Post surgery

[Hammerboy]

I’m just about 5 weeks post Aortic valve replacement and slowly getting more active . My paroxysmal AF increased substantially after surgery which was expected and Amiodarone was prescribed in hospital . I’ve gone from 3 times a day to once a day and in about a week will come off it for the two weeks till I meet the surgeon in clinic I’m also on 1.25 mg of Bisoprolol daily . The difference I’ve noticed from before and after surgery is that before when I had an episode I could feel it starting and also when it reverted which was usually under a couple of hours and quite infrequent .

Since surgery I’ve been in AF quite a bit but don’t feel anything unless I check my pulse . On this site I’ve read so many posts about taking Flecanide and other drugs as a PIP and wondered why Amiodarone was chosen as it’s not a nice drug . My EP has said they will consider another ablation once I’ve recovered from surgery (my third) which feels the right way to go and I’d love to go back to the way I was before the operation. Am I expecting too much ? I do know , as with an ablation, the heart has to heal after being handled and that takes time so I’m not expecting miracles overnight . In a perfect world I’d like to be off drugs other than anticoagulants like I was before surgery but I feel a bit helpless as once I come off Amiodarone I have no control over how my heart is behaving .

[mjames1]

Amiodarone is a common choice post invasive surgery because of its higher potency. Did they do any sort of maze procedure at the same time as the valve replacement?

Jim

[Hammerboy in reply to mjames1]

I asked before the surgery but they wouldn’t do it . They were more interested than getting me in and out so they could do the next patient in the afternoon. I got the impression it wasn’t something they liked to do and they said , and I quote, You come in with AF , you go out with AF .

[wilsond]

Can't comment on their choice of drug but am pleased you are on the road to recovery after OHS. Perhaps once you are off the amiadarone ,you could ask your AF team if you could take flecanide as a pip?All the best x

[Hammerboy in reply to wilsond]

Thank you , it was something my arrhythmia team mentioned last year when I started having short episodes of AF . I’ve just got to bide my time and get fit now

[wilsond in reply to Hammerboy]

Yes get yourself up and running ( well you know what I mean lol)X

[jeanjeannie50]

Wishing you a speedy recovery from your operation. I guess you will have to totally heal now before an ablation is considered.

Take care.

Jean

[Hammerboy in reply to jeanjeannie50]

Yes It’s not something to rush , just hoping I’m not plagued by AF till then

[mav7 in reply to Hammerboy]

As someone who will likely need aortic valve replacement in the future, may I ask did you have the TAVR or surgical procedure ?

And also may I ask did your aortic symptoms worsen along with the afib requiring the surgery ? Breathlessness, etc ?

If you would like to reply in a DM or choose not to reply, no problem. As you can imagine, I have a definite interest in this for the future. Thanks !

[Hammerboy in reply to mav7]

Hi , no problem . I had open heart replacement of the Aortic valve . I had no symptoms of stenosis which was moderate to severe after my latest echo . I did find I struggled with steep inclines which my cardiologist told me was the start of a decline and surgery was the best option . My Afib was very mild and infrequent up to the surgery

[mav7 in reply to Hammerboy]

Appreciatae the reply.

My symptoms are the same with the breathlessness during exertion but echo states moderate with good ejection fraction.

Read a study by NIH that stated surgery is often recommended vs TAVR for afib patients especially those with persistent/permanent afib. Sounds like your cardiologist made a wise decision and you are in good hands.

Thanks and best to you !

[Hammerboy in reply to mav7]

I was told TAVI is reserved for patients who are deemed unfit for OHS . My ejection fraction was fine and I’d had moderate to severe stenosis for about 3 years . The surgeon gave me 2 years to live without surgery . Best of luck on your journey 👍

[Jazz-62 in reply to Hammerboy]

That’s exactly what my surgeon said I would have 2 years if I didn’t have operation it’s really scary your journey sounds exactly like mine I can’t wait till I’m better

[Ppiman]

Has the valve replacement helped with energy levels or is it too soon to tell?

I think from reading about the various AA drugs available that doctors often feel that amiodarone is uniquely useful and (much against many comments here), relatively safe with monitoring. In low dose and used for as short a term as needed, I think I would be happy to be given it with requisite supervision.

Steve

[Hammerboy in reply to Ppiman]

It’s early to tell as tiredness decides how much you can do at this stage . The AF adds to the burden so it’s going to take time . I think what I’m trying to understand is has the valve surgery that was vital to my future health made my AF burden more prevalent in my life going forward. Understandably I would like the best of both worlds, the benefit of having my life extended by the surgery and a better quality of life and the life with AF as it was before the surgery . I will only find out in time but my preference would be to be able to live without taking strong drugs daily and maybe be having the back up of something to take as and when required if I have an episode that’s debilitating.

[Ppiman in reply to Hammerboy]

Can't life be difficult? I am sure you are on your way to a much healthier future, but it's a bumpier ride than some get, for sure.

Steve

[Hammerboy in reply to Ppiman]

Just my luck lol 😔

[Cliff_G]

Amiodarone is pretty much the standard a/a post open chest surgery as it's the most effective one, often initially intravenous (I certainly didn't know I'd been on it until after reading my discharge letter/op report.)

Sounds like you have a plan. I'd agree with alternatives to amiodarone in the long term, early ablation if poss. I struggled to get off Amiodarone having been put on it (again) 3 months after my surgery (I had a long history of AF) and it ground me down over time. My cardiologist was never sure it was the reason for my long term debilitation, but after coming off it (now 15 months off) and with another ablation, apart from the ectos, I feel almost like old normal, and I am personally convinced the Amio was the cause.

Post-ablation, I'm now on Flec and Diltiazem.

Best of luck to you.

[Hammerboy in reply to Cliff_G]

That’s very informative and helpful. I’m not expecting much in the way of a plan when I meet the surgeon in a couple of weeks but I do have the backup of the arrhythmia team at Norfolk and Norwich who have agreed to keep me on their follow up lists and said I could ring them at any time for advice . I also have my cardiologist who has been monitoring my valve for 6 years pre surgery so expect to have a review in time to come . Between them I’m sure a regime can be set up to cover any changes in my AF and another ablation if required . Good luck going forward yourself 👍

[Cliff_G in reply to Hammerboy]

Thanks

[WildIris]

Your experience seems strange to me. My aortic valve was replaced with minimally invasive surgery and I recovered right away. I don't understand why being "up to" OHS would make it better than non-traumatic surgery, but I guess I don't have to understand. Sympathies, and best of luck with the amiodarone

[Hammerboy in reply to WildIris]

Many thanks , I did ask about Tavi but was told I wasn’t frail enough basically and could manage the OHS . If I need it replaced in the future I will be considered for Tavi

[Jazz-62]

hi I have had the same operation as you I’m only 3weeks but want to be betterquickly how longdoyiuthikitwilltake todfeelnormalagain

[Hammerboy in reply to Jazz-62]

Hi , I’m now nearly 5 months post surgery and although I’m not back to the pre surgery levels of fitness I’m enjoying a mostly normal life again. Time is the key , my expectations were too high so I had to adjust to not being able to do what I wanted . I’ve just finished my cardiac rehabilitation course which was very beneficial and definitely something I’d recommend attending if offered. We are all different so hard to advise your individual journey but try staying positive and do what your body tells you to as far as rest is concerned . Walking daily within your limits is good for progress but don’t rush it , you will soon be looking back and surprised how far you’ve come

[mav7 in reply to Hammerboy]

Congrats on the progress !

May I ask how is your afib ? I know you mentioned a possible ablation after full recovery but has the doctor recommended a rate control or antiarrythmic drug if needed ?

[Hammerboy in reply to mav7]

Hi , since I came off the amiodarone around about the middle of October I’ve only been taking 1.25 mg of Bisoprolol as a rate control medication and apart from the odd short runs of ectopic beats I’ve had no AF episodes . I’m expecting that at some stage it will tap me on the shoulder and remind me it hasn’t gone away but at the moment I’m enjoying the break . I do still avoid any triggers that used to cause an episode