It often feels like the heart is fluttering chaotically, a shortness of breath, or a sudden drop in blood pressure that makes you feel woozy, says Gaurav Upadhyay, MD, a cardiologist and a cardiac electrophysiologist at the University of Chicago Medicine. He says that atrial fibrillation after surgery often occurs two to four days after the procedure as the body tries to recover from inflammation, which is part of the body’s natural immune response to surgery. “It is similar to an injury on another part of the body,” says Dr. Upadhyay. “The atrial fibrillation is a marker of stress and healing.” He notes that atrial fibrillation after surgery is much more common in open-heart surgeries, occurring in up to 20 to 40 percent of cardiac surgeries, and 10 to 20 percent of surgeries on other parts of the body, which is similar to what the research finds. While often not initially dangerous, afib should not be ignored, since it greatly increases your risk of stroke, says Christopher DeSimone, MD, PhD, a cardiologist who specializes in cardiac electrophysiology at the Mayo Clinic in Rochester, Minnesota. In a 2019 paper published in the journal Stroke, researchers analyzed 35 studies with more than 2.4 million participants and found that postoperative atrial fibrillation was associated with a higher risk of stroke and early death compared with those without postoperative afib. And while the risk of afib is higher in heart surgeries, the paper found that the risk of stroke was highest in non-heart surgeries. In addition to stroke, patients who experience postoperative afib are at a significantly higher risk of landing back in the hospital with heart failure, according to a June 2022 study published in the European Heart Journal. Researchers looked at a large group of 3 million patients across 11 states in the United States and found that patients with atrial fibrillation after surgery were 33 percent more likely to experience heart failure than those whose heartbeat stayed normal. The association was stronger for non-heart surgeries compared with heart procedures. In a 2020 review in Circulation: Arrhythmia and Electrophysiology, researchers analyzed 28 studies that included 2.6 million patients and found that postoperative afib after a non-heart surgery was associated with a threefold increase in incidences of stroke and death and a fourfold jump in heart attacks. In other words, while postoperative afib is more common in heart surgeries, it’s more worrying after non-heart procedures. The nature of surgery has several factors that may trigger postoperative afib. While the heart thrives on predictable rhythms with occasional stress from exercise, surgery adds stress and strain through anesthesia, fluids moving through the body, and inflammation. That flurry of activity may stretch and stress the heart, leading to a chaotic rhythm. The coordination of electricity that keeps the heart beating regularly suddenly misfires and the filling and pumping goes off track, leading to an irregular heartbeat, explains Dr. DeSimone. “Patients will often feel poorly in the days following surgery because the heart is ineffectively squeezing,” he says. “If you feel that way, no matter what type of surgery you’ve had, whether it’s abdominal, orthopedic, or a heart valve replacement, you should ask to see a cardiac electrophysiologist.”
How to Reduce Your Risk for Atrial Fibrillation After Surgery
“It’s really tough to prevent postoperative atrial fibrillation,” says DeSimone. “But there are several steps people can take prior to surgery to reduce their risk.” First, DeSimone stresses the importance of overall heart health prior to surgery. He suggests having a regular exercise routine and effective ways to manage stress. Work with your doctor to plan a healthier diet and improve your physical conditioning with exercise, the American Academy of Orthopaedic Surgeons suggests. DeSimone also insists that patients continue their medication regimen, especially if they are taking blood pressure medication. And if patients have sleep apnea, he says, it is critical to bring their sleeping aides with them to the hospital. Using medicines that prevent clotting and lower blood pressure, such as beta blockers, amiodarone, or statins, prior to surgery is effective at preventing postoperative afib, according to a 2018 review in The American Journal of Medicine, which was led by Upadhyay.
Taking Care of Atrial Fibrillation After Surgery
After heart or any other kind of surgery, you’ll likely be on a heart monitor so that the hospital staff can check you for atrial fibrillation, when the chambers of the heart beat 100 to 175 times a minute — normal is 60 to 100 beats per minute, according to the American Heart Association. Most people experience an odd sensation, like as if there is a flopping fish inside their chest, says Upadhyay. Yet some who are in and out of consciousness may not, which is why they need close monitoring. Most of the time, postoperative afib, like any other inflammation, heals by itself. If not, you may need to take medication to control both heart rate and heart rhythm. However, the risk of blood clots that lead to stroke is significantly higher with afib. “There’s a fivefold higher risk of stroke in afib and that may be even higher with all that happens postoperatively,” says DeSimone. Your doctor may give you a blood thinner to prevent a stroke. Blood thinners prevent clots that can form and break off, causing a stroke. Depending on the extent of the afib, your heart might need to be shocked back into normal rhythm with a procedure known as cardioversion, says DeSimone.
Afib Awareness Results in Risk Reduction
If you’re at risk for afib — such as having high blood pressure, a heart condition, or hyperthyroidism — and are planning any kind of surgery, discuss it with your doctor. And ask for a postoperative appointment with a cardiac electrophysiologist before you are discharged, says DeSimone. Once home from the hospital, call your doctor right away if you experience atrial fibrillation signs and symptoms. Don’t wait for your follow-up appointment, he insists.
Know the Symptoms of Atrial Fibrillation
According to the American Heart Association, symptoms may include:
Quivering, fluttering, or thumping heartbeatGeneral fatigue or fatigue when exercisingFast, irregular heartbeatDizziness, faintness, and weaknessShortness of breath, anxietySweatingChest pain or pressure in the chest
Additional reporting by Jordan Davidson.
