Contributor: Edward Soltesz, MD, MPH
After you have heart surgery, it’s fairly common to have atrial fibrillation (irregular heart rate). Though it’s sometimes a frightening situation, keep in mind that your heart rhythm should return to normal by the time your chest wound heals.
We think inflammation in the chest after the procedure causes afib, which occurs in up to 40 percent of patients after heart surgery.
Your heart pumps blood to your body through contractions in the upper, then lower chambers of the heart. The heart’s electrical system controls the speed at which your heart contracts. Most people’s heart rates are between 60 and 100 beats per minute.
But sometimes a series of rapid, chaotic pulses misdirect your heart’s rhythm. When this happens, the chambers can’t contract effectively and blood isn’t squeezed out properly.
Afib can occur sporadically or persistently. If it happens once, it’s more likely to happen again at a later time.
There is no way to prevent afib or even predict whether you are more likely to have it after surgery. But there are a few things you can do that reduce your risk.
1. Get into shape before surgery. Being in good shape prior to surgery is a good idea. If your surgery isn’t urgent, talk with your doctor to create a heart-healthy plan that helps get you ready for surgery. This generally includes eating a healthy diet and getting regular exercise.
The healthier your heart is going in to surgery, the less your chances of having afib afterward.
2. Get other conditions under control. Studies show that a few problems you may have before surgery can increase your risk of afib. These include:
Your doctor may perform tests before surgery to check for these issues. We also can provide guidance on ways to treat the problems, including changing diet or taking medication or vitamins.
3. Limit stress. Another reason surgery can produce afib is because stress sometimes triggers it. For that reason, ensuring that you have sufficient pain medication (to reduce stress on the body) after surgery is important.
Sometimes afib corrects on its own. Other times, however, you’ll need treatment. We typically treat afib either with cardioversion or medication.
With cardioversion, you receive a small dose of electric current applied to the heart to return it to a normal rhythm. While you are under sedation, your physician applies the current one or more times until your heart rate regulates. You may receive blood thinners afterward to reduce the risk of stroke.
We also use drugs to treat afib. Though medication is less invasive than cardioversion, it sometimes has side effects. Some are minor like nausea, dizziness and diarrhea. But some medications also increase the risk of more serious issues, such as heart rhythm disturbances and pulmonary scarring.
These medications also become less effective over time.
It is important to identify afib after heart surgery and treat it if necessary. Because the blood isn’t pumped efficiently during afib, it increases your risk of blood clots, which can cause a stroke. If it continues over time, it can weaken your heart, potentially causing heart failure.
Talk to your physician before and after surgery about your potential risks of afib and what you may do to decrease your risks.