Doctors & patients are saying about 'A-Fib.com'...
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Baltimore, MD
A-Fib Patients: Know Your Risk During Non-Cardiac Surgeries
For patients with Atrial Fibrillation, any surgery is riskier than for patients without A-Fib. That’s the finding of a 2022 study.
In a study from the Cleveland Clinic, patients with A-Fib undergoing non-cardiac surgery were associated with higher risks of mortality, heart failure, and stroke.
Study Parameters: Non-cardiac surgery was classified as vascular, thoracic, general, genitourinary, gynecological, orthopedics and neurosurgery, breast, head and neck, and transplant. (Basically any major surgery not involving the heart.)
Participants included 8,635,758 Medicare patients admitted from 2015 to 2019 for various surgeries not involving the heart (non-cardiac surgery). Out of this number of patients, 16.4% of patients had A-Fib at the time of their surgery.
Focus of the Study: Did post-surgery adverse events differ for A-Fib patients compared to the other participants?
Findings: The study found that pre-existing A-Fib is independently associated with postoperative adverse outcomes after surgery. These include increased risk of stroke, heart failure and other heart-related complications.
Editor’s Comments
Established Protocols: There are well established and known protocols to prevent, diminish or neutralize A-Fib when undergoing noncardiac surgery. The researchers, Waterford and Ad, state that preoperative oral amiodarone is the single most powerful intervention to dramatically reduce rates of POAF.
They recommend 400 mg oral amiodarone per day for 3 days prior to surgery, followed by 200 mg per day for 10 days through and following the operation regardless of whether or not POAF developed. It’s recommended that a patient be on a beta-blocker or a statin whenever possible.
Ideally, Become A-Fib Free Before the Surgery: If you have A-Fib and have to undergo non-cardiac surgery, try to become A-Fib free before the surgery. (This is even more important if undergoing cardiac surgery such as bypass).
Medication Adjustment: Even if you can’t have a catheter ablation, your EP can often adjust your meds so that you are A-Fib free at the time of the noncardiac surgery.
Proper Pre-Op Treatment: If it isn’t possible to be A-Fib free before the your surgery, make sure your surgeon knows about and uses protocols to prevent and diminish the effects of A-Fib on non-cardiac surgery. See Having Surgery? Post-Operative A-Fib & Protocols to Prevent it.
Be Insistent! Be Assertive! Be aware that many surgeons (and their staff) don’t know about or use these protocols.
If you’re told by the surgeon’s office staff to “Don’t worry about that.” or “The surgeon is very experienced,” don’t settle for platitudes.
You may have to be very assertive with your surgeon to make sure they understand your concerns and treat you properly before the surgery.
It’s Okay to Fire Your Surgeon: If your surgeon won’t work with you, there are many surgeons who will. It’s okay to fire your surgeon, and find another one who will address these concerns.
