Afib 6.75 years after OHS AVR??!!! WTF!!!??

[MidlifeCrisis]

Long story short, I went into Afib immediately after my OHS 6.75 years ago. They shocked me to get it back in rhythm. Then a month after I went into Afib while working to hard too soon. THEN nothing! Resumed my normal life. I'm on no meds other than once daily low dose aspirin. I've always been an athlete so I workout hard- Running, swimming and lifting weights. SIDE NOTE: I never returned to my normal cardio vascular shape after AVR. Used to run 8:30 minute miles now I can do 10:30. Can't hold a pace and never seem to get into cardio shape like a normal runner or swimmer.

WITH THAT SAID- Lately I've been working out pretty hard and yesterday while swimming I slipped into Afib! At first I had no idea just thought I was tired, etc.. Went home and went on a walk to a social with my son and felt really short of breathe looked down at my iWatch and me HR was 133 (normally about 65-75 while walking. My resting HR is like 45. I've always had a low HR and was a competitive swimmer and water polo player from 8 years old through college and competed in Masters in both.

ANYWAY, I was at the event and sat down and breathed etc. Then I got pissed and got up and started talking to people and just got through it for another hour with a pulse of 130. I went home and laid down rest of the day and stayed in aFib. I had some 6.5 year old Amiodrone and took two 100 mg pills (when I went into a Fib a month after AVR my Cardiologist had me take two 100mg in morning and night and went away.)

Anyway, I took two 100mg and then at night took 150mg. This morning I woke up with no aFib. I didn't sleep well but still went on a three mile jog just to test and maybe to spite my aFib to get my heart and mind back to normal. No aFib today.

So,,,, What I'm asking anyone... Is first WTF with my aFib??!!! I don't wanna go on meds and sure AF don't want aFib (who does) Has this happened to anyone else? I'm really hoping it's a one off freak thing that happened. I didn't contact my cardiologist yet. Not due for a check up til next spring I think. Speaking of check ups he always says my heart is great.

Please excuse my extreme ADHD ramblings and writings.

 

[dick0236]

I'd get checked out by your Cardio. I was diagnosed with chronic A-fib 50 years after my surgery so I guess A-fib can happen at any time. Mine is controlled with meds and does not affect my life negatively. I understand that during an A-fib episode the heart "flutters" rather than "beats" increasing the likelihood of a blood clot forming......then a stroke!

Incidentally, A-fib is not necessarily a by-product of heart surgery.....a lot of "normal" people have it.

 

[pellicle]

Hi

sorry to hear that.

What I'm asking anyone... Is first WTF with my aFib??!!! I don't wanna go on meds and sure AF don't want aFib (who does) Has this happened to anyone else?

Twelve years after my #3 OHS I developed tachycardia. It's almost a given after a sufficient duration after surgery (especially after having had a warning bout) that you'll need something else. Especially if there was any ventricular hypertrophy.

Almost nobody gets past 60 and does not need some drugs, particularly those of us who have been heart valve replacement patients. Just be thankful they exist now.

I would ask about metoprolol as a possibility, cos amiodrone is not something you want to be on for a lengthy period.

I never returned to my normal cardio vascular shape after AVR.

Another hint there that this (arrhythmia) was on the cards, however it could also have suggested some sort of patient prosthesis mismatch; I just don't have much other data to go on.
¯\_(ツ)_/¯

Life is about changing with your body, you changed from an infant to an adolescent to an adult; why did you think it would stop at any particular place?

Best Wishes

 

[pellicle]

PS
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3912619/
https://www.frontiersin.org/articles/10.3389/fcvm.2023.1156626/full
Longer term I expect it higher percentages (but they seldom do longer term analysis because of the view that the average age of a OHS VR surgery is over 60, and by you're 70's its higher

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4630199/
being an athlete makes it worse
https://academic.oup.com/eurjpc/article/30/9/887/7083755

The most common diagnoses during follow-up were arrhythmias (n = 33; 37%). Increasing age (OR = 1.047, 95% confidence interval (CI): 1.003–1.094; P = 0.0379)​

I know that's perhaps not what you wanted to hear, but forewarned is forearmed. I personally was glad I was always told the truth, told the darkside possibilities and told to not have high or unrealistic expectations.

@MidlifeCrisis I see from your Bio

metoprolol, losartan, baby aspirin​

but don't see what valve you chose. I was pretty clear (the surgeon was honest) that on my 3rd I did not want to pick a tissue to kick my can down the road and "defer warfarin" because:

• I don't want a 4th if I can avoid it (and at 48 that would be unlikely)
• I was of the view that warfarin wasn't "never going to be on my horizon"
• While I was a bit crestfallen about the "land mark" of needing to be on a drug forever it wasn't such a blow to my ego that I'd cut my nose off to avoid it.

Over the years (first one at 10 years, so more than 30 of them before OHS3) I came to understand that this condition has no 'permanent cure', all we have are management strategies that amount to deferrals on the ultimate.

That wasn't a resignation, it was a wake up call to enjoy my life. Here I am at the doorstep of 60 and I've had a pretty darn good life. I have very good and dear friends who never got that.

HTH

 

[Jerry D]

I had OHS and an Edwards Lifesciences aortic valve in 2018 (69 years old). Had A-fib three months later. Was controlled with diltiazem for three years, and then had a bout again. Had an ablation for A-fib and A-flutter in December 2021. Good for 2 more years, and then had an ablation for a new A-flutter in July and for the A-fib in August. Been on Xeralto since November 2021. Will probably been on that forever. Still coach and race 6-man outrigger canoes on the open ocean (10-12 miles), and still work full time. See your cardio right away, don't wait. I only had 2 incidents of A-fib in 5 years and was asymptomatic elsewise (A-fib only discovered with my EKG every 3 months), but it is nothing to fool around with. The risk of a stroke is too high. Meds and/or an ablation are far better than a stroke.

 

[pellicle]

Hi Jerry

please excuse me but I wanted to leverage this post to highlight a decision making criteria which is often neglected (and infrequently brought up by Cardio's in my observations of what people say they've discussed)

So my point is this: don't run your "mental projections" or "Scenario analysis" on a perfect outcome, because not everyone gets a perfect outcome. Indeed a cardio may not even think this is noteworthy.

My point is always "do not pick a valve just because you'll avoid blood thinners". Pick it for any other reason, but not that because we know well that in the long term follow-up you may just end up on them anyway.

Jerry made a very reasonable choice of a bio-prosthetic at 69 based on the criteria of valve durability (NB a bio-prosthetic will go the distance he needs it to do). However as he reports:

...Had A-fib three months later. Was controlled with diltiazem for three years, and then ... Been on Xeralto since November 2021. Will probably been on that forever.

so more importantly even though on blood thinners his life has not ended (a seemingly common castrophized implicit expectation). Rather:

Still coach and race 6-man outrigger canoes on the open ocean (10-12 miles), and still work full time.

gosh ... if I had a buck for every time someone said "I'm too active to go on blood thinners". From here on in I'm going to cease calling it the hysterical name of blood thinners and call it AntiCoagulation Therapy (ACT)

Now this next point is important

See your cardio right away, don't wait.

not just for Afib, but for surgery timing in the first place ... the times they are a changing, and we are now seeing past the fog of "complex surgery or you'll die" risk analysis and seeing into "surgery as soon as its needed for better long term outcomes" ... and not everything is about only the risk of death.

I strongly recommend a review of this thread:

https://www.valvereplacement.org/th...re-vs-waiting-for-symptoms.888781/post-920179
In particular Astro writes:

​

"This makes sense to me - why risk irreversible heart scaring? Replacing the valve won't fix irreversible heart scarring. If such scarring is present, this may effect life expectancy."​

This scarring manifests not just as the thing on the surface of your skin, but as a damage to the heart muscle tissue itself and is a cause of arrhythmias.

I only had 2 incidents of A-fib in 5 years and was asymptomatic elsewise (A-fib only discovered with my EKG every 3 months), but it is nothing to fool around with. The risk of a stroke is too high. Meds and/or an ablation are far better than a stroke.

which brings me back to my own tachycardia and arrhythmia: I was able to pick it up early because I had a mechanical valve. I was able to describe it well to the doctors who then using an ECG confirmed what I'd described. Further I was not stressed by this in the least because I knew that the first round of treatment would involve ACT which I was already on.

In my case my arrhythmia was controlled nicely with a low dose of Metoprolol (for now).

Lastly: don't just take my word for this, read those posts and associated linked articles, and bring this topic up for discussion with your cardio and or your surgeon.

HTH

 

[Gail in Ca]

I have been in chronic a-fib for 9 years. Mine is more of an irregular heart beat than fast heart beat. It started 3 yrs after my 3rd surgery, got cardio version, took Sotalol, a-fib gone for 2 years. Then, got another cardio version but it only lasted til I got home. So, I’m in a-fib all the time. I take warfarin (jantoven) anyway for mechanical valve so I just had to get used to the irregular rhythm.

 

[V__]

Long story short, I went into Afib immediately after my OHS 6.75 years ago.

I would concur with @dick0236 , that this is the prime feature for the cardiologist to look at.

I have some parallels with your story. Got AFib 1st time on the 2nd day post surgery. Went on Amiodarone for 6 weeks. Then 2nd time AFib happened about 5 weeks later. (Still on Amiodarone, but it self-converted to sinus rhythm with no additional measure.) It has been a year since, with no other occasions. However, my cardiologist was very interested in knowing whether I could recognize it if it were to happen again.

 

[pellicle]

(Still on Amiodarone, ..

still now?

 

[Gkeraney]

Hi Jerry

please excuse me but I wanted to leverage this post to highlight a decision making criteria which is often neglected (and infrequently brought up by Cardio's in my observations of what people say they've discussed)

So my point is this: don't run your "mental projections" or "Scenario analysis" on a perfect outcome, because not everyone gets a perfect outcome. Indeed a cardio may not even think this is noteworthy.

My point is always "do not pick a valve just because you'll avoid blood thinners". Pick it for any other reason, but not that because we know well that in the long term follow-up you may just end up on them anyway.

Jerry made a very reasonable choice of a bio-prosthetic at 69 based on the criteria of valve durability (NB a bio-prosthetic will go the distance he needs it to do). However as he reports:

so more importantly even though on blood thinners his life has not ended (a seemingly common castrophized implicit expectation). Rather:



gosh ... if I had a buck for every time someone said "I'm too active to go on blood thinners". From here on in I'm going to cease calling it the hysterical name of blood thinners and call it AntiCoagulation Therapy (ACT)

Now this next point is important


not just for Afib, but for surgery timing in the first place ... the times they are a changing, and we are now seeing past the fog of "complex surgery or you'll die" risk analysis and seeing into "surgery as soon as its needed for better long term outcomes" ... and not everything is about only the risk of death.

I strongly recommend a review of this thread:

https://www.valvereplacement.org/th...re-vs-waiting-for-symptoms.888781/post-920179
In particular Astro writes:

​

"This makes sense to me - why risk irreversible heart scaring? Replacing the valve won't fix irreversible heart scarring. If such scarring is present, this may effect life expectancy."​

This scarring manifests not just as the thing on the surface of your skin, but as a damage to the heart muscle tissue itself and is a cause of arrhythmias.



which brings me back to my own tachycardia and arrhythmia: I was able to pick it up early because I had a mechanical valve. I was able to describe it well to the doctors who then using an ECG confirmed what I'd described. Further I was not stressed by this in the least because I knew that the first round of treatment would involve ACT which I was already on.

In my case my arrhythmia was controlled nicely with a low dose of Metoprolol (for now).

Lastly: don't just take my word for this, read those posts and associated linked articles, and bring this topic up for discussion with your cardio and or your surgeon.

HTH

I agree with all of this but want to add that Edwards is pushing some of this agenda to do tavr's earlier on folks who are in the upper moderate range. Perhaps they are exactly right but they may benefit from this more than any other company. I lived well hanging at the edge of severe for around 13 years of my life. I admit no one should do this to that extreme and at the end it got dicey and I had 3 v tach events, so I had gone too far and knew it. But I think it's not going to be appropriate if the way this goes soon is that a young patient, say under 60 and in good shape and with no co morbidities has a mean gradient of 36 and good ejection fraction over 70, has surgery. Those folks can be monitored for years, imho. I agree that in someone over 70, they shouldn't play this game

 

[Chuck C]

Sorry to hear about your recent afib issue.

I didn't contact my cardiologist yet. Not due for a check up til next spring

I would definitely not wait, but would get that appointment as soon as possible. Make sure that they do an echo before your appointment also. I hope that they've had you get regular echos. It looks like you were 45 when you had your tissue valve. Young patients often go through tissue valves quickly, so getting regular echos is really important, especially once you are 6 or 7 years into your valve.

Lately I've been working out pretty hard and yesterday while swimming I slipped into Afib

It sounds like you really like to push the cardio. As to why young folks go through valves quickly, it was believed that it was due to being more physically active compared to the elderly. There has been some movement towards the idea that it is because the young immune system attacks the foreign tissue more aggressively than older folks. I suspect that both factors come into play.

Until you get some imagery, it would be hard to know why this is happening.

At 7 years into your valve, given your young age, it would not at all be surprising if you have some SVD that has started. If this is the case, your left ventricle could have started to thicken to adapt to the harder load. I have posted a link below to a 2021 meta-analysis showing the strong link between LVH and afib.

If surgery was delayed and you had LVH going into surgery, as many do, it is possible that the LV wall thickness never fully returned to normal, which would make a person more prone to afib.

Some people do develop afib when they get older, valve patient or not.

I would be very cautious self medicating, especially with amiodarone.

Really hoping that your afib was a temporary thing and that things are still going good with your valve, but do get it checked out and get an echo, so that they can see what it going on. They will also likely have you wear a device for a couple of weeks which monitors whether afib returns. When the pulse goes to 130+, one tends to notice, but going into afib is not always noticeable, so monitoring things for a while will give your cardiologist some good data.

Please keep us posted.

Study on the link between LVH and afib:

"Conclusion: LVH is strongly associated with AF and has a negative impact on outcome in patients with AF."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8362884/

 

[carolinemc]

Long story short, I went into Afib immediately after my OHS 6.75 years ago. They shocked me to get it back in rhythm. Then a month after I went into Afib while working to hard too soon. THEN nothing! Resumed my normal life. I'm on no meds other than once daily low dose aspirin. I've always been an athlete so I workout hard- Running, swimming and lifting weights. SIDE NOTE: I never returned to my normal cardio vascular shape after AVR. Used to run 8:30 minute miles now I can do 10:30. Can't hold a pace and never seem to get into cardio shape like a normal runner or swimmer.

WITH THAT SAID- Lately I've been working out pretty hard and yesterday while swimming I slipped into Afib! At first I had no idea just thought I was tired, etc.. Went home and went on a walk to a social with my son and felt really short of breathe looked down at my iWatch and me HR was 133 (normally about 65-75 while walking. My resting HR is like 45. I've always had a low HR and was a competitive swimmer and water polo player from 8 years old through college and competed in Masters in both.

ANYWAY, I was at the event and sat down and breathed etc. Then I got pissed and got up and started talking to people and just got through it for another hour with a pulse of 130. I went home and laid down rest of the day and stayed in aFib. I had some 6.5 year old Amiodrone and took two 100 mg pills (when I went into a Fib a month after AVR my Cardiologist had me take two 100mg in morning and night and went away.)

Anyway, I took two 100mg and then at night took 150mg. This morning I woke up with no aFib. I didn't sleep well but still went on a three mile jog just to test and maybe to spite my aFib to get my heart and mind back to normal. No aFib today.

So,,,, What I'm asking anyone... Is first WTF with my aFib??!!! I don't wanna go on meds and sure AF don't want aFib (who does) Has this happened to anyone else? I'm really hoping it's a one off freak thing that happened. I didn't contact my cardiologist yet. Not due for a check up til next spring I think. Speaking of check ups he always says my heart is great.

Please excuse my extreme ADHD ramblings and writings.

You need to see cardio ASAP. Never hurts to have things checked after an episode.

 

[V__]

still now?

No, it was just a single course long time ago. I probably didn't explain it well. The 1st episode happened while still in the hospital post-surgery. So they started on Amiodarone, which lasted in total of about 5 weeks. The 2nd episode occurred at the tail end of the course, with about a week to finish. The 2nd occasion was during the weekend, so I went to ER to check it out. The doctors there were considering applying electrical cardioversion, since it was still fairly new. But AFib disappeared during the discussions with them. So they consulted with a cardiologist and suggested to just finish the remaining pills. The experience did "sensitize" me to the AFib occasions, but so far they didn't return.

 

[mknuppel]

I'd get checked out by your Cardio. I was diagnosed with chronic A-fib 50 years after my surgery so I guess A-fib can happen at any time. Mine is controlled with meds and does not affect my life negatively. I understand that during an A-fib episode the heart "flutters" rather than "beats" increasing the likelihood of a blood clot forming......then a stroke!

Incidentally, A-fib is not necessarily a by-product of heart surgery.....a lot of "normal" people have it.

Do you use meds to control bpm and the heart rhythm? I just started heading down this path several days ago. It’s good to hear that it doesn’t affect your life negatively!

 

[trinitymcdermott]

My son who had his OHS for a mechanical aortic valve over 7 years ago had a bout with afib last year. He thought he was having panic attacks and dismissed the feeling until he felt really bad 3 weeks post Covid infection and went to the hospital with a RHR of 150-170. Cardioversion (shock) helped but he was in children’s hospital for 11 nights getting medication right and monitoring the arrhythmia as well as acute congestive heart failure (for those of you that know, ejection fraction as 25%!). Echo 3 months prior was perfectly normal. Heart failure is better now but could have avoided some of this if we would have picked up on the signs. He is on sotalol now and knows what to watch for. He has been in twice since. Once flutter, once afib. Does was increased. This is when I say “thank god for warfarin!”. In this instance it was a huge plus.

 

[pellicle]

Hi

He has been in twice since. Once flutter, once afib. Does was increased. This is when I say “thank god for warfarin!”. In this instance it was a huge plus.

back in the last waves of COVID I was exposed to someone who had a solid infection (accordging to a RAT test) and soon after that (a few weeks) developed a tachycardia which came and went. The duration of bouts became longer and while annoying I wasn't too perturbed because it abated by lying on my left side).

However the day came when it didn't abate and after over 2 hours of it I went to the hospital (half hour drive) where (short story) I was prescribed metoprolol; which I take to this day.

I perhaps would have not known about this without the smooth thud of my valve to constantly (like my breathing when exersizing) let me know about this tachycardia. I would perhaps have been concerned about the ongoing risks of thrombosis from this were I not already on the usually prescribed drug for that: warfarin.

Frankly I think as we age its a pretty good "dietary supplement" to be on.

Best Wishes