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Thread: A-Fib Post Valve Replacement Percentages?

  1. #1
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    Default A-Fib Post Valve Replacement Percentages?

    Seems we read here so many people who get A-fib in the weeks/few months following Valve Replacements.

    Two things have struck me and I'm wondering if I am mistaken or my 'casual impressions' from reading are somewhat accurate.

    I wonder if it could be as high as 75% or so of Valve Replacement patients have at least a few A-fib episodes but it seems to be more Aorta valves than Mitral. It seems there are fewer of us that have mitral replacements but unless I've missed many threads, do Mitral valvers have fewer A-fib events?

    Mind if I ask who had/has A-fib and who doesn't.... who never had an episode?

    I'm three years out from surgery and every now and then I think of it and continue to hope I remain A-fib free but know it can happen to anyone at anytime including people who never had a valve problem.

    Thanks.

  2. #2
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    I had A-flutter after my aortic valve replacement. While I was in the hospital for the A-flutter, one of the nurses told me that they see about 30% of all OHS patients after surgery for A-fib or A-flutter, and a higher percentage of those are valve replacements. She said that she thought the number of valve patients that had A-fib or flutter was upwards of 60%, and many more of those are aortic. I think she was saying that they SEE 60% of valve patients, which means that they were re-hospitalized. With that said, it may be that your number of 75% is accurate, as I am guessing that some people who have short bouts of A-fib or flutter don't go back to the hospital, particularly if they live a ways away. She related that when they are cutting for the aortic valve, they are very near one of the nodes for electrical impulses in the heart, and this causes a high rate of flutter or fib.

    Keep in mind that this is all from my memory of what she told me, and I have no personal knowledge of this stuff to know if what I am saying is fact. I do know that I had it with an aortic replacement (3 separate bouts of A-flutter in 5 days) and I don't want it again!
    Last edited by Jason; May 11th, 2011 at 03:50 PM.
    BAV...AVR March 7th, 2011 / Carbomedics mechanical 25mm
    Ascending Aortic Aneurysm replaced with Dacron at same time
    Sanford Heart, Fargo, ND, Dr. Roxanne Newman

  3. #3
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    I had a-fib before my AVR and we controlled it pretty well with meds but I elected to have an ablations done along with my AVR to ho;fully get rid of that pesky a-fib for good and get off the hammer drug .... I went into a-fib a week or so post AVR (was told to expect it), was cardioverted and it has never returned (5 plus years) ...

    I think a-fib is like a lot of things, just happens ....
    No shoes, no shirt, no problem
    AVR with Ablation -St Jude Mechanical--2006
    ~Easy Does It~

    The early bird get the worm but the second mouse gets the cheese

  4. #4
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    As far as I know, I have never experienced A-fib or A-Flutter in any significant way. I have had very short periods of skipped beats, eratic beats, etc. a number of times since my OHS. In the community where I live, there are several of us on warfarin and the vast majority have never had valve surgery and they are on ACT because of the A-fib.
    Starr-Edwards mechanical AVR 1967 at age 31.....University of Kentucky Med. Ctr., Dr. Richard Wood & Dr. Gordon Danielson surgeons. No surgery (heart or otherwise) since. On Warfarin ACT since surgery. No diet, lifestyle, or activity restrictions....and I live one day at a time.

  5. #5
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    I was told similar statistics regarding afib and even pacemaker implants after aortic valve surgery. I, too, was told that the main nerve bundle that carries the electrical impulses to the chambers of the heart was very close to the aortic valve, and that sometimes in order to remove a badly calcified valve these nerves are disrupted or damaged. The resulting rhythm disturbances can be either temporary or permanent. In my case, in the few days immediately following valve replacement, I had everything you could think of -- afib, a-flutter, bradycardia, tachycardia and, most frighteningly, long 15 to 20 second pauses between beats. Knowing all this, I readily agreed to the pacemaker implant. I think I'm getting used to it, and will just get on with living my life.
    Go Class of 2011!

    Steve Epstein
    9 Years in The Waiting Room, then on February 28, 2011,
    AVR with 23mm Edwards Bovine Pericardial Tissue Valve, Model 3300TFX, Pacemaker - Boston Scientific Altrua 60 DDDR IS-1 and CABG (LIMA-LAD) at Northwestern Memorial Hospital, Chicago by Dr. Patrick McCarthy and the most wonderful team of professionals I could ask for.

  6. #6
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    Thanks. Interesting. I'm mitral and so far no a-fib or flutter and keeping my fingers crossed.

  7. #7
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    I knew about the potential issues with A-Fib so I elected to have a MAZE procedure done while they were in there doing my mitral valve.

    So far, 5 months later, no issues that I am aware of.

  8. #8
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    I had a-fib 2 wks after my aortic valve replacement. Amiodarone controlled it, and after one more short episode a couple wks after that (might have been caused by my stupidity - got dehydrated) it hasn't come back since. I remember one of the caridologists telling me he thought the percentages were higher than the 30% I'd been told up to that point, he thought it was more like 2/3 of the time that OHS patients get a-fib while things are healing up. Whether it's really 30%, 50% or 75%, it's clear that quite a few folks get it, which is understandable considering the scar tissue the electrical current has to get used to traveling through. But the good news is, it also seems fairly common for it to go away within a few weeks/months after surgery. Mine hasn't come back and it's been a year now.
    - Andy
    Born with BAV; Moderate/Severe Stenosis/Regurgitation by age 49; AVR Surgery 5/5/10 by Dr. Robert Emery, St. Josephs Hospital, St. Paul, MN; St. Jude Regent Mechanical Valve

  9. #9
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    PS - I was only on amiodarone for about 3 mo (and that was just a precaution that I was on it that long). They said as long as I got off it that quickly, there wasn't much risk of the bad side effects it can cause. Would have gotten nervous if they wanted to keep me on it longer than 3 mo though.
    - Andy
    Born with BAV; Moderate/Severe Stenosis/Regurgitation by age 49; AVR Surgery 5/5/10 by Dr. Robert Emery, St. Josephs Hospital, St. Paul, MN; St. Jude Regent Mechanical Valve

  10. #10
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    I'm 10 wks post AVR and have had no Afib....so far. I consider my self lucky. I'm taking 12.5mg Metropol 2x/day
    AVS diagnosed 12/08
    Av .9 01/10 Mean pressure grad 31 01/10
    Av .8 01/11 Mean pressure grad 34 01/11
    3/04/11 Av replacement with asending aorta graft ,Datascope#IGW0026-30
    Edwards Perimount 25mm 3000TFX

  11. #11
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    Had A-fib before and after MVP! I was also cardioconverted, and put on Amiodarone. It's been almost 2 years and no more A-Fib.!!!!

  12. #12
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    Luckily, I was trouble-free.

    Brigham and Women Hopsital -Dr.Shekar OHS- June 1,09
    AVR-St.Jude Mechanical Valve. (25VAVGJ-515)
    Ascending/Transverse Arch Aortic Replacement


    Nelson

  13. #13
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    Default My A-Fib and surgery history

    Aug 2006 - A-Fib episode corrected by medication after 20 hours
    Nov 2006 - Mitral Valve replaced (porcine)
    Feb 2011 - A-Fib episode that lasted 3 days went into sinus on its own (with lots of meds on board too).


    I had no episodes (certainly sustained ones) after my surgery. I am one of those who feels every skipped/extra beat so apart from daily multiple palpitations that could be this or that (usual SVT when I've had a monitor) I have not had anything since surgery until recently. I am 4 and a half years out.

    Interestingly about 30 minutes ago I had 30 seconds of palpitations which I think was A-Fib. I rarely get bouts that last that long. Mostly I get 5-10 second bursts at worst. This was too the point if it had lasted a few minutes I would have gone to the ER. My last A-Fib episode I was able to walk around for the first few hours, but by the evening I was exhausted and could not stand without my heart rate shooting up. I'm waffling! bye

  14. #14
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    It will be 3 years next Thursday the 19th. Never experienced A-fib or flutter before or after surgery (knocking on wood right now).
    Chris
    Livin' Life At A Snail's Pace
    AVR May 19, 2008
    Edwards LifeScience Bovine Pericardial

  15. #15
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    I had afib twice during the weeks that followed AVR. First time I was cardioverted successfully, but it returned a few days later and I was put on Multaq for 6 months. Off it now for 4 months and my heart has been very steady with no afib.
    Doug, Bi-cuspid Aortic Valve
    AVR Jul 27, 2010
    Mayo Clinic, Dr Daly

  16. #16
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    I am only two weeks post AVR and no afib. My doctor gave similar percentages of post-op afib after valve replacement at 50%.

    Another thing that can cause arrhythmias is electrolyte imbalances. Post-op, you may go on lasix, which carries some potassium away when you urinate (a "potassium depleting diuretic" as opposed to a "potassium sparing diuretic"). This is why they check your blood levels and "replace" your potassium while you are on the lasix.
    Whether you are post-op or not, electrolytes in general, such as potassium, sodium, calcium and magnesium, help conduct the electrical impulses in your heart. Electrolyte levels that are too high or too low can affect your heart's electrical impulses and contribute to arrhythmias.
    AVR and ascending aorta repair 4/29/11
    27mm St Jude Regent valve
    Dr Gaudiani at Sequoia Hospital in Redwood City, CA

  17. #17
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    You need to be sure you are talking about A Fib vs A Flutter, they are different and the prognosis may be very different from each other as is the tx. The heart is very irritated after OHS and the Aortic Valve is in an electrical area of the heart. You should discuss this with your MDS if you are concerned. I had an ablation for A Flutter last week and had great results so far and the procedure was not awful to go through. Good luck to you.
    AVR 3-11-2011, Mechanical Valve, Aneurysm repair in Ascending Aorta
    Dr Bernard Harrison,
    Methodist Hospital, St. Louis Park MN

  18. #18
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    I met with my Dr. yesterday . He said that the numbers are 25% of arotic valve replacement folks have a-fib after leaving the hospital, also 7% need a pace maker. After talking to him it seems that stroke during surgery is there bigest fear. And for a re-do it is cutting a vein at the time you are being opeaned up.

  19. #19
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    I would have to imagine arotic valve surgery and mitral valve surgery might have very potential outcomes for a-fib. What do you think?

    But as I said before, once I was told they could do a cryo ablation modified maze at the same time, and that could dramatically cut my chances of getting a fib, it seemed a no-brainer. Were others offered this option?

  20. #20
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    I had aortic valve replacement and no afib for me. It will be 6 years next month.

    I'll have to check, but it seems that in past discussions, people having mitral valve repairs and replacement had more cases of afib.

  21. #21
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    A month or two ago, somebody posted a link to a university study on post-OHS (or post-AVR?) A-fib, maybe at Duke University, that gave numbers I found surprisingly high. Something close to 50%, can't remember exactly. I also saw another study, maybe done here in Toronto, that showed that post-OHS Magnesium supplementation cut the rate of A-fib down, maybe in half. Definitely Mg, not Potassium (K), in this study.

    Me, I had a brief episode in the CICU maybe ~1 day post-op. (I was told, I didn't notice.) Then at home, 3 wks post-op, I took an ambulance trip to the ER at "my" hospital for V-tach (~150 bpm) & A-fib. I'd had a bug, cough and fever for a week, then it faded, but I suddenly felt like garbage, dizzy, a bit nauseous, weak as a kitten. I'd been eating more Boost/Ensure garbage than real food for days. Eventually I gently collapsed onto the bathroom floor, HR ~150.

    After a few hours of thinking and preparing, we called the ambulance. By then I could walk down the stairs and down the walk and into the ambulance, but still HR ~150.

    At the ER, they started with a short of Calcium Channel Blocker (CCB?), which brought my HR down. At that point they said that the A-Fib had become A-flutter. (Just what IS the difference??) Then they gave me a Rx for Metoprolol (2 x 25mg/d), double the dose that I'd been on in the hospital post-op. I probably should have stayed on it, but the resident cardiologist at the hospital had a better idea and had taken me off it, probably a mistake. My blood sugar was also somewhat high in the ER (like 9 instead of <4.5), but nobody seems to think that the BS was my problem.

    I stayed on the Metoprolol until ~3 months post-op. Then a 48-hour Holter showed no A-fib or other problems, so I dropped the Metoprolol, and also the Warfarin that I'd been on for the 3 months post-op.

    I felt lots of heart beats post-op, including lots of PVCs. I don't think I ever actually felt the A-fib, I just felt like #$%^&.
    BAV, extended ARoot, some MV damage.
    68 y.o. (65 @OHS), keen active athlete until shortly pre-op, only symptomatic 1-2 months pre-op.
    AVR (Medtronics Hancock II) Dec. 1 2010 w/ Dr. C.M. Feindel at UHN aka Toronto General. Also a "tuck" on the Aortic root, and a (Dacron) Medtronics Simplici-T ring on my MV. I did ACT for 3 months for the ring, and Metoprolol (BB) for 3 months for A-fib.

  22. #22
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    I had fairly frequent A-fib before my AVR and so I had a concurrent Maze procedure. Post surgery I did have two quite significant (hours long) episodes while I was still on the bisoprolol but when I was petitioning the doc to let me off he had me wear a Holter monitor for 48 hours and said that the results were 'bizarrely' regular. I came off the Beta Blocker and haven't had an episode of it since. Oddly enough, prior to the surgery I used to have a sort of feeling, which I can't really describe, right before A-fib would start. I still get the feeling but those errant signals never get where they were going so I don't get the beats.

  23. #23
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    Live near Santa Barbara, California, treated at USC Keck Center 130 mi away. Am now post- op AVR, 4.19.11; 2.3cm St. Jude bovine valve.
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    Yeah...the one thing thar DID work on me was my good old ryrhmic self. Was it
    Because I went OFF coenzyme Qq10 and 4 days later I got A fib??? Frightened me into Amioderone like THAT...didn't even seem to know wHAT even what coenzymeQ10 WAS down there...! So, on crappy amerotione.
    ameorterdone(apparently... while have had this low grade 99 degree-99.7 (huge for me) and NO ONE is Paying a bit of attention. Gad!!! Heart surgery and everyone loses their common sense?.. So busting out with Kephlex, don't know what else to do...take it for tooth/ mouth pre-dentists stuff, everyone of my friend are sick, won't see my real Cardiologist for until Monday...my chest hurts a little...just saw how sick and hopelesscfeeling can be worse than anything. Well, blazes, here's hoping kephlex get the bad guys the blazes off me!! I'm just at witscend, cardio Monday. Michelle
    Last edited by Michellemar; May 21st, 2011 at 12:27 PM. Reason: Forgot

  24. #24
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    Live near Santa Barbara, California, treated at USC Keck Center 130 mi away. Am now post- op AVR, 4.19.11; 2.3cm St. Jude bovine valve.
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    What's the "hammer drug?" thanks Michellemar

  25. #25
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    It's Amiodarone, Michellemar.

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