Burton
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Burton, June 8,  2021  6:30pm EST

Afib after Mitral Valve Repair

I was told it would be appropriate to post this in both the Afib and heart valve section.

I had MVP repair surgery about year and half ago.  A few days after surgery while in the hospital, I had some "impressive" episodes of AFib such that they had to use a strong medication, amiodrone, to control and it slowed down my already slow heart rate, causing my O2 levels to drop dangerously low.  While they were able to stabilize things, the electrocardiologist asked me how I felt about getting a permanent pacemaker? (I guess to offset the low HR?)  I replied that I want to exhaust other alternatives first and he later agreed it was premature.  The world class surgeon predicted the Afib would go away on its own.  It did gradually give way to tachycardia but the electrocardiologist ordered a loop recorder implanted in my chest to monitor and report on a daily basis.  This was 10 weeks after surgery and by that time, all signs of arrhythmia were gone.  Just had one reportable afib event, during an exercise class in humid conditions, halfway through the last 16 months.

Nonetheless the EC wants to keep monitoring me for until the battery dies. and stay on metropolo medication forever.  The monitoring company's billing practices are a pain.  Why do they think I'm at such a risk of getting afib?  From what I've read up to 70% of patients get temporary afib after surgery.  Why are they so concerned about me?  Seems like they would take me off the metropolo while on the monitor to determine if it is a deciding factor.  Does anyone else have similar experience or one that afib came back after a year or two? 

Yes I'll ask the EC, but I'm not sure that he'll give me much insight.  Seems like this appears to be a low probability, yet high risk event that he wants to prevent.  Seems like everyone is a risk of afib as they get older, so I'd like to know if I'm 10% or 200% more at risk.

 

3 Replies
  • Larkspur
    Larkspur, June 9,  2021  4:45pm EST

    I had Afib before mitral valve repair (a MitraClip, not open heart surgery). I have not had any Afib since though I do take 75 mg of Flecainide twice daily. My EP thinks that the MitraClip helps to prevent Afib, though I also do have a pacemaker that will outpace PACs (with the aim of preventing PACs from turning into Afib). The pacemaker was for sick sinus syndrome. So my situation is somewhat different but I hope you work out an acceptable plan with your EP and wish you well!. 

  • rmiranda
    rmiranda, June 12,  2021  12:58pm EST

    I was diagnosed with AFIB and told that I had needed open heart surgery for MVP repair.  I had a MVP repair and aortic valve replacement and a open heart maze about a year ago.  I was placed on amiodarone for long term and things were going well for months.  My cardiologist decided to change my meds and within weeks things changed. I was recently admitted to ER for high heart rate and Atypical heart flutter.  I was taken off amiodarone and placed on metropanol and heart rate control meds. The Nurse practioner for EP suggested treatment of heart rate control meds then they would later schedule me for a cardioversion and placed on Sotalol.  I was told that after that I might need to have a heart ablation.  I am currently stable but I am told that the longer I wait to have the procedure the more diffcult it can be to place me back in normal sinus rythum.  I am seeking another opinion as I am not sure why I need this treatment it seems that there is not enough data.  The cardiologist and EP seem to have different opinions but I am really not sure.  I would think that they would monitor my heart rythum for a long term and look at the data.  I was told that my insurance would not cover the cost of heart rythum monitor unless I have had a stroke?  I am not sure what else to do other than seek the second opinion with another EP.  It just seems that I might get the same information from another EP.  The EP shares that AFIB and/or Atypical flutter are extremely common after open heart surgery but it seems that my condition is questionable as they have not monitored my heart on a long term basis.  I was told that the ablation and meds are only used for symptomatic relief of the AFIB or Atypical heart flutter- It just seems odd that EP recommends the procedure without first confirming what I actually have.  I guess I will follow the EP's advice for now.

  • Burton
    Burton, June 12,  2021  1:14pm EST

    Rmiranda - that doesn't sound right that an insurance company wouldn't pay for a monitor until after you had a stroke. Might want to double check that. Usually they cover pre-emptive  things that will otherwise save them large amounts. My insurance paid for at least 3 different kinds of monitors, the last being a $20,000 implant.  
     

    I would think the short-term monitors would not cost much as they are 1960's tech. 

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