Our Summary

This research paper discusses heart rhythm problems (arrhythmias) that can occur after heart surgery. It explains that slow heart rates (bradycardias) often happen but are usually temporary and can be fixed. However, if there’s a persistent problem with the connection between the upper and lower chambers of the heart (atrioventricular block), that might mean a permanent pacemaker needs to be fitted, especially after valve surgery. They also found that a procedure to replace the aortic valve can lead to even more pacemaker implants.

The most common heart rhythm issue after surgery is atrial fibrillation, which can lead to stroke, heart attack, heart failure, and even death shortly after the event. Ventricular arrhythmias, which come from the lower chambers of the heart, can result in an extremely high death rate in hospital, and also for those who survive the initial event in the long run. However, devices called implantable cardioverter-defibrillators have been found to reduce the long-term death rate for these patients.

FAQs

  1. What are the common types of arrhythmias that occur after cardiac surgery?
  2. When is it necessary to implant a permanent pacemaker after cardiac surgery?
  3. How do implantable cardioverter-defibrillators help patients with ventricular arrhythmias after cardiac surgery?

Doctor’s Tip

One helpful tip a doctor might tell a patient about cardiac surgery is to be aware of the potential for postoperative arrhythmias. It is important to closely monitor your heart rhythm after surgery and report any irregularities to your healthcare provider. Additionally, follow all postoperative instructions carefully, including taking prescribed medications and attending follow-up appointments. If a permanent pacemaker is recommended, it is important to understand the benefits and risks of this treatment option.

Suitable For

Patients who are typically recommended for cardiac surgery include those with significant coronary artery disease, valvular heart disease, congenital heart defects, and certain arrhythmias. Patients with severe symptoms such as chest pain, shortness of breath, fatigue, and palpitations, as well as those at high risk for complications or death from their heart condition, are often candidates for cardiac surgery. Additionally, patients who have failed to respond to medical therapy or other less invasive treatments may be recommended for surgery. It is important for patients to undergo a thorough evaluation by a cardiac surgeon and other members of the healthcare team to determine the best course of treatment for their specific condition.

Timeline

Before cardiac surgery:

  1. Patient undergoes preoperative evaluation and testing to determine the need for surgery and assess overall health status.
  2. Patient may receive preoperative medications and instructions for preparation for surgery.
  3. Patient is admitted to the hospital on the day of surgery and undergoes preoperative procedures such as IV placement and anesthesia administration.

After cardiac surgery:

  1. Patient is transferred to the intensive care unit (ICU) or cardiac care unit (CCU) for postoperative monitoring and management.
  2. Patient may experience pain, discomfort, and fatigue in the immediate postoperative period.
  3. Patient is monitored closely for complications such as bleeding, infection, and arrhythmias.
  4. Patient may undergo physical therapy and rehabilitation to regain strength and function.
  5. Patient is discharged from the hospital and continues follow-up care with the cardiac surgery team for long-term management and monitoring of cardiovascular health.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with cardiac surgery?

  2. What is the success rate of the specific procedure being recommended?

  3. How long is the recovery time after surgery and what can be expected during the recovery process?

  4. Will I need to take any medications after surgery, and if so, what are the potential side effects?

  5. Are there any lifestyle changes or restrictions that I will need to follow after surgery?

  6. What follow-up appointments will be necessary after surgery?

  7. What are the chances of developing postoperative arrhythmias, and what steps can be taken to prevent or manage them?

  8. If a pacemaker or defibrillator is needed after surgery, what will be the implications for my long-term health and quality of life?

  9. How will my existing heart condition be affected by the surgery, and what are the long-term implications for my heart health?

  10. Are there any alternative treatment options to consider before proceeding with cardiac surgery?

Reference

Authors: Clay-Weinfeld K, Callans M. Journal: Crit Care Nurs Clin North Am. 2019 Sep;31(3):367-388. doi: 10.1016/j.cnc.2019.05.006. Epub 2019 Jul 5. PMID: 31351556