Irregular Heartbeat After Heart Surgery: What Should You Know About That Strange Feeling in Your Chest

Post-operative Arrhythmia

If you have experienced an irregular heartbeat after heart surgery, you most likely experienced post-operative atrial fibrillation (POAF). This arrhythmia, or abnormal heart rhythm, is far and away the most common form of irregular heartbeat following cardiac surgery. You can learn about other complications following a common heart surgery here.

Atrial fibrillation can pose serious health risks for patients during recovery from heart surgery. In the general population, the causes are fairly well documented. However, the causes of POAF are much less understood. The implications of POAF can lead to serious complications for patients and “is associated with an increased risk of mortality and morbidity,” according to a study in the Journal of the American College of Cardiology. Post-operative AF occurs in 30 to 50 percent of patients following heart surgery of some kind.

Atrial Fibrillation

Atrial fibrillation is a cardiac arrhythmia in which the first portion of a heartbeat, atrial contraction, does not occur correctly. Instead of a full contraction, several short, chaotic contractions, or flutter (AF is commonly referred to as atrial flutter), occur. The over-arching implication of this is that insufficient amounts of unoxygenated blood are pumped to the next chambers of the heart, the ventricles, and then on from there to either the lungs or the rest of the body.

This arrhythmia is diagnosed using an electrocardiogram (EKG). Physicians look for an unstable P-wave on the EKG. This signifies erratic electrical pulses during atrial contraction.

Causes

As stated previously, the causes of AF in the general population are understood. But in cardiac surgery patients, the causes still elude researchers. There are, however, several risk factors that increase a patients susceptibility to experiencing POAF. The most important risk factor for patients is advanced age. Other risk factors include valve surgeries, history of AF, left atrial enlargement, diminished left ventricular function and withdrawal from beta-blockers following the surgery.

Implications

Should cardiac surgery patients experience POAF, it increases the likelihood of several other complications. Due to the erratic fluttering of the atria, circulatory compromise is possible, and this increases the possibility of blood clotting. A blood clot that compromises circulation in the brain can cause a stroke. A blood clot that makes its way to other portions of the body can cause myriad other complications. Post-operative AF consistently increases the length of patient’s hospital stays and costs of treatment. Other studies have shown that 5-year-survival rates are lower in patients who experience POAF.

Prevention

Before and after surgery, patients should be assigned a prescription of beta-blockers. There is plenty of evidence suggesting that these medications reduce the incidence of POAF. If this proves insufficient, amiodarone has shown promise as another oral medication used to reduce the prevalence of AF-episodes in patients. Similarly, it has been suggested that a round of corticosteroid treatments may reduce post-operative swelling and inflammation, which in turn, can help limit AF in cardiac surgery patients.

References

Journal of the American College of Cardiology: Mechanisms, Prevention, and Treatment of Atrial Fibrillation After Cardiac Surgery

Circulation: Atrial Fibrillation After Coronary Artery Bypass Surgery

Annals of Cardiac Anaesthesia: Atrial Fibrillation After Cardiac Surgery

Cleveland Clinic: What is Atrial Fibrillation?

Mayo Clinic: Atrial Fibrillation

Heart: The Management of Atrial Fibrillation After Cardiac Surgery

Kardiovaskuläre Medizin: Prevention of Atrial Fibrillation After Surgery