Atrial fib concerns when considering surgery

[kv]

I experience a-fib 4 to 6 times per year.  The events are typically tied in with hormonal swings (48 year old female).  I am taking Zebeta, Triameterene, Covera HS and Coumadin on a regular basis.  Unfortunately, I'm having some gynecological issues and the "obvious" solution is total hysterectomy and it would not be vaginal since there is concern about possible ovarian or uterine cancer.  My doctors have listed me as "high-risk" for surgery due to the a-fib and are concerned about taking me off the Coumadin before surgery (which they seem to feel they need to do and then to give Heparin during the surgery) due to the possibility of an a-fib event and its potential clots.  I'm not keen on the surgery to begin with and, with the doctors being so concerned, I'm almost scared.  Do you have any suggestions on ways to prepare for surgery that would lessen the risk of an a-fib event or which could reduce the possibility of my "stroking out" on the operating table?  FYI, I've had various surgeries prior to the onset of the a-fib and never had an issue with anesthesia or any other surgical aspects.

[CCF-M.D.-CRC]

Dear kv,
Atrial fib in the post-operative setting is an important issue.  It is not uncommon for individuals with a history of atrial fibrillation to have afib post-op occuring in about 25% of general surgical cases and upwards of 60% in cardiac surgery.  Whenever an individual is in afib there is a potential (albeit low) for formation of blood clots and a possible stroke.  The risk for a 48 year old with no structural heart disease is less than 2% off anticoagulants.  

There are several different ways to manage post-op afib.  One way is to stop the coumadin several days pre-op and then follow the rhythm on telemetry pre- and post-op.  As long as the rhythm remains regular there is no problem and coumadin may be started post-op once it is OK with the surgeon.  If afib develops then medical therapy and electric cardioversion may be necessary.

Another way to manage the risk is to use heparin as a "bridge" from coumadin either pre- and/or post-op.  This would decrease the risk of clot forming but would involve hospitalization prior to surgery.  There is also an increased risk of bleeding with this approach.

A final method is to use a low-molecular weight heparin that can be given as an injection at home.  The disadvantage of this method is the cost of the injections.

You can see that there are several different ways to manage this issue.  Your doctor can recommend the approach that is best for you.

[debra21784]

Atrial fib is a nasty little bugger isn't it? When I had surgery done my cardiologist and the team of doctors were in concert.They planned the event together.My advice is to have your cardiologist get in touch with your GYN and the anesthisist as well.Often Lovenox is substituted for the Coumadin about 72 hours preop and 4 days post op with Coumadin post op to get your INR level wher it should be ,then back to Coumadin alone.Get an appointment with the cardiologist to discuss

[Goodgal]

This is very similar to a queery i have. I have to have some tests done shortly--yes i have finally found SOMETHING--after a year of knowing there was something wrong.But I am now freaking out thinking about heart failure whilst on the operating table! For the past year so many mistakes have been made with my diagnosis, through slackness, it is not funny, and althought not all the questions are answered we have found a tumour!( and ONLY because i insisted on seeing a gyno and getting an ultrasound!)Dont get me wrong--im not terrible happy about it! but it means that I was right and there was something wrong after all ---still there are many unanswered questions and i am not convinced that the tumor has caused all the heart palpatations, numbness and other many weird feeling i have had.I hate my gp-and i am NEVER going back to her-my gyno just wants me in the hospital to do these tests as quickly as possible,( but she is very brisk and doesnt realy know much about my history--all she wanted to do was look at the xrays, book me in and get it started-- and I realy dont know what to do.Is there a possibility that if i have blocked arteries something could happen whilst im under?? Help pls guys. Also I have been taking Omega 3 and evening primrose for weeks to help circulation--should his be stopped before an op??

[Goodgal]

sorry to take up the space but i just managed to repost this as a question to the doctor--good luck.

[njh]

my son as atrial fib. could infection in his body cause atrial fib? Friends have suggested homopathic treatment.  Is there any truth to this method or is he being lead a stray?  He has been bother with atrial fib off and on for over 8 years but has been going though about a month and half of sporatic atrial fib. One Dr. has suggested surgery. Any answers to these question would put our minds at ease. Thanks!