Atrial fibrillation, the most treated heart rhythm abnormality in the United States, is a worrisome and sometimes complex medical issue. It occurs when the atrial upper chambers of the heart’s four chambers (2 atria or auricles and 2 ventricles) beat erratically and ineffectively. Patients who suffer this often describe a “skipping,” “flip-flop” sensation or other unusual feeling in their chests and can complain also of fatigue, dizziness and lightheadedness. Some patients have no symptoms at all. Atrial fibrillation (abbreviated AF or Afib), affects 2.7 million Americans and places people who leave it untreated at a five times greater risk of stroke and a doubled risk of cardiac-related death.
The traditional treatments for AF have been effective in lowering these risks, and they include medication, cardioversion (a non-invasive surgical option) and ablation (a more invasive surgical option). Many of the medications are structured to control the heart’s ventricular rate, which often gets accelerated due to the spastic and disorganized activity in the atria. The atria in a normal heart conducts electrical impulses to the lower chambers, the ventricles, so that the heart beats in an organized and effective way. Cardioversion is an electrical shock to the heart designed to restore normal heart rhythm (also known as “normal sinus rhythm,” named for the sinus node in the heart, the bundle of nerves that help regulate the heartbeat.) Ablation is a surgical procedure formulated to electrically excise the abnormal focus of tissue that is causing the atria to go into spasm. It requires general anesthesia to accomplish that. Another less invasive option is a new technique that removes a part of the atrium, the “appendage,” that is responsible for the faulty electrical signals. Finally, there is invasive treatment for AF, usually associated with other cardiac surgery.
But while AF alone is of concern, there has been increased attention paid to the presence of AF following surgical procedures, and this is something to look out for. The Journal of the American Medical Association (JAMA) has reported that after non-cardiac surgery, a number of patients present with a new onset of AF, which places them at a 2.69 increased hazard ratio for subsequent stroke or transient ischemic attack (the so-called mini-strokes). The National Institutes of Health in an older report (1995) found that between 0.4% and 26% of post-operative patients, depending on the study, developed AF. This post-surgical AF can be temporary or permanent. It requires monitoring and follow up to know which. And if permanent, it requires treatment.
Researchers postulated that there were a number of factors that contributed to that, including increased pain, increased sympathetic nervous system activity, low blood oxygen, low blood or plasma volume, too much acidity to the blood, abnormally low blood glucose, inflammation and other factors. That’s why it is so important for doctors, nurses and the rest of the medical team keep these parameters as normal as possible in the immediate after-surgery period. It’s also vital that patients and their loved ones inquire whether these abnormal factors are present.
The good news: If AF does not develop within days of surgery, most likely it will not occur because the contributing factors mentioned above will have abated. Some higher risk patients may want to consider the advice in this new study presented at the American Heart Association’s Scientific Sessions 2020 concerning 24-hour-a-day monitoring for 30 days after heart surgery.
So the next time you go in for surgery, particularly if you are older, have existing significant medical history (high blood pressure, heart disease, diabetes, inflammatory diseases or cancer, among others), have an advocate, family member, friend or other trusted person ask the staff if your heart rhythm has remained stable in the after-surgery period. This is an often overlooked but vital parameter that requires attention should any abnormalities arise. In these days of over-stressed healthcare and hospital systems, it behooves you to be your own advocate, especially in something as important as your beating heart.
For more with Dr. Sherer, click here for his podcast and video interviews, and here to buy David’s book, Hospital Survival Guide: The Patient Handbook to Getting Better and Getting Out.
