Can Dental Procedures Cause Afib Episodes?

[Corazon17]

I have had two minor dental procedures recently: two small fillings, done quickly and competently. I never have emotional anxiety about dental procedures.

But I did have two forms of anesthesia: One was something swabbed on my gums with a gauze pad, and the other was something delivered by needle. The area became well numbed.

On both occasions, I was soon in afib -- "soon," as in within ten minutes. I just knew I was in afib; it wasn't confirmed by a device.

The episodes lasted about six hours each, relatively short for my episodes when I get them.

During both procedures, I was lying flat on my back, with very slight elevation of my feet. I am never in this position naturally.

So I'm wondering: Does anyone here know of an association between afib and either (a) the anesthesia or (b) the horizontal position?

The first med -- the one swabbed one -- was lidocaine.

The second med -- the injected one -- was a mixture of epinephrine and articaine.

I was informed by a person at the dental outfit that epinephrine is literally the same thing as adrenaline.

This person said that the purposes of the epinephrine are (a) to reduce swelling, (b) to prolong duration of the articaine, and (c) to reduce bleeding.

This person said that in the future, I could get articaine without epinephrine.

I am wondering about adrenaline: Isn't that also for affecting the heart? Is this appropriate for afibbers?

I rule out emotional anxiety, because it is not present. I am "a stupendously good patient," in the words of my dentist.

[Cavalierrubie]

Probably the anesthesia. There are different types and some are adrenaline based. Always a good idea to ask for a non-adrenaline anaesthesia. I am not sure about the elevated position , but perhaps someone else can help with that, although l would have thought that was a fairly natural position. With raised feet, your blood pressure could have dropped. Hope it settles for you.

[Corazon17 in reply to Cavalierrubie]

Thank you!

I'm not sure you saw my edited version, in which I disclose the exact chemicals used. By coincidence, I received a follow-up phone call from the dental outfit, and then updated my first post.

To my great surprise, the person calling me knew what the meds were, and knew their purposes.

And you seem to be right: Adrenaline is likely an issue. In fact, it's now arranged that I will not get adrenaline next time I get a filling.

As for the natural position, I meant "typical" or "usual" for me -- not natural for any human being. But the possible effect on blood pressure is clever thinking.

[Cavalierrubie in reply to Corazon17]

Good you have got to the bottom of it and that it won’t happen again. 👍

[Corazon17 in reply to Cavalierrubie]

Well, it looks that way.

The thing is that the dental place is aware that I have afib and am taking blood thinners. Or *should be* aware, because I did tell the actual dentist. But he may have been overly focused on the blood thinner and the fact that no bleeding was anticipated on account of gums not being involved in the work.

I guess it's "my bad," as they say in Amerika, that I didn't learn about anesthesia.

When I was little (9 years old), I did not get anesthesia for dental work. This was 1957. Well, I often suspected that I had a fake dentist. He smoked cigarettes while working, and he had the rattiest office you've ever seen, and he charged $6 for a filling. Perhaps the $6 was on account on my divorced mother being poor, very pretty, and really really smart.

[Paulbounce]

Hi Corazon.

Always ask for a non-adrenaline anesthetic. Sometimes the denists need a gentle reminder! Love the bit about about the dentist smoking. Reminds me of the doctors in Bulgaria who can always be found in the corridor smoking.

Paul

[FraserB]

I believe the primary cause is likely the anesthesia, so I'd request the non-adrenaline option. A secondary factor could be body positioning. Whether I'm in a dentist's chair or a recliner at home, I need to adjust positions slowly. If the dentist reclines the chair too quickly with my feet elevated, I often experience a series of ectopic beats and feel like I might go into AFl. I always request to be lowered slowly and to maintain a more even, straight body angle. I've learned that I'm highly sensitive to body positioning, too fast and it causes rapid shifts in blood flow and pressure, which affect my heart, likely due to vagal influence.

[BobD Volunteer]

We alwaays advise those here who ask to request non adrenaline local anaesthetic as this is often a problem otherwise At least you know now. .

[Peony4575]

Yes I think to the horizontal . I normally sleep with three pillows . I had the only two short episodes of AF I have had( normally 24 hours). One lying on colonoscopy table no drugs or sedation , second on MRI table no drugs or sedation involved . I don’t do well lying completely flat. The episodes stopped when I sat up and changed position

[opal11uk]

I always ask for Adrenalin free anaesthetic and have not had a problem, although for me, stress of going in the first place could set me off, however it hasn't ever so far!

[Pommerania78 in reply to opal11uk]

How long have you used adrenalin free anaesthetic? Thanks.

[opal11uk in reply to Pommerania78]

Ten plus years, maybe longer as cant really remember. Your dentist should add this to the health conditions that were part of your joining the practice.

[Lizziedoodle89]

My previous dentist Only gave me anesthetic that wouldn't be adrenaline based so it wouldn't cause the AF to kick in

[Pommerania78 in reply to Lizziedoodle89]

How did it work out? Thanks.

[Cliff_G]

Yes, my dentist uses an anaesthetic without adrenaline.

[Pommerania78 in reply to Cliff_G]

How does it work out for you? Thanks.

[Cliff_G in reply to Pommerania78]

Fine thanks, but then for a while I was on strong meds (Amiodarone) and pretty much in NSR, or in continuous arrhythmia once I was off Amiodarone. Before mg first ablation 20 years ago I don't know if I had adrenaline in the injections or not. So I can't say I can provide meaningful data other than when there's a potential issue, dentists use no-adrenaline injections

[Garaidh]

Hope you're doing OK now!

I'm 65 and remember that one of my first known triggers as a teenager was the jab at the dentist - quickly learned to ask (and check twice!) to get the anaesthetic without adrenaline.

I'm sure there are better options now, anyway.

Never had an issue with general anaesthetic, thankfully!

Stay well!

[Cozzer]

As everyone says adrenaline is a known trigger, I had the non adrenaline one and had a reaction to it so ended up in persistent flutter anyway, !!! I just don't go to dentist anymore, but I believe that's very rare,

[Chocolat1]

I don't think it's good to be laid flat, I mean that won't cause afib ,but, really not a good position, causes me to be dizzy.

[Qualipop]

The anaesthetic injection they usually give which has adrenaline always send my heart crazy. I always ask for the one without . It doesn't last quite as long and sometimes needs to be topped up.

[Margareta3]

This is a paper about dental management of patients with arrhythmia:

suffolkrootcanal.co.uk/wp-c...

[Corazon17 in reply to Margareta3]

It's "old" (2003), but it gives a superb summary of heart conditions! As for the information connected to dental procedures, I'm sure it is still accurate. Thank you so much! I'm a bit embarrassed at how blase I was over getting those meds, and a bit censorious over the casual approach of the dentist, who was advised of my anticoagulant and the reason for it. Plus, the fillings that I'm getting are expensive and perhaps not truly necessary.

I was advised by my cardio office to have the dentist send a risk-assessment form to the cardio office, and I will see what develops. I understand from the article you sent that even lidocaine (the topical anesthetic) may be something iffy.

[Pommerania78]

What kind of Afib medicine were you taking at the time of the dental procedure? How are you now? Thanks.

[Corazon17 in reply to Pommerania78]

I have been taking 25 Metoprolol and 5 Eliquis twice a day for several months, and I was "under the influence" of them at the time of the procedure.

The afib stopped about 7 hours later.

I took my first Flecainide (50) ever about 3 hours after this episode began. I had been prescribed it a few days before, but was waiting to take it a week before a scheduled EKG.

Maybe the Flecainide helped to end the episode? I dunno, of course.

Despite the drugs I take, I get episodes roughly once every 8 days. They last an average of 10 hours. They have high pulse rates, and they are mildly to quite symptomatic.

[Pommerania78 in reply to Corazon17]

You know, you might talk to your doctor about increasing the Flecainide up to 100mg twice a day, and maybe increase the Metoprolol. I take 100 mg of Flecainide twice a day and 50mg of Metoprolol once a day. Also, in the year since I had to go to the Emergency Room I have lost 30 percent of my body weight and radically changed and improved my diet. And the Afib has ceased. It will probably take a little while, maybe several months, for your body to get used to the Flecainide and for it to be very effective. In the meantime, assuming you haven't already, you can start reforming yourself and your diet. Also, I take D-Ribose once a day. It is a supplement you can get many places. And many people claim that it eliminates all arrythmias. Thanks.

[Corazon17 in reply to Pommerania78]

Yup, medicos and I are working on the dosing now. I'm only on day three of the flecainide. In fact, it has not been approved for permanent use yet, as I need EKGs to confirm that it's OK. As for diet (no alcohol, after 40 years of wine most days) and body weight, I believe I am performing well. Losing 30 percent of my weight would put me at 112 pounds, a bit light for 5 feet 7 inches. I will check out D-Ribose. Thank you!

[EW518]

Epinephrine will most definitely act as a trigger. I always advise the dentist or dental technician prior and most all procedures can be done with an alternative product

[CkdMwc]

the epinephrine and lidocaine (which has epi in it typically can both start an afib episode. I avoid them at all procedures. (Dermatologist too)

[opal11uk]

This was being discussed the other day, I always ask for Adrenalin free anaesthetic and have had no problems