I was due to have a knee replacement on 27/02, got as far as the room and the anaesthetist asking questions, I mentioned I had occasional bouts of Afib and had had 3 random episodes in the month or two before. In conjunction with the Consultant he chose not to go ahead until I've had a 24 hr ECG. Apart from being angry and upset, I'm baffled by this decision, I was having an epidural not a GA. Finally a letter has been sent to the surgery, according to them my pre-op check ECG showed sr with pvcs, on the day my BP was normal but pulse irregular. I had mentioned the Afib to the consultant at my initial appointment so he knew. I'm not medicated.
What bothers me is whether this is standard procedure and will it affect any future surgery, has this happened to anyone else? I can't see the problem, I'm pretty healthy for my age and it set me wondering, why is this even a problem, surely there must be people in far worse physical state than me who have knee replacements and other surgeries? My sister in law's hubby had one on the exact same day as me, he's obese and has a bad back. My SIL has had 2 done, she has Afib too. I'm seeing an ENT consultant tomorrow as I've been diagnosed with a deviated septum for which a surgical repair is likely, do I tell them too?
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This subject has already come up today and as I explained the final decision is for the anaesthetist as it is they who have to look after you during the procedure.
I have experience of this having had a radical prostatectomy in 2011 for cancer, I had to fight for the operation anyway as they don't like t o operate if they can treat by radiotherapy. Eventualy they agreed but only because my third ablation in 2008 had stopped my AF and I had been clear since. When they operated they found the cancer had already spread and they were able to remove a few extra bits I could live without. I have now been cancer free for 14 years and can say with confidence that my ablations saved my life.
Best to include your cardiologist/EP prior to surgery where they can consult with the surgeon. Does seem they would have done prior if familiar with your medical history.
I don't have a cardiologist. The only one I've seen was when I got fed up of waiting for the NHS and saw one privately, he was recommended by a friend. He organised an echocardiograph which showed no structural problems. I didn't go back to him because he made my skin crawl lol. The echo result is on my med record and the anaesthetist has seen and commented on it.
Unless your atrial fibrillation is uncontrolled, the medical team, including the anesthesiologist should be prepared to operate. I would assume it's in your medical records that would've been reviewed ahead of time, but I guess we cannot assume anything these days.
I read it that SPG had an irregular heartbeat but it's not medicated. There are medications which can stop the irregular heart beat. The anaesthetist appeared to be pointing out to the GP that she should be on medication. Every echo I've had has shown my heart to be physically fine, but it doesn't stop AF, which needs treatment. That appears what the anaesthetist was pointing out, not that s/he wouldn't undertake the operation.
”There are medications which can stop the irregular heart beat” Are you referring to the likes of Bisoprolol and Fleicanide? Reading this forum it seems that they work for some but not for all.
Agreed Thomas. Mjames had said she wasn’t in Afib most of the time. I was meaning if SPG was asymptomatic then she wouldn’t always know she was in Afib.
I understand your frustration. I suggest consulting a different cardiologist ("skin crawling" is not good) before your surgery, as I did before my total knee replacement.
After tests and reviewing my medications (I have paroxysmal AFl/AF and I am rate controlled and with an anticoagulant), my cardiologist cleared me for surgery. However, this didn't guarantee everything would go perfectly, just that it was considered safe at the time. AF’s unpredictable nature means no surgery is 100% risk free but then again what surgery is risk free. Get the 24 hour ECG -- AF guidelines are formally followed because AF can increase surgery and post surgery risks, particularly arrhythmias or stroke, though this is rare and hundreds with AF have surgeries every day doctors still need all areas of confirmation.
To give your surgery the best chance for success, I recommend getting approval from one doctor, preferably a cardiologist, to confirm your readiness for surgery. This approval then can be shared with both your TKR surgeon and especially the anesthesiologist. I know it's frustrating to do this but at least you're own peace of mind is also involved. Getting that test and any needed medications from a specialist's approval then over to another seems to be required. But I found it wasn't the TKR surgery itself that was a problem it's being prepared for the long road to recovery afterwards. The most important member on my medical team besides the anesthesiologist was my physical therapist -- they are essential.
My whole situation is quite convoluted. On my medical record for example, it says I have paroxysmal atrial fibrillation and permanent AF. There is a consultant cardiologist’s letter, whose only contact with me was one phone call, saying I didn’t have AF! He based that on the Kardia readings I sent to him, after the phone call, which are all designated as possible AF but which he said didn’t show that. He went from saying on the phone I should have blood thinners, control medication and an ablation to saying in an outcome letter that I had refused anticoagulants (I didn’t because he never offered any only said he recommended them) and I didn’t need an ablation or medication. I don’t have a cardiologist, the NHS phone call was as near as I got. His outcome letters both said he’d seen me in clinic, he hadn’t, and that he would make a follow up appointment, he didn’t. If I had to start back at the beginning and await a referral and appointment to see a cardiologist my knees (both are due to be replaced) are never going to have surgery.
The anaesthetist said I must understand that they are not equipped for any emergency. I was due to have it done in a private hospital paid for by the NHS. It left me wondering what emergency Afib starting up might provoke.
There is definitely inconsistency in your cardiologist’s approach, especially not seeing you in person and contradicting themselves in follow-up letters, that is concerning and could explain some of the confusion about your diagnosis and the anaesthetist refusal. Definitely a communication breakdown by the doctor. It might be helpful to request clarification of your medical records and get that second opinion from a new cardiologist, ideally one who can assess you in person (at least further tests) and provide a clearer treatment plan. If anticoagulants or an ablation are recommended, it’s really important that you're fully informed and everyone is on the same page (including the ENT). I know myself how bad knees can get and I understand that frustration, but the anaesthetist’s caution is likely due to concerns about the risks of AF during anaesthesia. I had a pre-op consult with the anaesthetist before my surgery and he said they are prepared but need a best as possible clear history of your heart in case something does happen and need guidance what meds to give and what meds not to even go near.
" I was due to have it done in a private hospital paid for by the NHS. "
This is likely the cause of your frustrating last minute cancellation. I was scheduled to have my first TKR at a private hospital, arranged by the NHS in December 2023. But they cancelled by letter a few weeks before the due date, citing my medical record - Permanent though asymptomatic AF and 'heart failure' five years previously. The private hospital simply doesn't have the emergency cardio facilities should something go wrong during the knee op.
The TKR was eventually done in an NHS hospital in July 2024. They were very diligent with pre-op tests and all went well. I too opted for just the epidural and stayed awake throughout the op. As a side note, I found hearing all the sawing, drilling and hammering curiously interesting, though it did make me think of the surgeon's in Nelson's navy!
I'm now awaiting a date for knee no. two and can't wait, as I am very pleased with the huge improvement that the first one has delivered. Good luck (but take the painkillers and do the exercises...)
As you have had your gall bladder removed, and apart from AF have Thyroid problems, its likely that your heart rate could well rise above normal. I have AF and asthma. During an operation to remove my appendix, my heart rate rose to over 180bpm. I was kept under anaesthetic for 4 hours. The removal of the appendix was planned to take one hour. I had to keep in hospital for an extra 3 days while my heart rate dropped slowly to 70bpm when I was discharged .
Interesting. My heart rate has never been that high during an episode, my basal heart rate at rest can drop as low as the 40’s. I am weight training 3 times a week and take other exercise, I had hoped this would help to improve my overall fitness so if I needed surgery I stood a better chance of recovery etc. I had the pre op, ECG, BP, blood tests and nothing was reported as abnormal.
My heart rate never got as high as that normally. It shot up during the operation. I was of course "recoagulated" with vitamin K, before they would do the operation.
Again. I went on to have 2 more surgeries but my Heart Rate at rest was controlled down under 100.
But if over they weren't going to operate.
I have a low 47avg bpm h/rate at night while I am asleep. Surely anaesthetic GA would put me to sllep hence the low h/rate at any operation. It is my normal. But I still have AF throughout.
I think the ‘not medicated’ might be the problem. I had a big spinal operation some time back. I had to have a lung function test and ecg beforehand plus cardiology consult and I had previously had a battery of tests including an angiogram and stress test and was on approved medication so the anaesthetist had all the info he could want. Yours had hardly any and certainly not the information as to what medication would be suitable should things go pear shaped as did happen to me but digoxin sorted it. The wrong medication could be fatal. It looks like the ecg is the minimum requirement. Hopefully that and the echo will allow your surgery to go ahead, best wishes.
I’m hoping so, I’ve probably already gone to the back of the queue which is very disappointing. Apart from the Afib (which has never been “professionally” diagnosed I don’t have any other medical problems.
Possibly but I made it clear to the consultant at the first appointment, surely at that point he should have taken it into consideration. Sitting on the bed waiting for a much needed replacement only to be told they aren’t going ahead is hugely upsetting.
Yes I totally agree, waiting until the day of surgery must be very upsetting and should have been discussed at pre op assessment, I hope you get something sorted soon
I had a similar thing happen late last year but it was for a colonoscopy. A week before the procedure the anaesthetist was reviewing my files and called to say he wouldn’t do my procedure. He said they didn’t have an emergency unit at the hospital if anything went wrong with my heart
It was eventually sorted out by my gastroenterologist who spoke to my cardiologist. They did the procedure at a different hospital where there was an emergency unit if it was needed. It put my procedure back by 6 weeks though which was frustrating!
I’ve been told I can’t have a hip replacement done privately because I need to have it done in a hospital with an IT unit, in fact the physios words were ‘with an IT bed available which I thought was a bit much.
I had ankle and leg surgery in December. The surgeon knew that I have a-fib (not daily or extremely regularly but I get tachycardia bouts a lot). Night before my surgery, I couldn’t sleep at all (have serious insomnia for decades) and I had to be at the hospital operation area at 530 am. (I formally sleep after 5 am due to my shift as well).
I had some tachycardia the night before and morning of surger, at home. I didn’t check of it was a-fib related. I mentioned it to the pre-surgery nurse and she still had me go ahead with getting prepped for surgery. They did an ECG and took my BO and pulse. Think it was all normal at that point. I saw anesthesiologist before my surgery (that morning of surgery) and my surgeon and explained that I have history of A-Fib and tachycardia (and brachacardia when resting). Explained that I was nervous because when ai had an endoscopy and colonoscopy in 2019, I quit breathing and developed Aspirational Pneumonia. He assured me that he is used to these things and it’s very rare to have issues.
I was not on any medications besides omeprazole before the surgery. I don’t take anticoagulants or BP medications and my EP is OK with this as my a-fib is not that regular and usually lasts minutes to a few hours. I have successfully used the Vagal Maneuver to stop my A-Fib, almost every time. I learned that from Dr Sunjay Gupta, In the UK, via his Youtube channel. Fortunately it has worked for me, so far.
I never had any issues during surgery and woke up as soon as I arrived back in the post-surgery area. Wish you the very best and hope nothing delayed, I am sure all will be fine!
I’ve watched a lot of Dr. Gupta’s videos, he comes across as a very well informed cardiologist, maybe it would be worth stumping up to see him in York 🤔 I’ve tried every suggestion I’ve seen about how to stop an attack, none of them worked for me. I’ve tried the cold water face splash and the totally cold shower when having an attack, it didn’t stop, maybe though because I do the cold water thing everyday anyway. I can only wait and see how it goes. I suspect the surgeon also works for the NHS, perhaps he could just move me across to his list there once he’s covered everything about which he’s concerned.
The Anaesthetist is in control of your life and well being during surgery and therefore the final decision rests with them however, if it was me, I would be taking this further, see a cardiologist and make sure that your condition is under control, usually by medication in the first instance. I have had operations over the past 20 odd years and always had to go through an anaesthetist prior so it is standard procedure and he/she has the right to refuse if in doubt.
I suspect his refusal was based on it being a private hospital and there not being any sort of emergency help there, they aren't geared for it or so he said. I can understand that but I'm still not understanding what emergency an occurrence of Afib would cause? I've had it and dealt with it on my own for years.
Last time I had afib I was very poorly with a blood pressure of 53/33. I was saved by the crash Team. That could not happen in a private hospital as they only want to do simple stuff to make money.
Private hospitals don't normally have a 'crash team' and this is what can happen to anyone undergoing surgery regardless, with A/F it is an unpredictable factor and shows a disposition to heart problems affecting blood pressure, cardiac arrest, blood clots etc.etc., the Anaesthetist has to assess whether the patient is able to go through a viable surgery and come out the other side, in other words they do not want the responsibility of someone dying on the operating table and their judgement is normally final and for the reasons stated. Sort out your condition with a Cardiologist, once it has been evaluated and medicated/controlled then the surgery shouldn't be a problem. I have been through breast cancer surgery, total hip replacement all whilst having A/F and once assessed by the Anaesthetist all have gone well.
In 2006 I was in a private hospital having a left shoulder done.
I was pushed int theatre late about 4pm.
Then there was trouble. the lass prior with her tonsillectomy bleed was in trouble. They asked me if they could 'see to the lass'. I said 'yes' so all was well but I was delayed another hour.
The main hospital was 15mins away.
Having nursed some I was keen to have the lass attended to. A PRIVATE HOSPITAL.
Under our ACC in NZ the Johnson & Johnson Mesh Kit shoud have been carried out i a private hospital but Mrs Eva Fong - the top Uro-Gynae Specialist for removal or repair wanted me at the Public Hospital. She said "You will have more support".
She said she was afraid of the bleeding risk. Luckily it all went wel and I was discharged at 24 hours.
I can really understand your disappointment at having your op cancelled but sounds to me your anaesthetist was doing a good job. It’s up to him to keep you alive and without complications . I may be reading you wrong but it sounds like you turned up and told him about a heart condition that has never been properly investigated or diagnosed , let alone with a management strategy , your ecg showed irregularity and there were no emergency facilities. Drugs and surgery can trigger AF .
If he had proceeded and something had gone wrong not only would you have been in trouble but his head would have been on the block for being negligent . Properly investigated and managed AF isn’t usually a bar to surgery but unknown quantities should be investigated first . Hope you get re scheduled soon
I take your point. I mentioned the Afib at my first appointment, I’d have thought he would have taken it further if he’d been as concerned then as he was on the day.
I suppose they are just following procedure, they will be concerned because Afib can cause strokes and also knee replacements come with risks anyway of forming blood clots, my knee replacement was cancelled last year because my haemoglobin was too high because my testosterone had been increased the week before, I’ve now had the knee replacement done 8 weeks ago and the pain is horrendous the first 4 weeks, good luck 🙂
I really feel for you. The disappointment must be huge! I was recently turned down for an op due to a low CPEX score. The op would have been a major one. Next I was sent to an oncologist who agreed to set up targeted therapy. Two weeks later they had decided to watch and wait and phone me in 6 months after I've had another MRI. I felt as though the roller coaster had stopped in mid ride but I was still flying through the air!Also, I was expecting a ct scan of my lung nodule. Now I'm not having it! Two radiographers and the MDT have reportedly decided that I need no further follow up.
TBH I think we are being fobbed off for all sorts of dubious reasons!
However, on the other hand, I have a friend who had a hip op recently at a private hospital (NHS funded) and it went terribly wrong. They have no facilities for emergency and so there was an urgent move to another hospital and then once stabilised she was transferred to a specialist hospital. Thankfully she has recovered now.
If there was genuine doubt about your fitness to operate on the day, you may well be better off waiting for an NHS hospital to do the job.
However, it's not an easy thing to get your head around, is it, when your notes are so confusing and contradictory and to turn you down for surgery on the day must have been awful.
I've had both a knee and hip replacement since I've been diagnosed with af. I was in sinus rhythm throughout surgery both times. My most recent surgery was 11 days ago.
thats unfortunate for you i had a knee reconstruction requiring a general so i advised both the Orthopedic Surgeon and Anaesthetist of my occasional AF, they did an ECG on the spot and yes saw some ectopics but said they appreciated knowing in case i went into AF. I was not on medication at the time. No issues during surgery
your records should be with your doctor, especially if you’re having any kind of surgery. They only have 15 days to deliver here in the states requested by a doctor. I was told whether or not they will do a surgery depends on risk versus necessity of the surgery yes there are many reasons they will cancel a surgery just before due to have it. my dad had a heart issue and I remember his cancer surgery being postponed because of problems with the even on the day of the surgery. You shouldn’t get angry about them caring about your life. They are not going to take a chance with it. We are not doctors. You are getting just basic information that doesn’t mean there isn’t a lot more for your doctor to be dealing with. As painful as knee is a doctor is not going to put your life in jeopardy for it. My uncle had knee surgery. They gave him too much of a medication. FYI, he had heart issues very serious ones, including a quadruple bypass that he had had done. Long story short, my uncle had a major stroke from the medication. He died less than two years later. They had other options for the knee including draining it but someone made the wrong call. You decide what would you rather keep working and feeling better your knee or your heart?
My late sister was due to have an operation for gall bladder removal. She did not know she had AF at the time (it transpired that all 5 of we sisters and my dad are/were affected). She was admitted, but they could not get her HR down, so they sent her home with a box of Aspirin ! Unfortunately she had a mild stroke a short while later. She was never recalled for her op. Sadly she became jaundiced and was readmitted. It turned out that one of the stones had migrated from her gall bladder into the bile duct and formed inoperable cancer, She died a few months later, an otherwise fit and active 78 year old, prior to the gall bladder problem, .
There is no right or wrong, it’s all a risk and if it was assessed to stop surgery then that would be in your best interest as assessed by the most competent person available. Now the decision may not have been right, we will never know but best safe than sorry. Personally I would be glad the professionals ignored cost and only thought of the best for you based on the best information they had. That said I am sure it was really disappointing and having to go through it all again is hard.
I’m beginning to see that, it was just very hard on the day and the follow up has been painfully slow. I have rung the hospital 3 times trying to find out who needs to organise the ECG. Six weeks after the cancellation the anaesthetist has finally sent the outcome letter and hopefully the ECG can be organised promptly so I can at least have some idea of what might happen next.
I have had many operations through the years with little or no reaction suffering from AF.Had my knee replacement .mbut because of AF I had an epidural and twilight sedation came through it just fine. Only time it caused a bit of a hiccup was when I had my thyroid removed as its something about the para thyroid being touched that sets AF off. But still here, still with intermittent AF
That is kind of my point, I’ve had Afib for at least 10 years, I’ve never once gone to A&E, I just ride it out. It’s unpleasant but not painful and I tend to just carry on as normal. If some folk are permanently in Afib for years then presumably it’s not dangerous or particularly life threatening.
I recently went along for my pre op.anaesthetic review for a knee replacement op.nearly 3 years after damaging it. Meanwhile my Long Covid high BP and HR had got much worse and I’d also got a diagnosis of postural hypotension giving syncope, so I was effectively shown the door. Over previous years I had ecgs, echocardiogram, 24 hour Holter monitor, respiratory tests, X-rays and structures ok, so never got to any medics. Just left with high BP, that drove high HR as it plummeted, and random 135+ just doing minor domestic task and 4-5 antihypertensives. But no one seemed prepared to do anything else re.odd heart ( not Afib), nor knee surgeon/ anaesthesia team ucompromising or even talking directly to me. The surgeon’s secretary was only one willing to engage by giving me a 6 months leeway to remain at the top of waiting list , and get odd BP/HR cured, or else put back at bottom of waiting list. I can’t see a cure going on as had Long Covid cardiovascular oddities 5 years now, and infact spent last two years self help going swimming 50 mins 5x a week, and I’m now rather off the idea that 8 weeks whatever post op and not going swimming might make these symptoms worse. I can’t walk anyway as a few mins.standing up has me in presyncope, so do I need a new knee?
Was your operation to be in an NHS hospital? In my area people often get treated on the NHS in the local private hospital, but I had to wait to be treated in the NHS hospital, as cardiologist advice for AF would be available if needed. Fortunately I was in sinus rhythm at the time of both my knee replacements - maybe your surgeon wasn't happy to operate at a time when an irregular heartbeat suggested you may have gone into AF, and you weren't on any medication? Are you under a cardiologist? You might be able to get the surgeon to discuss with them if so. Hope you can find a way to have your op.
It was going to be done in private hospital via the NHS. I don’t have a cardiologist but at last the referral for the ECG has been done so I should be able to have that shortly. I’m resigned to probably being referred back to the NHS for the surgery, that will no doubt mean more waiting.
Private hospitals are nervous about doing ops on anyone with existing conditions that may cause a problem as they don’t have emergency facilities.
I had a very complex op last year in a private hospital and the night before it was due to happen the anaesthetist had a hissy fit about my AF and he refused to do it however my surgeon was confident all would be well so she got a different anaesthetist and he was absolutely fine to go ahead so seems to be down to differing opinions.
I was all scheduled to have cataract surgery and like you let them know I had proximal AF, so when it got to the call from the nurse she wouldn't approve me without a release from a cardiologist. which then messed up the whole schedule and once I got that release I told them that I didn't get a release and found another surgeon. So yes and cataract surgery is nothing. They don't put you out, however, that was not the case with the first surgeon they want to put out all their patients. Another reason I choose a different surgeon, I don't do well with anesthesia.
AFers take an anti-co.agulant , I take PRADAXA 110 x twice day to prevent any clots forming in heart to dissapte so no stroke. It is lowered.
Anaesthetists refuse to operate if your h/rate at rest is over 100.
They want you controlled at rest.
Unless operation is necessary. I had a thyroidectomy in Feb 2020 after diagnosis on 4th day of diagnosis of embollic stroke, rapid & persistent AF. Then shadow on thyroid - papillary cancer.
Usually AFers are put under a heart specialist who order ECG, ECHO and Heart Monitor 24hr or more.
My hip surgery was postponed due to a newly diagnosed case of AFib during the pre-surgery ECG. I eventually had the procedure with AFib, but they wanted to do more testing and properly diagnose my heart prior to surgery. I was frustrated and angry like you, because I was in end-stage arthritis and had to wait a few more months to get back on the hip surgery schedule. Looking back now, I guess I understand them wanting to take it safe and postponing it. But at the time, I was pretty cross.
I needed knee replacement surgery and my surgeon informed me that the procedure would not be approved unless I was on a blood thinner. They are concerned that you could have a clot sitting in your heart.
I had very few episodes which I guess were Afib over the years but could always get myself back into SR. At the end of 2023 I had my right hip replaced. After that I noticed my irregular beats becoming more frequent and read that major joint surgery can cause Afib to worsen or even initiate new onset Afib. I went into Afib in April 2024 and ended up in the ER. I had a cardiac ablation 4 months after my hip replacement. It has taken me a year to recover from having both so close together and I’m hopeful after lots of irregular beats that my heart has finally settled. I think your anesthesiologist made the right call and I would follow up with an EP doctor.
yes, normal procedure - if you are in Afib or experiencing irregular heart beats - SMART physicians will not give anesthesia of any type. I was scheduled for a simple colonoscopy that was cancelled at the last minute due to irregular HB on a pre- procedure EKG. Your doctor is looking out for your safety and health. Why would you be angry?
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Electro cardioversion cancelled at the last minute, I am so upset
Anyone that has been diagnosed in their 20s/30s with afib? 
BMI to high for Ablation 
Anyone with AFib & HYPOthyroidism?
