Surgery & heart rhythms

[Marge]

I finally got an answer from my cardio's office yesterday about the results of my Holter monitor. No significant abnormal heart rhythms, occasional skipped beats, which the cardio sez are not significant. I'm apparently in what he calls normal sinus rhythm now. What I'm wondering: do people who don't have "significant abnormal heart rhythms" often develop them DURING surgery? (Like A-fib?) If you do, do they persist afterwards? I would have asked the cardio, but the message about the Holter was relayed by his nurse.

 

[Christina L]

Marge,

If you do not have a-fib before your surgery, the likelihood is VERY low that you will have it after surgery. You may have a bout or two of it right after surgery because your heart is just totally irritated from all that has been done to it - but the a-fib should go away in a few weeks or a few months.

I had one bout of a-fib two weeks after my surgery. Of course I was put on Rythmol and that is controlling things right now. I will be taken off the Rythmol in a month. It scares me - I do not want to go into a-fib again.

I had read a bit about a-fib before I had my mitral valve repair last November. That is one of the reasons my cardiologist wanted to go ahead with my surgery, as I had not gone into a-fib yet.

If you have a-fib for a good length of time BEFORE your surgery, the chances are that you will have it after surgery.

So, Marge, it sounds like you will be in great shape! Don't worry, you'll be fine.

Christina L.

 

[Tom F.]

I did not have A-fib before surgery, however while I was still in the hospital two days post op I had a quick spell. The docs medicated me and it went away. I was told that after open heart surgery a relatively small percentage of people go into A-fib post op briefly. Once I got home my heart did skip beats from time to time as it healed, which of course freaked me each time. But in time everything got back to normal again.

 

[weekycat]

Me Too!

Me Too!

Hi Marge,

I too wore a Holter monitor last week, because of irregular heartbeats, and just got results today. In fact, I was just coming on here to post that, and found your post. Anyway, I didn't have A-fib before surgery, and I don't think that's what I have now, but my PCP called this morning and informed me that I was having "lots of extra heartbeats". Tell me something I don't know , that's why I went to see him in the first place.

He called in a prescription for a Beta Blocker, (Toprol), and insisted I go pick it up and get started on it today. I did.

I asked him what he thought was causing this problem, and he said he wasn't sure, it might have something to do with scar tissue from my mitral valve surgery. That would make sense, I have lots of scar tissue on the outside... probably have some on the inside too. He also wants me to see a cardiologist, (the appt is on the 25th), to see if he wants to do any further testing.

Anyone else have this problem more than a year post-surgery?

 

[Raverlaw]

Over the past two years, I have had a few instances of skipped beats, always while resting in bed at night. When it happens, the heart will beat normally 13-16 beats in a row, then miss one. It is a wierd feeling- it doesn't hurt, but the wait before it starts up again seems interminable. I don't know what this condition is called.

Since my stress echo in November, I've had a few instances where the beat was irregular for a minute or less - I don't know what this is called, either, but the heart did a "ba-da-dump" kind of beat, which I could feel very strongly over the left breast.

I went for so many years not even noticing my heart beat, and now I suppose I am hyper-sensitive to it. My resting rate is usually around 67, but my pulse is so weak that nurses have difficulty finding it sometimes. I can usually only take my pulse when I am laying quietly in bed at night, since I can hear my heart (and murmur!) quite clearly then.

If anyone recognizes my description of the erratic beats, I'd sure like to know what it's called.

 

[Bryan B]

Bill,

I too have the "ba-da-dump" on occasion. Usually (but not only) during exertion, and more frequently since I had endocarditis.

I too would like to know the tecnical term for this.

 

[Nancy]

There are so many different heart rhythms. You would need to have it looked at with an EKG or monitor to determine which one you have. If they become bothersome, go to your doctor and have an EKG run. Most of the time, they're nothing to worry about, but if they persist or are giving you other symptoms, find out what's going on.

 

[warnerd]

I did not have any a-fib before surgery and had 2 episodes post. I'm on digoxin now and have been for over 2 years. The thoracic said I'd be on it for 6 months to a year. The cardio says forever. Oh well. daw

 

[Nancy]

I just reread the above posts and couldn't resist. I guess one of the rhythms to watch out for would be Ba-Da-Bing That one could break your kneecaps. Those outside of the US may not know what I mean.

 

[Marge]

I think I have always had skipped beats, and they never bothered me before I was diagnosed with heart failure -- I guess I didn't know they were supposed to bother me. I'm on a beta blocker now, and I am still aware of them now from time to time, & they still don't really bother me. My cardio has always sort of pooh-poohed my questions about the notations on my EKG print-outs -- I think he would have preferred that I never got hold of those print-outs! He keeps telling me "not to worry about them." I think he ordered the Holter just to placate me rather than because he thought one was needed.

Apparently on my latest EKG the "tachycardia with unusual P axis" that was there at one point is gone, but the LLBB is still there, and my cardio is still telling me not to be concerned, but not WHY I should not be concerned!

He is not very communicative, is my cardio. One of these days (but after the surgery) I will take all these print-outs to my PCP who is much more patient and ask him to explain it all to me.

 

[ALCapshaw2]

I believe the most common causes of 'skipped beats' is either Premature Atrial Contractions (PAC's) or Premature Ventrical Contractions (PVC's)

The premature beat occurs very close to the previous beat and therefore there is a long delay before the next one, leaving the impression of a 'skipped beat'. I've had both types. I've been told by nurses (and Cardio) that it is impossible to distinguish between them without an EKG to pinpoint which type is occuring.

PVC, PAC, and A-Fib are grouped under the heading of Arrhythmia's which stands for any type of heart 'irregularity'. Any and all of them can be brought on by exercise and / or stress, especially following surgery.

'AL"

 

[Marge]

<< I believe the most common causes of 'skipped beats' is either Premature Atrial Contractions (PAC's) or Premature Ventrical Contractions (PVC's) >>

Yeah, that's what my cardio says I have. "Benign PVC's and/or PAC's." They're very common, supposedly. I like the "benign" part.

My surgeon was also reassuring: he said, "Looks to me like you have normal sinus rhythm. Oh, those funny looking things on the EKG? They're just spikes." (Spikes??? Is that a medical term, even?)

 

[bvdr]

It seems like everything is about covered above. It is impossible to know for sure without an EKG. You can catergorize them by slow or fast arrythmias and if they are regularily irregular (like every other beat or every third beat) or irregularily irregular (no rhyme or pattern).

Sometimes though, even experts don't entirely agree with what they see. I remember in the hospital following my surgery that there was a group of doctors standing outside my door looking at my latest EKG. I kept hearing things like "well, I could also make a case for.....".

You may sometimes hear some medical people refer not only to PVCs and PACs but to FLBs (funny little beats).

 

[Raverlaw]

My EKgs are always perfectly normal. It's like when your car is running rough; you take it to the mechanic the next day and it runs fine. Then as you're driving home it does it again...

I can never get my heart to do the "ba-da-dump" thing when I'm wired up.

And Nancy, I'll only worry if it goes "ba-da-bing, ba-da-boom" Since I don't have the slighest bit of Italian in me, I doubt it will happen.

 

[ken]

Atrial Fibrillation after Cardiac Surgery

Atrial Fibrillation after Cardiac Surgery

Annals of Internal Medicine

18 December 2001 Volume 135 Number 12

Atrial Fibrillation after Cardiac Surgery

William H. Maisel, MD, MPH; James D. Rawn, MD; and William G. Stevenson, MD

Pages 1061-1073

Purpose: To review the epidemiology, mechanisms, complications, predictors, prevention, and treatment of atrial fibrillation following cardiac surgery.

Data Sources: MEDLINE search of English-language reports published between 1966 and 2000 and a search of references of relevant papers.

Study Selection: Clinical and basic research studies on atrial fibrillation after cardiac surgery.

Data Extraction: Relevant clinical information was extracted from selected articles.

Data Synthesis: Atrial fibrillation occurs in 10% to 65% of patients after cardiac surgery, usually on the second or third postoperative day. Postoperative atrial fibrillation is associated with increased morbidity and mortality and longer, more expensive hospital stays. Prophylactic use of -adrenergic blockers reduces the incidence of postoperative atrial fibrillation and should be administered before and after cardiac surgery to all patients without contraindication. Prophylactic amiodarone and atrial overdrive pacing should be considered in patients at high risk for postoperative atrial fibrillation (for example, patients with previous atrial fibrillation or mitral valve surgery).

For patients who develop atrial fibrillation after cardiac surgery, a strategy of rhythm management or rate management should be selected. For patients who are hemodynamically unstable or highly symptomatic or who have a contraindication to anticoagulation, rhythm management with electrical cardioversion, amiodarone, or both is preferred. Treatment of the remaining patients should focus on rate control because most will spontaneously revert to sinus rhythm within 6 weeks after discharge. All patients with atrial fibrillation persisting for more than 24 to 48 hours and without contraindication should receive anticoagulation.

Conclusions: Atrial fibrillation frequently complicates cardiac surgery. Many cases can be prevented with appropriate prophylactic therapy. A strategy of rhythm management for symptomatic patients and rate management for all other patients usually results in reversion to sinus rhythm within 6 weeks of discharge.

Ann Intern Med. 2001;135:1061-1073.

Author and Article Information

From Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

Acknowledgments: The authors thank Drs. Laurence M. Epstein, Gilbert H. Mudge Jr., Patrick T. O'Gara, and Sharon C. Reimold for significant contributions to the development of the treatment algorithm outlined in this manuscript.

Requests for Single Reprints: William H. Maisel, MD, MPH, Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115; e-mail, [email protected].

Current Author Addresses: Drs. Maisel and Stevenson: Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.

Dr. Rawn: Division of Cardiac Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.

Keywords: Atrial fibrillation; Cardiac surgical procedures; Adrenergic antagonists; Amiodarone; Cardiac pacing, artificial

 

[Valve-Viking]

In my case the area around the a.valve in the heart was also
badly infected to the surgeon had to "clean up" lot´s of infected
tissue. This messed up the nerves in my heart and due to that
I have a pacemaker now, it is picking up the right sinuse-impulse
and leads it further to the chambers(I´m Swedish so I do not
know all the english medical terms). Without pacemaker my
pulse was 52 and it´s stuck there(or at least was?). With
pacemake my pulse was 100-110. So had to start beta blockers
(emconcor) and now it is always down to 60 bpm where the
pacemaker stops it and keeps it. Max pulse is 130 bpm, by the
pacemaker.

As it seems these nerves stand a good chance of regrowth.
One question I have for my next visit soon due to the hospital, is how it will feel when my heart regains control of what the pacemaker is most of the time doing now? Lately I had some funny kind of tickeling feelings up my throath which I suspect is from the pacemaker getting in our out of duty.

At times I also had a few slow beats, especially at rest, never
while active. Typically these have come after poor sleep,too much coffee etc. But I think it is hard to judge as a few uneven beats
at times also make you afraid, and you pulse immiediately goes
high because of the scare, or is it by any other reason? But at
least I get this warm scary feeling when this happens and I
tend to think the pulse goes up due to your anxiety more then
anythingelse? Might be wrong though.


What I´ve understood is that just a few irregular heartbeats
at rest is not too uncommon or even dangerous. The heart might
compensate this by a little bit of higher frequency immiediately
after and then it´s gone as quick as it came. What is more
dangerous is irregular heartbeat while you´re active or excercizing as far as I understood. But I like to stress things
might be very different due to your medical history, this maybe
goes more for people without our situation here?

It would be nice to hear if there are anybodyelse with replaced
valve and pacemaker as a result of the surgery and to share
experiences!

 

[Mb]

Hello all:

Interesting post.

Mu husband had chronic a-fib before surgery, and has it now. Had a Holter monitor recently, as his cardio thinks he needs a pacemaker. He has: chronic a-fib, premature ventricular contractions, and heart rate pauses, 35 of which were over 2 seconds long in the 24 hour period. His heart rate 47 to 157 that date. He is resistant to a pacemaker. (Already has two artificial valves, and a severely leaking tricuspid valve, so this makes him a "high risk" for pacemaker insertion.) As long as he keeps relatively calm, doesn't exert himself, and nothing upsets him, he seems to do ok., Needless to say that's tough with heart disease. -Marybeth

 

[M&M]

Hi Ken, your article is very interesting. William Stevenson is a world renowned electrophysiciologist. The only thing I would like to add - is to be very careful when administered 'amiodarone' thats a very potent med and should be avoided at all costs in my opinion unless its the last choice of drugs. Having alot of arrhythmias myself - and I'm inplanted with an ICD for ventricular tachycardias - I was offered that drug (amiodarone) and instead I opted for a combination of drugs called atenolol and mexiletene which worked just fine is keeping my vt's away. Its my understanding if you take amiodarone - you need just about every body function monitored on a regular basis. Alot of patients that take it complain a great deal about the side effects. It may do the job - but at what costs - and would another drug serve the purpose just as well. Those are questions I asked myself when offered that drug..

Just something to think about.

Best Wishes
Marilyn and **** (runner)

 

[Les]

Two AVR surgeries, two bouts of a-fib since and all sorts of weird rhythms...constantly. On Atenolol and Digoxin for ten years. Great EKG results, but sometimes have to slow down to almost a walk while running. Living with it though...

 

[M&M]

Les, I know what you mean - they drug the arrhythmias down and unfortunately it prevents us from being able to 'go fast'. I have found that when my ICD is programmed for 'rate response' which means upon exertion it detects that I need more 'beats' and the machine provides them. Up to a certain point of course. The only problem is the machine doesn't 'comprehend' hills. So, I have to stop and walk. Do you have a pacemaker ? I have the dual chamber ICD pacemaker/defibrilator and its actually the pacemaker portion that gives me the ability to run.. There are all kinds of programs in those devices to help keep us active when the meds prevent us.

Marilyn