Is there a definition of valvular AF?

Hi - I 'm new to this forum so apologies if I'm asking something that's been asked many times before.

Although I'm in my 50s I had an aortic valve replacement for a congenital condition last year. I had AF for a few weeks pre op and then post op. Prior to that I had one short episode of AF seven years earlier which was treated with Amiodarone, aspirin and diuretics throughout that period. Otherwise I have been fit and well and led a completely normal life.

Last December I had a successful cardioversion. However, I remain on Warfarin and have not really had a full explanation why. I'm also on Levothyroxine and Bisoprolol 10mg but Amiodarone and diuretics have been discontinued.

I would like to discuss alternatives with my cardiologist and understand that some of these are not suitable for people with valvular AF. A few questions therefore:

If someone has had successful cardioversion, how long do you have to be AF free for doctors to accept that it has gone?

Is there a layman's definition of valvular AF?

Experiences of anyone with the new drugs?

Would love to hear from anyone who has had AF and successfully argued for withdrawal of Warfarin.

Thanks in advance.

6 Replies

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  • catbird,

    First Welcome to the forum.

    You, maybe even without knowing, have asked a bunch of questions in this post.

    To start off... most people deal with what's called Non-Valvular AF which is a heart arrhythmia disorder that occurs in the absence of another heart condition. There are many cases of those who have developed AF after a Valve procedure or due to a heart valve problem. Having the AF 7 years prior to the heart surgery could cause it to be termed as the Non-Valvular but that is really a mute point.

    Start off with the Cardioversion... A Cardioversion is nothing but a jump start to shock the heart back into rhythm (NSR). Once performed it is over and has no ability to keep the heart in rhythm and the irregular rhythm will return with the next attack. Just like jump starting your car when the battery dies, will not "fix" the battery. You will need to do it over and over until you do something to actually fix (replace) the battery. After a cardiversion, You could go back into AF in minutes, days or years.... Just whenever it happens again. Which brings us to the next...

    "If someone has had successful cardioversion, how long do you have to be AF free for doctors to accept that it has gone? " You probably won't find any "Good or Informed" EPs that will accept the idea that the AF is gone. In most people AF starts out only occasionally, sometimes years between attacks and progresses to happen more frequently and usually lasting longer with more symptoms. Mine started with maybe 1 time a year (possibly earlier and less than that but attributed it to something else) and after 10 years from the diagnosis I was having 1 or 2 attacks a week. Most people who have AF and Drs who treat will be quick to tell you that AF doesn't just "Go Away", it hides and waits to happen again.

    Now the drugs.... Amiodarone is the strongest and most aggressive type of rhythm control drugs but carries some really bad side effects so it is good that he used it as a short term solution. The diuretics were to reduce fluids which will reduce the blood pressure and stress on the heart. Not so good for the kidneys... You are taking a beta blocker which slows down the heart rate to both make AF more tolerable when an attack happens and also lower blood pressure. Your statement about some not being suitable for those with Valvular AF is correct. Many of the Rhythm control meds have side effects that can cause serious problems in those with heart valve conditions and other heart problems. So they can not be used....

    Now to the warfarin... You won't find many on these forums, who understand the risk of developing a blood clot, that will agree an anticoagulant can be "Safe" to stop. Unless a procedure has been performed to stop the AF from happening and after having no irregularity problems for an extended period of time. How long is that period? Who Knows??? I just had an ablation done 13 weeks ago and it is looking very positive that it has worked BUT I will remain on warfarin until I can be sure my AF has completely stopped. Just *one* AF attack is all it takes for a clot to form and a stroke to happen.

    You will find a bunch of help on here with information. All here have AF and many of us, for a long time.

    Again, welcome to the forum.

    Tim

  • Thanks Tim.

    I had been warned when I had my cardioversion that there was a 60 percent chance that it would return within a year. What I didn't realise until reading some of the post on this forum was that an even smaller percentage of people seem to get rid of AF altogether, just by cardioversion. I was also told at the time of the cardioversion that one of the main reasons for doing it was to reduce the drugs.

    I chose to have a tissue valve because I did not want to be on Warfarin long term. I feel a bit cheated. They knew I had pre op AF.

    I would really prefer to take an alternative, for many reasons, and I accept that I will need to take something. I would just prefer it not to be Warfarin. However, I guess I will need to discuss this with my cardiologist.

    Your point about whether I have valvular or non-valvular AF is interesting, is what I expected and needs to be defined if I am going to be allowed an alternative to Warfarin.

    I'm pretty good at quizzing doctors but just wish they would be a bit more open and share both good and bad information about treatments.

    Thanks again.

  • No Problem, Giving you the 60% chance was pretty much a sure bet. I know many who have had the cardioversion and started back into AF before leaving the hospital. Which type of cardioversion did you have? There are 2 different types. One using drugs through an IV (normally Cardizem) and the other using the electrode paddles. They have used the drug method on me a few times but I would not do the paddles.

    Honestly, I have never met or spoken to anyone who had a confirmed and diagnosed case of AF and it just stopped. It may wait a few years before it happens again, but you can bet that it will.

    That's rotten that they didn't inform you before the surgery. My EP told me before my ablation that if it works, I will come off of the Rhythm drugs but may be on warfarin for life. We just have to wait and see. Have you thought of any of the newer anticoagulants. I have read about them but don't know enough to say if they are safe with other heart conditions.

    I have seen, in some Drs, the attitude that you need to just do as I say and you don't need to know why. Sad but true.

    Keep us posted on what's happening.

    Tim

  • Thanks again Tim.

    I had the electrode version. It was not a problem in itself at all and I have felt so much better since. The big hassle was needing weekly blood tests for a month beforehand as the INR has to be right. I had to fight very hard to get the procedure on time as my INR dropped marginally and briefly the week before and they threatened to put my through the whole cycle again.

    Currently I am awaiting fairly minor surgery on my tear duct and, guess what, I have to have the Warfarin stopped for a few days and painful heparin injections instead. Then more blood tests to get my INR back to where it was. My INR is currently stable and I only need the test every two months. So this is very much a retrograde step. I can see that as I get older, it will be harder to persuade them to take me off Warfarin. Any even minor surgery that's needed will require mucking about with my dosage and more tests. Warfarin interacts with so many other drugs, including the antibiotics that I needed recently. Yet more INR tests.

    That's what I want to discuss with my cardiologist, whether the new drugs are suitable or whether I could even go back to aspirin, which I was on for 7 years. But they will probably need to define whether or not my AF was valve-related.

    I am fed up with being treated like a patient first and a person second.

  • catbird,

    I understand the hassle. I just went through another colonoscopy and had to stop my warfarin 5 days prior. Luckily I have the home test kit for INR so I can test as often as needed. Yes it is a real pain. I hope you can go onto one of the newer drugs and bypass all of the testing.

    As to the aspirin, I have a blog that I posted here about 3 or 4 weeks ago named Stroke Risk, Aspirin or Anticoagulant. Here is a link. I tried to explain the different types of strokes and why different types of prevention is required.

    afassociation.healthunlocke...

    Hope it helps to explain why they use an anticoagulant for AF. Both Valvular and Non-Valvular would be the same risk.

    Honestly, being diagnosed with AF you were unprotected for 7 years on aspirin.

    Tim

  • Hiya Catbird

    As of a week ago Warfarin was stopped ( it caused major flare up of IBS ) and am now on Rivaroxaban... and it seems to be doing the job really well. No INR tests are necessary but have to have kidney function test once a month for 2 months then providing all is well every 3 months.

    The fact that it has no antidote ( atm) was a risk I chose to take as its life in your body is less than 24 hours. All scenarios were rushing through my brain but as the consultant said you cannot prevent the risk factors ..... & not even Warfarin as a tried and well tested drug can be relied on for every eventuality.

    good luck with your talk with cardio man. :)

    Nik

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