Managing Postoperative Atrial Fibrillation and Low Cardiac Output After Heart Surgery

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• Atrial Fibrillation After Heart Surgery
• Treatment of Postoperative Atrial Fibrillation
• Temporary vs. Chronic Atrial Fibrillation
• Low Cardiac Output Post-Surgery
• Other Postoperative Complications
• Full Transcript

Atrial Fibrillation After Heart Surgery

Dr. Ottavio Alfieri, MD, notes that atrial fibrillation is a common complication following open-heart surgery. It typically occurs within the first few days to a week post-surgery. This condition can significantly impact a patient's prognosis if it persists, affecting both survival and quality of life.

Treatment of Postoperative Atrial Fibrillation

Dr. Ottavio Alfieri, MD explains that postoperative atrial fibrillation is usually treated with amiodarone, an antiarrhythmic medication. In cases where amiodarone is ineffective, electroshock therapy may be employed. Prompt treatment often results in a favorable outcome, allowing patients to maintain a normal long-term prognosis.

Temporary vs. Chronic Atrial Fibrillation

According to Dr. Alfieri, temporary atrial fibrillation is typical in the immediate postoperative period. If atrial fibrillation persists beyond a month or two, it may be considered chronic. In such cases, ablation of arrhythmogenic foci might be considered to manage the condition effectively.

Low Cardiac Output Post-Surgery

Dr. Ottavio Alfieri, MD highlights low cardiac output as a significant postoperative complication, especially in patients with pre-existing ventricular dysfunction. Treatment options include medication, intra-aortic balloon counterpulsation, and ECMO. While severe cases are rare, they can be life-threatening if not addressed promptly.

Other Postoperative Complications

Dr. Alfieri also mentions other potential complications following heart surgery, such as renal dysfunction, pulmonary problems, and rare but severe brain injuries. These complications, though infrequent, underscore the importance of vigilant postoperative care and early intervention to ensure optimal patient outcomes.

Full Transcript

Dr. Anton Titov, MD: Let us discuss postoperative complications after open heart surgery and after minimally invasive transcatheter heart valve treatment procedures. One of the common complications is atrial fibrillation, but it's not the only one. How to treat postoperative atrial fibrillation? What is the prognosis in postoperative atrial fibrillation after heart surgery?

Dr. Ottavio Alfieri, MD: Atrial fibrillation is one of the possible complications. It is, I must say, quite common after open-heart surgery. Usually, the patient responds very fast to the treatment with amiodarone. The situation can be very well controlled. The patient will have a long-term prognosis which is absolutely normal.

If atrial fibrillation persists after the surgical treatment of some heart disease, then the impact on prognosis is not negligible. It is so because atrial fibrillation has a negative impact on survival and the quality of life. A patient has to have oral anticoagulation. Certainly, also the style of life is totally different. But this is true if atrial fibrillation was not present before the surgical operation.

It is very difficult if the atrial fibrillation has been present in the long term. If atrial fibrillation is only temporary, those cases can be very easily treated with antiarrhythmic medications.

Dr. Anton Titov, MD: What do you consider a period during which you would say to a patient? Okay, your postoperative atrial fibrillation is transient. Let's give it another month or two months.

Dr. Ottavio Alfieri, MD: Usually, atrial fibrillation occurs after surgery in the first few days, in the first week. If a heart valve operation has been successful, rarely, atrial fibrillation occurs later on. So temporary atrial fibrillation is typical of the first week after cardiac surgery.

Dr. Anton Titov, MD: How long does usually atrial fibrillation last after surgical operation?

Dr. Ottavio Alfieri, MD: The patient is still hospitalized in this case, and atrial fibrillation is treated immediately and almost invariably with a very good result. Atrial fibrillation treatment is usually an infusion of amiodarone. If this is not effective, electroshock can be used.

Dr. Anton Titov, MD: So if it goes on for a month or two months, that's already considered chronic atrial fibrillation?

Dr. Ottavio Alfieri, MD: This is very uncommon, but if atrial fibrillation was not present before the surgical operation, it's very uncommon that atrial fibrillation is present postoperatively. It is very uncommon that atrial fibrillation lasts a long time.

Dr. Anton Titov, MD: Then you consider the ablation of the arrhythmogenic foci?

Dr. Ottavio Alfieri, MD: You can consider ablation of arrhythmogenic foci and treat atrial fibrillation when it becomes chronic.

Dr. Anton Titov, MD: What are the other common complications postoperatively in heart valve surgery?

Dr. Ottavio Alfieri, MD: One of the most common complications can be different degrees of low cardiac output. Low cardiac output is quite common, particularly if the operation is carried out not in the very early stage of heart disease. Heart valve problems can be present for a long time. There was ventricular dysfunction before the surgical operation. Then you can have a low cardiac output postoperatively.

Low cardiac output is treated first with the medication. Then you can use intraaortic balloon counterpulsation. You can even use ECMO, which supplies the heart and the lungs for a while with artificially oxygenated blood. Low cardiac output can be treated. Sometimes low cardiac output can be so severe. It can also be fatal. Fortunately, it is very, very rare nowadays.

Then you can have other complications like renal dysfunction. You can also have pulmonary problems. And this is very catastrophic, but it is very, very rare. You can have a brain injury after cardiac surgery. That is really something that is a tragedy. It occurs very, very rarely today, but it's something that can happen.