I’m scheduled for a knee replacement on 9/5. I don’t want to do it but really need. I’m not on any antiarrhythmic except flecainide as PIP. Luckily, haven’t had any a fib in 16 mo. My fear is the drama of the surgery may stir it up. I’m trying to decide whether it makes sense to ask cardiologist if I should go back on it daily for a few months until my surgery is well behind me? I’m trying to remain calm but am not having daily palpitations, which is new.They aren’t running together, very isolated but fearing it might b a pre warning. Thoughts?
Addendum 8/22: Just heard back from my heart doc, he said it was fine to go back on daily flecainide for a couple months if I want. Bet I’m the first patient he has had asking to go back on antiarrhythmic!!! Plus he is the one I had to argue with to do PIP as he isn’t a fan of PIP. I’m sure he is eye rolling me😉
Definitely talk to your cardiologist. I had the same situation with a bladder restructure- was on pip Flecanide. Pain meds and surgery trama put me in AFIB at night- night nurse wouldn’t give me pip till am and I was a mess- did convert to nsr.
Then whole team of plumbing cardiology came in and wanted to put on a pacemaker and I said no way
I have to heal - I can’t think of going to heart unit. Went home returned to EP and he said no you don’t need a pacemaker
I did not have anymore AFIB event while healing from surgery
But alas did down the road and eventually had first ablation one year later due to frequent AFIB events
Try to be calm with which ever method works for you- best wishes keep us informed
My gut feeling is take flecainide daily for a few mo. If my cardiologist had his choice I’d b on it daily all the time. He isn’t a PIP fan. I got along fine with flec before re no side effects
Hiya Hoski,
I had a partial knee replacement on 6 Nov 2015. This was roughly 7 months after my last AF event. I'm on Coumadin, Bisoprolol for the AF stuff; am on Ramipril and Felodopine for blood pressure and Simvastatin for Cholesterol.
I told the orthopedic surgeon and he didn't see an issue and didn't require me to be cleared by cardiologist.
I DID NOT lurch into AF at any point during or after the surgery. Don't forget to tell the anethestist too. From memory now my surgery was about 3 hours.
To be honest, the level of pain and the lack of mobility I was at prior to surgery for the knee I was more likely to be going into AF from the pre op mess I was in than from surgery - or from the post op exercises.
Now post op knee exercises ..... that's another thing ................... ! What have you been told about them ?
One more thing, being on Coumadin was even more of a challenge than the prospect of an AF hit. I had to come off it a week before surgery, then immediately after surgery the nursing team gave to me two injections of a bridging anticoagulant, Fragmin, to give me a protection boost. No problems Hoski.
John
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Thanks for that, very encouraging. My cardiologist has given the nod of approval. Next week I see the ortho doc’s medical physician, have to pass his inspection, which I’m sure I will. Just need to quiet my mind.💜
Hoski, I don't know if the surgery will upset your heart. But as we all know, sometimes in the times of greatest physical and mental stress our hearts behave, and then go off (like mine did in the middle of the night) with no apparent cause. What I do know is that several friends of mine have had a knee replacement and if (and it is a big if, but you will know this with your background) you do all the physiotherapy and exercises afterwards it will make a huge difference to your QoL. Taking flecainide sounds sensible.
Please let us know how you get on. Thinking of you.
I can only say what happened to me. Recently I had emergency spinal surgery and was supposed to have a GA but my heart rate and BP were so high that the anaesthetist advised against it. So I had sedation. The surgery was long and painful and I was very anxious but I didnt go back into AF. Weird but true. Try not to worry. Your heart will do what it will do.
I stopped my rivaroxiban 72 hours before my tkr, which was done nearly 3 weeks ago. I had a slight problem with bleeding and therefore had to stay as a guest of our wonderful NHS for 5 nights to ensure all was well. I was given an injection each evening to prevent blood clots and was told that these would also protect my heart. The rivaroxiban was restarted the day before I was discharged, no more injections needed because that would now also protect me from blood clots in my leg.
As far as my af is concerned my usual pattern of having episodes is generally 10- 20 days. I did have an episode the evening after my surgery which after causing some rumpus in the ward was dealt with as usual with my PiP (flecainide). This was just a short 6 days days after my last episode. Whether it was caused by the stress of surgery I can't be sure as I have had other odd episodes closer together in the past. My next af episode was yesterday, 17 days later and was over within 1 1/2 hours by again taking my PiP. So it looks like I'm falling back into my usual pattern.
I haven't felt any other strange beats or short episodes apart from the ones I've stated above so it would seem that my af hasn't really been affected at all by the surgery.
I do take bisoprolol daily which I continued to take as usual.
When I spoke to my surgeon at the pre op he said he was quite happy to operate as long as my heart was in a normal rhythm at the start of the op. The anaesthetist was not concerned either and would deal with anything that came up.
It's easy to say just relax and take each day as it comes but if you are worried it wouldn't hurt to speak to your cardiologist and ask their opinion.
Good luck with your surgery and make sure you do your exercises afterwards. Good recovery is in our own hands.
On another note I have recieved an appointment for an ablation in September. After speaking to the arrhythmia team I'm deferring for a few months. They agreed that it would be too soon after the knee surgery and I need to recover from that first, especially as it was my right knee which was replaced and they would be going through the groin on that leg.
Do you not think that perhaps the thought of having a knee op is your major concern.
I was very much like you in the run up to a hip replacement three years ago. Try and let it all "breeze" over you, you'll be fine ! Best wishes to you.
Yes it would be nice to fast forward to October as I would be nearly 2 months post my tkr. Mine is next week Hoski - maybe we should compare notes later.
I went into afib after many months free after major bowel sugery last year. I think it was due to a combo of dehydration and hunger! When they took out my catheter I could not stop peeing and it was difficult to replace the fluid as the keyhole surgery leaves you very bloated. They had taken me off the drip at the same time so double whammy. I also overdid my Ventolin spray to help get rid of the post op mucous as coughing it up was painful! Luckily I went back into NSR after my breakfast the next morning ( sneakily took some magnesium with it). With knee surgery you won't have any bloating problems but remember to stay well hydrated.
Hope it all goes well. My right knee gives me pain but someone I know had both knees replaced and was told she could not kneel on the new knees. As I could not garden without kneeling I have resigned myself to putting up with the pain (which mainly comes after kneeling down to weed anyway!).
I asked the same question of my EP when I was to have my gall bladder removed as I take flecainide pip and concerned the stress of pending and actual surgery might trigger arrhythmia. His answer to me was a resounding no stay as you are. I did and all was well but I understand your very real concerns. See what your EP recommends you may get a different answer to the one I got. Good luck.
I am to stop my anticoagulant next week ready for a nasty invasive procedure on Wednesday and understand your concerns re your surgery, the stress of it and arrhythmia. One of the real side effects of my procedure is listed as cardiac arrhythmia so not looking forward to it. Best wishes.
This discussion is very interesting as I have just seen a consultant physiotherapist about my hip pain and he said that when I was ready for a hip replacement the anaesthetist would be the one to give the go ahead and he wouldn't start unless there was an ITU bed available in case things went pearshaped. Either he is over reacting or my heart is more wonky than I was aware of 😰
Had 2 knees done both full replacements. Do you have an Electrophysiologist? If so he should have a consult with you and the team who is doing your anesthesia that seemed to be my EPS greatest concern that my vitals were watched every second I was under. He also suggested I double up on my magnesium for three weeks before surgery. All went well for me and I hope the same applies to you. A great team makes a big difference and a wonderful hospital for replacements is imperative
No, my EP is from another area, he dismissed me after a couple years when he finally asked me about ablation and I said no. Guess I wasn’t that interesting, but my a fib is an infrequent visitor, so I wasn’t excited about an ablation then. There is a good group of cardiologists at the hospital I’m going to. The ortho guy is the best in our area, all he does is knees. I had a lot of his patients when I was working as a nurse and always thought he was the best. Doubling up on Mag is a good idea. Thanks!
All I can say is that 24 hours ago I had a right knee Arthroscopy having gone into A Fib in the early hours of Monday morning for the first time since my first episode and cardioversion ten months ago. Flecainide fixed it within 90 minutes and neither my cardiologist, the knee guy or the anaesthetist were even slightly concerned. Indeed the anaesthetist said as I came round “sinus rhythm all the way”.
I absolutely love my new knees - great to have a pair that actually work & don’t hurt! Having said that, I worked myself up into a right old state before both ops, especially the first one and really, as long as you can get through those first few days by following physio instructions & keeping your pain relief topped up, it’s not so bad. Funnily enough I found that first standing on the new knee did not hurt that much, it’s more any twisting or sudden movement you need to avoid.
My AF was not diagnosed until 6 weeks after my 2nd knee, however, looking back, I’m sure I had episodes in between the 2 ops, but put my palpitations/near faints down to stress/ dehydration etc. I had no problems at the time of either surgery.
All the best - there was a great tune back in the 60’s called ‘bend it’ that needs to be your mantra for recovery🦵
Pat x
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I will keep Bend It in my mind, lol. Thanks for your encouraging thoughts! My sister-in-law has 2 knee implants and she does great also. I’m looking forward to walking without a frown😉
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