fib came back in 2014, cardio version didn’t work, so I’m in a-fib all the time. Couldn’t have ablation as I have mechanical valve. It’s not bad living with it. I was already on warfarin, so no more drugs needed.
Thanks for your response. Yes, I am on Xeralto and suspect they will keep me on it forever. Fortunately I am asymptomatic. Be well and take care.
Haoming Li
Member
Hello Gail, I am also a member, but didn't post much. Just came across your post now, I also had AFib couple times after valve replacement since June 2016. I had fast heart beat in last 2weeks,
already scheduled to do cardioversion on coming Wed. It will be the 4th time I am having this procedure, cross fingers that it will help. Many people say they could live with AFib, but it bothers me too much!!
Thank you for listening to me.
HaoMing Li
ChristinaColorado
Member
Hi - I was just found on EKGs to have atrial fibrillation - I know now that I have had it for several months. I had a mitral valve repair 20 years ago and have had no issues until now. Wondering about ablation and if I should have it done. I have asymptomatic, continual afib - I can really feel it when I am exerting myself and when I am worrying about all of this, my heart will go into overdrive with tachycardia and afib. I am very depressed about this, although I knew it could come someday. I believe having my gallbladder removed last year possibly set it off - I think it started maybe at the beginning of the year. I had no idea I was in afib. I would like to know what others here think about ablation and blood thinners. Thank you so much.
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hi @ChristinaColorado. First piece of advice I can offer is to try to scrape yourself off the ceiling (i.e. reduce your level of worrying) and try to ignore all those TV commercials in the U.S. that tend to overemphasize various AFIB drugs! AFIB is serious but you have been through serious before and since you are working with a cardiologist you are already working on it. AFIB is quite common and there several options to control and in some cases eliminate the problem. I expect the cardiologist will first try to identify a cause. There are many: stress, thyroid, alcohol, along with those internal to the heart itself. My experience was to first attempt to correct the AFIB with medication, then cardioversion, then more various medications and cardioversions, then finally ablation. All of these approaches are successful with some patients and not with others.
Personally, I was on warfarin before I had AFIB and now have a mechanical valve and consider the warfarin a non-issue. Primary risk with AFIB is clot formation so something to prevent that is prescribed.
A note on ablations: Purpose of the ablation is to block and/or eliminate erroneous electrical pathways. You can think of it as the electrophysiologist going inside (or outside in the 'old' days) and using a tool (knife, cryogenic catheter, rf catheter) to scar the heart in very specific locations. If you have had a valve repair (or replacement) you already have some scarring and (likely) structure in place. That can make an ablation more challenging, and in some cases not possible, depending on exactly where the erroneous signals need to be dealt with.
Personally, I was on warfarin before I had AFIB and now have a mechanical valve and consider the warfarin a non-issue. Primary risk with AFIB is clot formation so something to prevent that is prescribed.
A note on ablations: Purpose of the ablation is to block and/or eliminate erroneous electrical pathways. You can think of it as the electrophysiologist going inside (or outside in the 'old' days) and using a tool (knife, cryogenic catheter, rf catheter) to scar the heart in very specific locations. If you have had a valve repair (or replacement) you already have some scarring and (likely) structure in place. That can make an ablation more challenging, and in some cases not possible, depending on exactly where the erroneous signals need to be dealt with.
I have had three open-hearts for bicuspid aortic valve stenosis with the 3rd an aortic aneurysm. I started to get intermittent A. Fib about 30 yrs after my initial valve surgery. It was slightly bothersome but short episodes. I was already on warfarin so I was covered for embolization from clot formation in the atrium.
Finally during a climb on a bike I got A. Fib that wouldn't quit. I ended up in the ER had an echocardiogram and in 2006 was converted back to normal sinus rhythm. Due to that echo my life may have been saved since the 6.5 cm aneurysm was seen and one month later I had surgery.
I developed 3rd degree block s/p the surgery and needed a pacer. So when my heart did go into A. Fib the A. Fib was not seen by the ventricles due to the block. I did feel however that my total level of function dropped due to the lack of the "atrial kick".. So I had 3 ablations over around 6 years or so. They worked for a year or so then the A. Fib returned. Finally during Covid I considered a more aggressive approach to ablation but I declined. So now I am in chronic A. Fib. Since I have a mechanical St. Jude I have to stay on warfarin so I am covered for the A. Fib anticoagulation.
As a general rule the two primary reasons for dealing with A. Fib is to avoid chronic anticoagulation and to have rhythm control. Some patients in A. Fib have difficult to control rhythms giving them fast or slow ventricular responses. If you already are on anticoagulation and haven't much in the way of rhythm issues than the need to get out of A. Fib is not as important.
Bye the way. I was hit by a trailer being pulled by an SUV last week while road biking. Four broken ribs, one broken clavicle, one damaged T9 vertebra and lots of road rash and hematoma formation. Fortunately no neuro damage no head trauma. Home now about 4 days with very sore back due to the ribs. This was all while on warfarin with an INR of about 2.4. I am very lucky. It was the driver's fault for not getting over since the trailer was wider than his SUV. They did stop. Taken to the trauma center and had many CT/X-rays. Now I glow in the dark.
Finally during a climb on a bike I got A. Fib that wouldn't quit. I ended up in the ER had an echocardiogram and in 2006 was converted back to normal sinus rhythm. Due to that echo my life may have been saved since the 6.5 cm aneurysm was seen and one month later I had surgery.
I developed 3rd degree block s/p the surgery and needed a pacer. So when my heart did go into A. Fib the A. Fib was not seen by the ventricles due to the block. I did feel however that my total level of function dropped due to the lack of the "atrial kick".. So I had 3 ablations over around 6 years or so. They worked for a year or so then the A. Fib returned. Finally during Covid I considered a more aggressive approach to ablation but I declined. So now I am in chronic A. Fib. Since I have a mechanical St. Jude I have to stay on warfarin so I am covered for the A. Fib anticoagulation.
As a general rule the two primary reasons for dealing with A. Fib is to avoid chronic anticoagulation and to have rhythm control. Some patients in A. Fib have difficult to control rhythms giving them fast or slow ventricular responses. If you already are on anticoagulation and haven't much in the way of rhythm issues than the need to get out of A. Fib is not as important.
Bye the way. I was hit by a trailer being pulled by an SUV last week while road biking. Four broken ribs, one broken clavicle, one damaged T9 vertebra and lots of road rash and hematoma formation. Fortunately no neuro damage no head trauma. Home now about 4 days with very sore back due to the ribs. This was all while on warfarin with an INR of about 2.4. I am very lucky. It was the driver's fault for not getting over since the trailer was wider than his SUV. They did stop. Taken to the trauma center and had many CT/X-rays. Now I glow in the dark.
I had a tissue AVR in 2018 and had a case of a-fib 4 months later. Went to ER, had an infusion, and was in sinus rhythm in a few hours. I was in sinus for 3 years after that, but had an episode of light-headedness in the fall of 2021. I was put on Xeralto and had an ablation for flutter and fib in December. Six months later I was taken off the Xeralto. I was then in sinus until March 2023 when the flutter and fib came back--bit in a different part of my heart--and I was put back on Xeralto. I had an ablation for the flutter in July and for the fib in August.
Except for those two episodes I have been asymptomatic since the OHS. The cardiologist only discovered the the flutter and fib this past March because of the EKG. I coach and race 6-man outrigger on the open ocean and raced 5 "Iron" races in May and June (12 miles on open ocean.) Never had a symptom, but I was told that asymptomatic can be the most dangerous. So now I have had three ablations, and two weeks after my last one I feel great, except for the bruising on my leg on the side the catheter went into the groin. With modern cardiac/catheter technology, ablations are very safe and the results are excellent.
Sorry about your accident. No head trauma is a blessing. Hope you have effective pain control. Did they arrest the driver? Some jackasses with trailers need to be given a strong wakeup call.
David Robbins
Active member
I had 2 AVRs in 2008. I was in Afib which was controlled by meds after 2 failed cardioversions. Once I learned of the dangers of Difetalide and sudden heart death I decided to get a 2nd opinion regarding meds for rhythm control. I had serious side effects to 2 other meds and decided not to take meds and continue on my anticoagulant regime to minimize clotting risk. I have never went into tachycardia despite vigorous and intense exercise regime. After lifting and running for over 54 years, I have a resting heart rate if 45 and nighttime lows can been in the high 30’s. I’ve never had a heart rate since the last surgery that exceeded 170 and never experienced any negative effects such as dizziness or respiratory distress. My HRR has been exceptional and my cardiologists told me I am not a candidate for ablation because after 15 years my heart has remodeled to accommodate the Afib condition. She said if it hasn’t been a problem in any state of activity, I can choose to live with it. With or without the Afib, anticoagulant treatment will be necessary because of the mechanical valve. I was advised that by the time I’m 75, I may need a pacemaker or risk heart failure due to a further reduction in resting heart rate which happens naturally as we age.
The low 30's rates when sleeping may suggest that a pacer is in your relatively near future. Clearly you are only getting a percentage of your atrial beats through to your ventricles. Likely 2nd degree heart block. So if you are feeling punky or have any sort of fainting don't wait too long in evaluation. Statistically ablation is much less effective in chronic A. Fib for whatever the reason.
pellicle
Professional Dingbat, Guru and Merkintologist
Hi Dave
very interesting post and thanks for putting that together. I'm not sure if you're asking me a question or not but if you are I don't feel that I have any strengths in those areas (Ablation, remodelling, AFib) because I've not ever researched those things (seems weird perhaps, but I'm economical with my research and usually follow a reasonably specific path which relates to my own situation).
I'm glad you've got a handle on it and are lifting that load more easily than without that handle. (Note: try lifting a 40kg block of expanded polystyrene foam without a handle)
very interesting post and thanks for putting that together. I'm not sure if you're asking me a question or not but if you are I don't feel that I have any strengths in those areas (Ablation, remodelling, AFib) because I've not ever researched those things (seems weird perhaps, but I'm economical with my research and usually follow a reasonably specific path which relates to my own situation).
I'm glad you've got a handle on it and are lifting that load more easily than without that handle. (Note: try lifting a 40kg block of expanded polystyrene foam without a handle)
Best Wishes
