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Atrial fibrillation, or A-fib, is the most commonly treated arrhythmia, or heart rhythm problem. The CDC estimates that more than 12 million people in the U.S. will have A-fib by 2030. It’s a serious condition because left untreated it increases your risk of blood clots, heart failure, and stroke.

There’s a lot you can do to prevent and control A-fib. But one cause of A-fib — heart valve problems — can require surgery. And surgery to fix other heart problems can also trigger what’s known as post-operative A-fib.

Here’s what you need to know about A-fib if you have heart valve problems or need heart surgery.

What Is A-fib?

A-fib is when the upper chambers of your heart (atria) beat out of sync with the lower chambers (ventricles). If your heart beats too fast, too slow, or in an irregular rhythm, you could have atrial fibrillation.

Can a Heart Valve Problem Cause A-fib?

There are 2 types of A-fib: non-valvular and valvular.

In general, non-valvular A-fib is the kind you can control with lifestyle changes and medication. Risk factors for developing non-valvular A-fib include high blood pressure, diabetes, obesity, smoking, heavy drinking, and chronic stress.

Valvular A-fib, on the other hand, is related to valvular heart problems, such as mitral valve stenosis or having artificial heart valve. An estimated 4% to 30% of people with A-fib have valvular A-fib. It’s a wide range because doctors don’t agree on when heart valve problems are the cause of A-fib.

Symptoms of valvular A-fib

Whether you have non-valvular or valvular A-fib, the symptoms are often the same. The main symptom is feeling like your heart is fluttering, racing, or thumping. Other symptoms can include:

  • Chest pain or pressure.
  • Dizziness or lightheadedness.
  • Excessive tiredness or weakness,
  • Heart racing when sitting still.
  • Shortness of breath and anxiety.
  • Faintness or confusion.
  • Fatigue when exercising.
  • Sweating.

Oftentimes, you don’t even know you have A-fib until you see your doctor for something else or you get an electrocardiogram (EKG).

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Complications From A-fib

A-fib increases your risk of blood clots, heart failure, and stroke. In general, A-fib causes some 158,000 deaths in the U.S. each year.

If you have valvular A-fib, you’re at an even greater risk of blood clots than those who have non-valvular A-fib. That’s because having mitral valve stenosis or an artificial heart valve already increases your risk of blood clots.

Treatment for A-fib

If you have A-fib, it’s important to get treatment. Treatment options include:

Medications for A-fib

To treat your A-fib, your doctor will first use medications. These include:

  • Anticoagulants and antiplatelets. A-fib increases your risk of blood clots. So it’s often treated with blood thinners and similar medications that keep your blood from clotting.
  • Medications to slow and control your heart rate. Most people feel better once their heart rate resets. These medications include beta blockers, calcium channel blockers, and digoxin.
  • Medications to control your heart rhythm. If you need additional medications to control your A-fib, your doctor can use an anti-arrhythmic drug. These include sodium channel blockers and potassium channel blockers.

Non-surgical and surgical options for A-fib

If medications don’t work or you can’t take them, there are other options, These include:

  • Electrical cardioversion. For this outpatient procedure, doctors use a machine to deliver a low-voltage electric current to your heart. This can help restore your heart’s normal rhythm.
  • Catheter ablation. This minimally-invasive procedure attempts to isolate the tiny parts of your heart that are sending abnormal electrical impulses and causing A-fib. Doctors insert thin wires called catheters through a vein up into the heart. Electrodes at the end of the wire deliver heat, which can destroy the tissue causing the A-fib.
  • Surgical ablation. For this option, also called the maze procedure, surgeons create scar tissue with small incisions, radio waves, freezing, or microwave or ultrasound energy. The scar tissue blocks the abnormal electrical signals that cause A-fib.
  • Left atrial appendage closure. This procedure lowers your risk of stroke. A surgeon implants a device known as the WATCHMAN™ into your heart to close off the part of the heart that most commonly forms stroke-causing clots.
  • Implanted devices. A surgeon puts a device, like a pacemaker or an Implantable Cardioverter Defibrillator (ICD), in your heart to monitor your heart’s rhythm. If they detect abnormal rhythm, they deliver an electric shock to restore normal rhythm.

Heart valve surgery and A-fib

For those with valvular A-fib caused by a faulty aortic or mitral valve, heart valve surgery can repair or replace damaged heart valves. Oftentimes, your surgeon will correct A-fib during surgery for other heart issues.

It’s not uncommon to still have A-fib after heart valve surgery. A-fib after heart valve surgery increases your risk of heart failure and dangerous blood clots known as thrombo-embolisms.

When heart valve surgery doesn’t fix your A-fib, your doctor can consider other surgical options.

A-fib after heart surgery

You can also develop temporary A-fib after heart surgery. A-fib is the most common complication after heart surgery, according to the American Heart Association. It affects from 20% to 60% of heart surgery patients, found a study published in the journal Acta Anaesthesiologica Scandinavica.

Can aortic valve replacement cause A-fib?

After open heart surgery, a third to half of all patients develop A-fib. Several types of open heart surgery can trigger A-fib. This includes aortic valve replacement, where your surgeon replaces a narrowed or leaky aortic valve.

Other types of open heart surgery that can trigger A-fib include:

Risk factors for A-fib after heart surgery

It’s unclear why someone develops A-fib after open heart surgery. But risk factors for A-fib after heart surgery include:

  • Obesity.
  • Older age.
  • Genetic predisposition for A-fib.
  • High blood pressure.
  • Heart failure.
  • Chronic obstructive pulmonary disease (COPD).
  • Thyroid problems.
  • Surgery on a heart valve, such repair or replacement of aortic valve or mitral valve.
  • Pneumonia after surgery.
  • An electrolyte imbalance after surgery.

How serious is A-fib after heart surgery?

Developing A-fib after heart surgery leads to longer hospital recovery, more time in intensive care, and worse long-term outcomes, according to UpToDate. Along with the usual increase risk of stroke and heart failure, A-fib after surgery can increase your risk of infection, kidney dysfunction, and brain dysfunction.

A-fib typically develops within 7 days after open heart surgery. But it can also take up to 90 days to notice A-fib symptoms.

In some cases, A-fib is temporary, only lasting a few days. Then it goes away on its own.

For others, A-fib after heart surgery is permanent. It doesn’t go away. In this case, you’ll need to receive treatment for the condition.

Sources

Sources:

A Guide to Atrial Fibrillation After Open Heart Surgery. Jan. 8, 2021. U.S. News & World Report. Link.

Atrial Fibrillation After Surgical Correction of Mitral Regurgitation in Sinus Rhythm. 2014. Circulation. American Heart Association. Link.

Options for Heart Valve Replacement. American Heart Association. Link.

Non-Surgical Procedures for AFib. American Heart Association. Link.

Atrial Fibrillation Medications. American Heart Association. Link.

What Are The Symptoms of Atrial Fibrilation (AFib or AF)? American Heart Association. Link.

How to Define Valvular Atrial Fibrillation? Oct. 2015. Archives of Cardiovascular Diseases. Link.

Atrial fibrillation. Centers for Disease Control and Prevention. Link.

Valvular heart disease. Link.

Roles of Your Four Heart Valves. American Heart Association. Link.

Heart Valve Problems and Causes. American Heart Association. Link.

About Heart and Vascular Institute

The UPMC Heart and Vascular Institute has long been a leader in cardiovascular care, with a rich history in clinical research and innovation. As one of the first heart transplant centers in the country and as the developer of one of the first heart-assist devices, UPMC has contributed to advancing the field of cardiovascular medicine. We strive to provide the most advanced, cutting-edge care for our patients, treating both common and complex conditions. We also offer services that seek to improve the health of our communities, including heart screenings, free clinics, and heart health education. Find an expert near you.