A-Fib: I'm SO confused!

[Marge]

Could somebody give me a quick summary of A-fib as it relates with mitral valve disease?

I keep seeing A-fib mentioned in connection with mitral valve problems but I do not quite understand the relationship. I have gathered that a lot of people who have mitral valve regurgitation ALSO have A-fib. I have mitral valve regurgitation (in my case, at 3+) and systolic left ventricle dysfunction that is moderate to severe. So far nobody has said anything about me having A-fib.

The other day my surgeon said something about "if a person goes into A-fib, then they need coumadin." I didn't follow up on that. If you didn't have it before, is A-fib something you can go into during valve surgery? after surgery? If it is, does this happen a lot? What do they do if it happens? Does it go away later?

Actually, now that I think of it, what EXACTLY is A-fib, anyway? Is it related to arrythmia? I may or may not have some type of arrythmia acc. to the EKG printout I have. The surgeon looked at the printout & said I have "spikes." (I have no idea what he meant.) The cardio said I most likely have "benign PCV's and/or APC's" and ordered a Holter; they don't have the results back yet.

As you see, I'm pretty clueless about all this. I HAVE tried to read up on it, honest, before asking the question here, but all I have gotten out of it is confusion and headaches. I'd at least like to know what are the right question(s) to ask my doctor(s).

 

[Marty]

A fib ??????

A fib ??????

Marge, These are all good questions. You need to have them answered by your cardiologist and if it comes to that, again, byyour surgeon.
Write your questions down in order and do not leave the consultation room until they are answered to your satisfaction. Take notes so you can remember the answers and explain them to others.
You should also "google" atrial fibrillation and find a post that will discuss it to your satisfaction. Its a big subject.

 

[Nancy]

Hi Marge-

You can go into afib, before, during and after surgery. It is a fairly common heart arrhythmia.

Joe has it and has had it for a long time. his is chronic and will probably not ever go away. Lots of the time he is in normal sinus rhythm, but under stress he can go into afib, and aflutter also. His pacemaker helps some with it, but otherwise he's not on any medication for it other than digoxin. He's on too much already. And his doctors don't seem to be too worried about it. Many people can live with it. Joe's on Coumadin anyway for his 2 mechanicals.

There are several meds that can help or eliminate afib. There is also cardioversion, which might help, but sometimes the heart reverts back to that rhythm.

There is a new surgical technique called the Maze procedure which eliminates it permanently for some people. But not everyone can have that done. It takes several months after that for the afib to go away.

The important thing to know is that not everyone gets it, and most that do, return to normal sinus rhythm on their own.

Sometimes after heart surgery, the electrical pathways of the heart become irritated, and after more healing takes place it goes away.

 

[bvdr]

HI Marge,

When a person has valve disease, particularily mitral valve disease, the left atrium often enlarges. Stretching out the walls of the atrium can disturb the electrical system of the heart and cause the rhythm of the heart to become very fast and very irregular....atrial fib. It becomes so fast that it is less effective as a pump.

Atrial fib was also the earliest indication that I had heart disease. I have had it on and off for about 2 and a half years now. I was on coumadin before my surgery because of the atrial fib. As part of my surgery my surgeon completely sewed down the left atrial appendage to hopefully reduce some of the risks of clot formation.

I do know I feel better when I am in sinus rhythm. The medication I am on is not as effective in suppressing my atrial fib as it once was and in a week or so I have an appointment with my cardiologist to address the problem. It is one area of cardiology that has exploded with new technology and treatments in the last several years.

 

[hensylee]

Marge, you can go to about.com - look for heartdisease/cardiology (Dr Richard N Fogoros), go into forums. You can ask him these questions and he will give you personal answers pretty quickly. He doesn't give medical advice, tho - just general explanations, but it's his own PERSONAL response to you - no go-betweens.

 

[Nan]

Hi Marge, I also have A-Fib.....and a regurgitant mitral valve. I am not sure that that is the cause of the A-Fib, however. There can be many causes.

I saw from the responses to your posts that we have some folks who are in constant A-Fib.....I hope that they don't feel it!

When I am in A-fib I am horribly aware that something is wrong with very strong palpitations and an impending sense of something really bad happening.

Clearly not everyone feels like this. My cardio seems to treat it as an emergency, perhaps because I have a history of CHF.

Hopefully you will never experience it. It is not something that seems to automatically come along with mitral valve disease.

But I agree that you should go into your doctor with a list of questions and hopefully someone else with you to help you "hear" the responses.

Best of luck to you.

 

[Marge]

I am very grateful for all these replies. I am pretty sure I do NOT have A-Fib.
What was confusing me, I think, was all the talk about arrythmia. I thought: if you don't have A-Fib now, but if you have other arrythmias (even benign ones like my cardio thinks I have), would you be likely to develop A-Fib during the surgery or afterwards?
I don't need that!!!! Like somebody said, I don't need more on my plate.
I will try to find out as much as possible, and follow the leads posted here, but I'm also trying to remind myself not to borrow extra troubles B4 they even happen.
--------
As the surgery (although date still unset) looms closer all kinds of dire thoughts race through my mind! I suppose this happens to most of you?
The worst is the niggling thought: will this surgery really help me all that much? I have read some BAD stuff indicating that mitral valve surgery may not actually help people with severe left ventricle dysfunction all that much--in terms of long term survival or of functional improvement. I have no doubt my surgeon can do a technically perfect repair, but what will it do for me down the road?
Oh, I have many MORE questions for my surgeon, I can tell!!!

 

[Nancy]

Marge-

It's true that you will have dire thoughts, but the most dire thought is--

What will happen to me if I DON't have this surgery when it becomes necessary?

Please remember that when this surgery was not available, all of the people on this site who have had this surgery would not be here at all.

Sure things can happen, but they can also happen with any surgery. My husband went in for gallbladder surgery and almost died from a major bleedout. He had to have a second surgery, and he was disabled for months and months.

Surgery is risky, but the alternative is even worse.

 

[Christina L]

Marge,

I think I have found my "partner in crime" when it comes to worrying!! However, you wouldn't be normal if you weren't frightened of surgery and the outcome of it, what will happen after the surgery.

As for not being any better after the surgery if you have left ventricular dysfunction, etc. - you will most definitely be better - if you let severe mitral regurgitation go on, your heart will enlarge to the "point of no return." One hundred or even fifty years ago - the scenario with me would have been the townspeople whispering and saying, "Christina's heart is getting weaker and weaker - it won't be long." Thank God for modern medicine and the added years we are given by successful valve repairs or replacements.

I read a lot (probably too much) on mitral valve repair/replacement and atrial fibrillation. I did not have a-fib before my surgery and that is one of the reasons we decided to go ahead with the repair or replacement (it was repaired) as if you go into a-fib and have it for many months or years before your valve is fixed up, you will likely continue to have a-fib. If you don't have a-fib before surgery, there is still a chance that you will get it after surgery, but the chance is a lot less, and if you do have a few bouts of a-fib, it could be only because of the healing process of your heart.

I had a bout of a-fib two weeks after my surgery and I was electrically cardioverted. I am still very scared that the a-fib will rear its ugly head again. I am on Rythmol and was put on Coumadin to ward off a stroke because of the bout of a-fib.

Because of all my worrying and being afraid, I have been put on Prozac and I use Ativan to sleep at night. I am feeling much, much better physically seven weeks now post surgery but I take it VERY easy as from what I have read, overdoing it after surgery can put you into a-fib. I am trying to be very careful regarding my activities - letting things go around the house - the house needs cleaning so badly - but what is more important - my health or a clean house??

Anyway, hope this answers your questions and eases your fears a bit. Only God knows tomorrow and I can do nothing to change the future by worrying about it - only doing the best I can today to help me face whatever tomorrow may bring. So easy to say, but so HARD to do. I truly can empathize with you, but you are going to be just fine - stay on this board and you will get encouragement and understanding from these wonderful people who know exactly what you are going through.

I don't know what I would have done had I not found this board before my surgery - Ross and all - wonderful people!!

God bless -
Christina L.

 

[Missy]

I have chronic atrial fibrillation. I had mitral valve stenosis with mitral reguritation and moderate aortic reguritation. I have rheumatic heart disease.
When my heart was working too hard to pump blood it caused my left artium to enlarge. When it went beyond the 4.0 limit there was only a very slilght chance that it would shrink back down and go back into sinus rythym with cardioversion after my MVR. It did shrink some but it still didn't convert. I had been in a-fib too long and it didn't shrink enough. They told me this is usually the case although my cardiolgist didn't want me to give up hope and had wanted to do the cardioversion. He told me maybe they should have done the surgery a little sooner than they did. Because I live so far away I didn't get in right away when the valve reached the surgery time. If I remember correctly, I think that is at .9 cm. Mine went a little beyond that. I think I was at .5 or .7. So my heart was really working. It accelerated at a very fast rate the last three months before the surgery.
So for those of you that have this problem don't let it go too long. It is very important not to let it get too calcified or stenotic. This is kind of a simple version of what happened to cause my afib and why it wouldn't convert after the surgery. When I came out of surgery my heart was in normal sinus rythym and we had high hopes but noooo ... it had to jump right back into afib. I was just so disappointed. Because it does make me feel worse and I can't keep up the activity and do as much as I used to. Everything seems to be a big effort. The more strenuous the harder it is.