Many people experience irregular heart rhythms during surgery. But physicians often ignore this thinking of it as a common consequence of getting surgery that will eventually subside. However, will they actually subside?

Reuters reports on a new study that shows that irregular heart rhythms during surgery should not be ignored. In fact, research shows that this issue can cause strokes during surgery. 

The large study was conducted in the U.S. and it found that people who developed irregular heart rhythms during hospital stays for surgery were much more likely to have a stroke shortly thereafter or later on in life. Surgeons usually thought that the heart flutters and fibrillation may result from short-term stress associated with having surgery. But that is not the only thing it could mean. These flutters could also be a sign of undiagnosed vulnerability to stroke and should be immediately examined.

The study’s lead author, Dr. Kamel from Cornell Medical School said, “We want patients and clinicians to be aware that having (atrial fibrillation) after surgery does have long term implications and has to be followed up on after surgery is over. Rather than viewing the occurrence of (atrial fibrillation) after surgery as a temporary condition, I think it needs to be clearly documented and communicated with the patient.”

The researchers found that the risk of strokes among people who developed irregular heart rhythms while hospitalized for surgeries unrelated to their hearts was actually double the risk of people who did not produce the condition. Atrial fibrillation is the most ordinary form of irregular heartbeat. The Centers for Disease Control and Prevention say that this condition affects an around 2.7 million people in the United States.

In the midst of people with chronic atrial fibrillation, which causes irregular blood flow, the condition can lead to clots that heighten the danger of ischemic stroke and patients often take blood thinners to decrease clotting. Ischemic strokes are caused by an interruption in the flow of blood to the brain, usually by clot. More needs to be discovered about the long-term stroke risk of surgery patients who produce the atrial fibrillation as a short-term response to the additional stress on the body. Kamel’s study was recently published in the journal of the American Medical Association (or JAMA).

How was the study conducted?

The researchers looked at data from almost two million people who had surgeries at California hospitals between 2007 and 2011. Of those people, around 24,711 were diagnosed with atrial fibrillation during their hospital stays and almost 14,000 had ischemic strokes in the recent years after they were discharged from the hospital.

What were the statistical results?

“Among patients whose surgeries were not related to the heart, the researchers found that about 1.5 percent of the patients newly diagnosed with atrial fibrillation in the hospital had strokes in the year following their surgeries. That compared to about 0.4 percent of those who didn’t develop fibrillation while hospitalized. Among patients who were having heart surgeries, about 1 percent of those who developed atrial fibrillation went on to have strokes during the following year, compared to about 0.8 percent of those who didn’t develop the irregular heart rhythm,” according to Reuters.

The researchers also adjusted for factors that may affect the patients’ stroke risk. These factors include: age, sex and heart disease. The experts found that those who developed atrial fibrillation during their hospital stays for a non-heart-related surgery had a two-fold heightened danger of having strokes during the next year. Amidst heart surgery patients, producing atrial fibrillation during the hospital stay was tied to about a 30 percent heightened danger of having a stroke.

Researchers have not been able to find out why the increase in risk would be different between non-heart surgery and heart surgery patients. “For example, heart surgery patients may enter with an increased stroke risk and may be watched more carefully for signs of stroke,” according to Reuters.

Why do patients need to know about these risks?

It is important for patients to be educated about the condition so that they can act as their own best advocates. Their physicians also need to be told about the development so that they can make it a point to follow up and put together treatment plans to lower the risk of getting a stroke.

The New York Times also reported on the study.

They said, “A large new study suggests that doctors should take these abnormal heart rhythms, known as atrial fibrillation, or A-fib, more seriously. It found that patients who experienced one or more episodes after surgery had a striking increase in their risk of having a future stroke. The findings are likely to encourage doctors to potentially monitor and in some cases treat the patients who experience them.”

Atrial fibrillation is considered an extremely dangerous disease, especially when left untreated. Around one out of 5 people who have a stroke have it after a-fib after/during surgeries.

Dr. Easton from University of California Medical School in San Francisco was not involved in the study. However he did comment on it as an expert in the field, “This is telling us that once you see atrial fibrillation in the hospital, that’s a marker of potential trouble to come. You may have identified a patient who is going to develop atrial fibrillation in the future, and here’s your chance to intervene and treat it and prevent. I strokes. I would be monitoring that patient like crazy for weeks if I was in that position.”

Gerry Oginski
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