A-fib/flutter

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ETC908

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I've shared my story a couple of times here, and I'm grateful for this forum and all of the support. I had AVR and repair of the ascending aorta performed on November 10th, 2021, with placement of an On-X valve. I developed inflammatory pericarditis post-operatively, and as a result had a ton of post-op pain. The surgeon and the care team said this was common given my age, as I'm a male, age 42 and was in good physical shape pre-surgery. I guess my demographic is more prone to increased post-op pain and inflammation. That was my only issue post-operatively, and I was discharged from the hospital 5 days later. I still have pain, but it is substantially improved.
Before surgery, I was asymptomatic and was not treated for any medical issues. I was not on any medications. I'm currently on metoprolol, as well as warfarin and aspirin of course. I'm also completing a course of anti-inflammatories to treat the pericarditis.
For the first couple of weeks post-op, I had home PT and gradually tried to increase my physical activity within the confines of my restrictions. Last week I increased my daily total walking time to about 2-3 miles a day. I began experiencing runs of palpitations, which the cardiologist felt were likely PVCs. He wasn't concerned, however when I saw his PA in follow-up she ordered a loop monitor, and an echocardiogram which are being done tomorrow. I've incorporated more breaks, have focused on staying hydrated, etc. I have avoided caffeine (other than chocolate) since the surgery.
Two days ago, which was post-op day 25, I went into atrial flutter. I was out and about with my family for a couple of hours out in the cold, and felt my chest racing. I checked my pulse, it was well over 100 and thought it was irregular, figured I had gone into a-fib. I panicked, and since we were already out and I was feeling some symptoms associated with it I had my wife take me to the ER. They felt the EKG/ECG was more consistent with flutter, HR was in the 130s. Thankfully, it broke on its own after about 60-90 minutes total. My electrolytes were normal. A bedside ultrasound showed no evidence of an effusion. No treatment was needed and they discharged me, knowing I'd be having additional testing in a couple of days.
I haven't had any issues in the nearly two days since then. I started cardiac rehab yesterday and they saw no issues other than two PACs. Yesterday was probably the best day I have had from the standpoint of my physical tolerance.
I know that these arrhythmias are common post-op. I guess in my case, I'm a bit dismayed by the fact that I had no immediate post-op issues, but had this event occur over 3 weeks later. I'm not sure what triggered it. I did have a couple of beers the night before so I guess that's the most likely explanation, although I had had several beers over our Thanksgiving holiday weekend and had no issues. I'm going to refrain from alcohol for the foreseeable future.
I've read through a lot of the threads here and I know that others have had more significant issues with A-fib, have had pacemakers placed, ablation, cardioversion, etc. And I know that every situation is different and hard to predict.
I was just curious if anyone had any similar experiences or insight as far as having a more "delayed" episode like this, whether it recurred, etc. I'm also just wondering when this post-op window of increased risk starts to decrease? Ideally I'd like to eventually have caffeine, alcohol in moderation, etc (I realize these are not necessities in life but they are things I enjoy). I'd also like to get back to my prior level of physical fitness without hopefully triggering an event. I know that even if I don't have another event in the near future that I will be nervous when I attempt to re-introduce these things. Again, I'm assuming/hoping that this event was a result of post-op inflammation or whatever, as I had no prior issues with arrhythmias, but I honestly don't know what to expect moving forward.
I figured it wouldn't hurt to hear other experiences and thoughts. I appreciate the help and insight. Sorry for the lengthy post!
 

Lynn

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ETC908, I also had concerns around my heart rate/rhythm for a couple of months post op. Like you I had never had arrhythmia issues pre op. Obviously, having the tests and ruling anything serious out is important, but it could end up being just normal post surgery stuff. I say this because I had what I would describe as “slight” flutters and what for me was an elevated heart rate on activity for several months after surgery.

Actually, I became a bit obsessed with my heart rate. Reading on this forum, that it had taken several months for others here to experience a sustained decrease in heart rate made me feel better. One of the things I noticed is that when I would increase activity it seemed to aggravate things for a day or so. My cardiac rehab kinesiologist said this was fine and Normal. She also advised that consistent but not crazy cardio exercise would bring my resting heart rate back in line. And she was right, I am 8 months out and for several months now my resting heart rate is at or below my pre surgery rate in the 60s. Flutters are gone. The exercise coupled with relaxation and meditation worked, it just took a bit longer than I though.

I will also say that I passed on the beta blocker after surgery due to a previous bad experience, and though I did end up with a pacemaker I have a solid upper chamber rhythm it is paced to-so the heart rate decrease is all me. Not the pacemaker or meds. The only medication I have now for my heart is warfarin, no blood pressure or beta blocker needed.

I hope you find out it is nothing, and time and healthy living will fix it. If something else is going on, better to treat it now. Good luck.
 

gpr100rs

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Dec 12, 2016
Messages
35
Location
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I've shared my story a couple of times here, and I'm grateful for this forum and all of the support. I had AVR and repair of the ascending aorta performed on November 10th, 2021, with placement of an On-X valve. I developed inflammatory pericarditis post-operatively, and as a result had a ton of post-op pain. The surgeon and the care team said this was common given my age, as I'm a male, age 42 and was in good physical shape pre-surgery. I guess my demographic is more prone to increased post-op pain and inflammation. That was my only issue post-operatively, and I was discharged from the hospital 5 days later. I still have pain, but it is substantially improved.
Before surgery, I was asymptomatic and was not treated for any medical issues. I was not on any medications. I'm currently on metoprolol, as well as warfarin and aspirin of course. I'm also completing a course of anti-inflammatories to treat the pericarditis.
For the first couple of weeks post-op, I had home PT and gradually tried to increase my physical activity within the confines of my restrictions. Last week I increased my daily total walking time to about 2-3 miles a day. I began experiencing runs of palpitations, which the cardiologist felt were likely PVCs. He wasn't concerned, however when I saw his PA in follow-up she ordered a loop monitor, and an echocardiogram which are being done tomorrow. I've incorporated more breaks, have focused on staying hydrated, etc. I have avoided caffeine (other than chocolate) since the surgery.
Two days ago, which was post-op day 25, I went into atrial flutter. I was out and about with my family for a couple of hours out in the cold, and felt my chest racing. I checked my pulse, it was well over 100 and thought it was irregular, figured I had gone into a-fib. I panicked, and since we were already out and I was feeling some symptoms associated with it I had my wife take me to the ER. They felt the EKG/ECG was more consistent with flutter, HR was in the 130s. Thankfully, it broke on its own after about 60-90 minutes total. My electrolytes were normal. A bedside ultrasound showed no evidence of an effusion. No treatment was needed and they discharged me, knowing I'd be having additional testing in a couple of days.
I haven't had any issues in the nearly two days since then. I started cardiac rehab yesterday and they saw no issues other than two PACs. Yesterday was probably the best day I have had from the standpoint of my physical tolerance.
I know that these arrhythmias are common post-op. I guess in my case, I'm a bit dismayed by the fact that I had no immediate post-op issues, but had this event occur over 3 weeks later. I'm not sure what triggered it. I did have a couple of beers the night before so I guess that's the most likely explanation, although I had had several beers over our Thanksgiving holiday weekend and had no issues. I'm going to refrain from alcohol for the foreseeable future.
I've read through a lot of the threads here and I know that others have had more significant issues with A-fib, have had pacemakers placed, ablation, cardioversion, etc. And I know that every situation is different and hard to predict.
I was just curious if anyone had any similar experiences or insight as far as having a more "delayed" episode like this, whether it recurred, etc. I'm also just wondering when this post-op window of increased risk starts to decrease? Ideally I'd like to eventually have caffeine, alcohol in moderation, etc (I realize these are not necessities in life but they are things I enjoy). I'd also like to get back to my prior level of physical fitness without hopefully triggering an event. I know that even if I don't have another event in the near future that I will be nervous when I attempt to re-introduce these things. Again, I'm assuming/hoping that this event was a result of post-op inflammation or whatever, as I had no prior issues with arrhythmias, but I honestly don't know what to expect moving forward.
I figured it wouldn't hurt to hear other experiences and thoughts. I appreciate the help and insight. Sorry for the lengthy post!
I had a similar experience. I'm 63 and had AVR 4-13-21 (25 mm Edwards Inspiris); persistent a-fib in the hospital, two failed cardioversions but I spontaneously corrected and was discharged day 9. All fairly normal for four months, then out of the blue I had a bout of a racing heart beat (135 resting), an a fib episode (which spontaneously corrected after about a 1/2 hour) and then the PVC's started, I would get 2-6/minute. I have an Apple I Watch that has the EKG function so I can track. Felt like my heart wanted to jump out of my chest, very annoying. My regular cardiologist said so long as no associated symptoms (dizziness, chest pain, etc.) nothing to worry about. He said the surgery is a major trauma to the heart and as scarring forms, very common to have rhythm issues. No matter, it really bothered me. Incredibly, after having consistent and annoying PVC's for 4 months, they stopped this past Sunday evening and I haven't had one since. I can offer no medical explanation, but hope for you that your heart will eventually settle down once it FULLY recovers.
 

pekster11

Well-known member
Joined
Apr 20, 2011
Messages
235
Location
Chester, UK
I've shared my story a couple of times here, and I'm grateful for this forum and all of the support. I had AVR and repair of the ascending aorta performed on November 10th, 2021, with placement of an On-X valve. I developed inflammatory pericarditis post-operatively, and as a result had a ton of post-op pain. The surgeon and the care team said this was common given my age, as I'm a male, age 42 and was in good physical shape pre-surgery. I guess my demographic is more prone to increased post-op pain and inflammation. That was my only issue post-operatively, and I was discharged from the hospital 5 days later. I still have pain, but it is substantially improved.
Before surgery, I was asymptomatic and was not treated for any medical issues. I was not on any medications. I'm currently on metoprolol, as well as warfarin and aspirin of course. I'm also completing a course of anti-inflammatories to treat the pericarditis.
For the first couple of weeks post-op, I had home PT and gradually tried to increase my physical activity within the confines of my restrictions. Last week I increased my daily total walking time to about 2-3 miles a day. I began experiencing runs of palpitations, which the cardiologist felt were likely PVCs. He wasn't concerned, however when I saw his PA in follow-up she ordered a loop monitor, and an echocardiogram which are being done tomorrow. I've incorporated more breaks, have focused on staying hydrated, etc. I have avoided caffeine (other than chocolate) since the surgery.
Two days ago, which was post-op day 25, I went into atrial flutter. I was out and about with my family for a couple of hours out in the cold, and felt my chest racing. I checked my pulse, it was well over 100 and thought it was irregular, figured I had gone into a-fib. I panicked, and since we were already out and I was feeling some symptoms associated with it I had my wife take me to the ER. They felt the EKG/ECG was more consistent with flutter, HR was in the 130s. Thankfully, it broke on its own after about 60-90 minutes total. My electrolytes were normal. A bedside ultrasound showed no evidence of an effusion. No treatment was needed and they discharged me, knowing I'd be having additional testing in a couple of days.
I haven't had any issues in the nearly two days since then. I started cardiac rehab yesterday and they saw no issues other than two PACs. Yesterday was probably the best day I have had from the standpoint of my physical tolerance.
I know that these arrhythmias are common post-op. I guess in my case, I'm a bit dismayed by the fact that I had no immediate post-op issues, but had this event occur over 3 weeks later. I'm not sure what triggered it. I did have a couple of beers the night before so I guess that's the most likely explanation, although I had had several beers over our Thanksgiving holiday weekend and had no issues. I'm going to refrain from alcohol for the foreseeable future.
I've read through a lot of the threads here and I know that others have had more significant issues with A-fib, have had pacemakers placed, ablation, cardioversion, etc. And I know that every situation is different and hard to predict.
I was just curious if anyone had any similar experiences or insight as far as having a more "delayed" episode like this, whether it recurred, etc. I'm also just wondering when this post-op window of increased risk starts to decrease? Ideally I'd like to eventually have caffeine, alcohol in moderation, etc (I realize these are not necessities in life but they are things I enjoy). I'd also like to get back to my prior level of physical fitness without hopefully triggering an event. I know that even if I don't have another event in the near future that I will be nervous when I attempt to re-introduce these things. Again, I'm assuming/hoping that this event was a result of post-op inflammation or whatever, as I had no prior issues with arrhythmias, but I honestly don't know what to expect moving forward.
I figured it wouldn't hurt to hear other experiences and thoughts. I appreciate the help and insight. Sorry for the lengthy post!
your situation is almost identical to mine!

I had aortic valve replacement and repair of the aorta in April.
I'm 47, was asymptomatic pre-op, and in good shape

Around 2 weeks after the surgery i went into atrial flutter and had to spend 3 days in hospital again.
I then started on bisoprolol and was cardioverted in early July
My ECG showed nothing systematically wrong with my hearts electrics. The a-flutter was put down to post op inflammation

Since then I've had my dosage of bisoprolol reduced by half, and hopefully I can come off them completely in time.

You're still in the early stages of recovery, so don't worry

Cardioversion is no big deal really...just an outpatient procedure 👍
 

Mister_James

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Aug 23, 2013
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143
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NYC
All in all, heart rhythm problems are usually there before surgery but we do not notice them. You feel a flutter, a feeling like an elevator drop if you even notice.
With a mechanical valve, you hear your heart and are more acutely aware of your arrhythmia.

In the Immediate post surgery months, I made a fee trips to ER because of Afib and tachycardia. Got chemically converted a few times, never shocked yet.

Today, I still notice rhythm problems but I am in no rush to go to the ER or call my doctor. I will actually wait closer to 48 hours before I call my doctor.
Why? The biggest risk is churning blood clots but I am well with my warfarin.
I have metoprolol and I know I can double up on my dose and see what happens.

Don't be overly cautious with these things, they are just one of those things that slowly happened when your atriums dilated to compensate and slicing your heart didn't help. Scar tissue creates new conductive pathways. You have to learn to live with it and if it is too much then consider ablation.
 

ETC908

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Thank you all for the responses and sharing your experiences. Lynn, I have also been tracking my HR closely now. It's still a consistent 10 bpm higher than my pre-surgery resting HR, which was around 60. Pekster, I was curious about your history. Were you cardioverted in July because you remained in persistent a-flutter, or did you continue to have episodes? I assume you've had no episodes since the cardioversion? Also, not sure if you indulge in such things but what is your approach with caffeine and alcohol right now?
Thanks again.
 

TellTaleHeart

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New England
Another similar story, a-flutter (130 resting heart rate) hit out of nowhere 10 days post discharge. Another hospital stay, ultimately cardioverted And discharged. Six weekly later, no reoccurrence. Now enjoying coffee in the morning, “sociables” a few times a week.
 

ETC908

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Thanks Telltale, that's reassuring. When you say cardioverted, did they have to shock you or did you revert back on your own/with meds? Either way, glad you are doing better. Weirdly, it's only been 3 days but my PVCs have calmed down since the episode of a-flutter. I have a loop monitor now which I'll wear for the next week, so we'll see what it shows.
 

TellTaleHeart

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Thanks Telltale, that's reassuring. When you say cardioverted, did they have to shock you or did you revert back on your own/with meds? Either way, glad you are doing better. Weirdly, it's only been 3 days but my PVCs have calmed down since the episode of a-flutter. I have a loop monitor now which I'll wear for the next week, so we'll see what it shows.
Electrocardioversion for me, but they had unsuccessfully tried to control it medicinally first.
 

pekster11

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Apr 20, 2011
Messages
235
Location
Chester, UK
Thank you all for the responses and sharing your experiences. Lynn, I have also been tracking my HR closely now. It's still a consistent 10 bpm higher than my pre-surgery resting HR, which was around 60. Pekster, I was curious about your history. Were you cardioverted in July because you remained in persistent a-flutter, or did you continue to have episodes? I assume you've had no episodes since the cardioversion? Also, not sure if you indulge in such things but what is your approach with caffeine and alcohol right now?
Thanks again.
I was in persistent flutter, heart rate was 140bpm, then after going on b-blockers around 90bpm at rest.

since cardioversion i've had no more episodes

i drink coffee once a day...alcohol i've just started drinking a little since the surgery...about 2 pints of lager (seems to do nothing to me as far as heart rhythm and INR aswell)

(y)
 

pekster11

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Just had my outpatient checkup (ECG, echo, consultation).

Consultant agreed that my resting heart rate of ~45bpm was a little too low.
My dosage of bisporolol is to be reduced to one 2,5mg tablet in the morning (no more evening tablet) for 2 weeks
If my heart rhythm remains Ok, then after 2 weeks I'm coming off b-blockers completely :)
 
Last edited:

ETC908

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That's great news! Pretty interesting how the heart rate swung to the other side of the spectrum. By the way, is there a reason why they wait to do the cardioversion while you remained in a-flutter all of that time?
 

pekster11

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That's great news! Pretty interesting how the heart rate swung to the other side of the spectrum. By the way, is there a reason why they wait to do the cardioversion while you remained in a-flutter all of that time?
I have a naturally low resting heart rate anyway tbh. Before surgery it was around 50-55 bpm

Yes , the wait between going into a-flutter and cardioversion was 2 months !
Annoyed me quite a lot actually, and I spent plenty of time phoning up etc to try and get it done
Problems with staffing at the hospital was the main reason given, plus I wasn't a priority case as I was already on warfarin for the valve, and wasn't really suffering much with the a-flutter
 

ETC908

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Sorry you had to deal with it for so long, but at least you weren't suffering. Glad to hear things have been ok since. Pretty fascinating how it can happen and then not recur. Best of luck with coming off the beta blocker.
 

AZATADINE

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I'm going through something similar now....my aortic valve was replaced on Nov 4th 2021. Everything went swimmingly for 4 weeks. However, after 4 weeks and 2 days, I started getting what seem like PVC's. Every evening and night going on since last Saturday. My heart rate is always around 60 and it doesn't increase when these damn episodes are going on.

Naturally, when I got an ECG done a couple of days ago, it was fine...so I have a Holter monitor on now.

They started 2 days after I stopped taking Gabapentin. Not sure if that's anything to do with anything but it's the only thing that strikes me. I'm on Bisoprolol 2.5mg which I take in the morning.

It's not so noticeable during the day but it's very uncomfortable in the evening and in particular at night. Walking or exercise seems to banish it too.
 

ETC908

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Hopefully the Holter monitor will clarify things. I've also tried to associate a "trigger" that may have caused my abnormal beats/rhythm. Originally I thought that increasing my physical activity, possibly in conjunction with inadequate fluid intake, may have caused the PVCs. So I started hydrating, taking breaks, etc. With the flutter, I thought maybe having a couple of beers the night before, or potentially being out in the cold for a long time triggered it. In reality, there may not have been any trigger. Since the flutter episode my PVCs have calmed down, so I question whether the heart just needed to "reset" itself. Whether I have another episode or not, my tolerance for physical activity has dramatically improved since the flutter episode as well. I generally just feel better overall. Perhaps with all of the trauma, the heart just needs time to "recalibrate". Of course I have no physiologic basis to that statement, but I told my wife it's almost as if a volcano was rumbling for a few days and then just needed to erupt. Now, so far at least, things are calmer.
Here's hoping that things turn out ok!
 

AZATADINE

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Thanks!

Got the Holter results this afternoon and the GP reviewed the results. Nothing alarming jumped out to him but I'm meeting my surgeon for 6 week check up next week so I'll feel more comfortable after he has reviewed the results. I'm sure the GP would pick up on anything alarming but still, he's not a cardiac surgeon or cardiologist (with all due respect intended).

One thing that did give me some peace of mind is that my heart rate over the 24 hours was pretty good. Average BPM = 67 and range was 53 -99 and the 99 was when climbing a reasonable gradient on a 30 min walk.
 

ETC908

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All great news! Glad to hear things are looking ok. Best of luck with the surgical follow-up. I'm on the monitor for a few more days, so we'll see what it shows...
 

AZATADINE

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Thanks.

Got blood results and GGT is through the roof for some reason. Something else for me to worry about and keep my mind occupied I suppose 😄.

That's one of my takeaways from this whole thing, I thought a lot about my valve preference and the operation ahead of time. However, even though my recovery is going well physically I think, there's a whole mental side of things that I hadn't really considered beforehand really. Tend to analyse everything and always assume the worst!
 

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