Atrial fibrillation, often referred to as AFib, is a heart condition characterized by an irregular and often rapid heart rate. This irregular rhythm originates in the heart’s upper chambers, causing them to quiver rather than contract effectively. When the atria do not pump blood efficiently, it can lead to poor blood flow to the rest of the body.
A stent placement procedure, known scientifically as percutaneous coronary intervention (PCI), is a common medical intervention performed to open narrowed or blocked arteries, most frequently those supplying the heart. This procedure involves inserting a small, expandable mesh tube called a stent into the artery to help maintain blood flow. The goal is to restore adequate blood supply to the heart muscle, thereby alleviating symptoms like chest pain and reducing the risk of heart attack.
How Common is Atrial Fibrillation After Stent Placement?
New-onset atrial fibrillation after stent placement, particularly following percutaneous coronary intervention (PCI), does occur, though its incidence can vary. Studies indicate that new-onset AFib developed in about 6.1% of patients undergoing primary PCI for ST-elevation myocardial infarction in one study. Another study reported new-onset AFib in 7.5% of patients after PCI with stenting of the right coronary artery.
The incidence of AFib can be influenced by several factors beyond the procedure itself. Patients with pre-existing conditions such as hypertension, diabetes mellitus, or older age are more likely to develop new-onset AFib after PCI. For instance, patients with type 2 diabetes mellitus, hypertension, or those older than 60 years showed higher rates of AFib after right coronary artery stenting.
The type of procedure also plays a role. New-onset AFib is less common after PCI compared to coronary artery bypass graft (CABG) surgery. One prospective study found a cumulative incidence of AFib of 2% after PCI compared to 56% after CABG within 30 days. This suggests that while AFib can occur, it is a less frequent complication following stent placement than after more invasive open-heart surgeries.
Reasons for Atrial Fibrillation Development
The development of atrial fibrillation after a stent procedure can stem from several underlying factors. The procedure itself can induce an inflammatory response within the body, which may contribute to electrical instability in the heart’s upper chambers. Stress on the heart muscle, particularly during an acute event like a heart attack that often necessitates stent placement, can also disrupt normal electrical pathways.
Fluid and electrolyte imbalances, which can occur during or after any medical procedure, are another contributing factor. The body’s stress response can activate the sympathetic nervous system, leading to an increase in heart rate and excitability, potentially triggering irregular rhythms. Catheter manipulation during PCI, especially near or within the right atrium, can also directly induce AFib.
Pre-existing conditions, even if they haven’t caused AFib symptoms before, can be exacerbated by the stress of the procedure. For example, patients with a lower ventricular ejection fraction or those with a history of myocardial infarction may be more susceptible to developing AFib post-procedure. The physiological stress and changes in the cardiac environment during and after PCI can contribute to the onset of this arrhythmia.
Identifying Atrial Fibrillation
Recognizing atrial fibrillation involves being aware of specific sensations. Many individuals report palpitations, feeling like a racing, pounding, fluttering, thumping, or skipped beat in the chest.
Shortness of breath is another common symptom, occurring even during rest or light activity, as the heart may not be pumping blood efficiently. Fatigue and general weakness are frequently experienced, sometimes described as extreme tiredness or a lack of energy, because the body is not receiving enough oxygenated blood.
Other signs include lightheadedness or dizziness, and in some instances, fainting. Chest discomfort or pressure may also occur. Symptoms can vary widely, and some individuals might not experience any noticeable symptoms at all, making regular medical follow-ups important after a stent procedure.
What to Do if Atrial Fibrillation Occurs
If you experience symptoms suggestive of atrial fibrillation after stent placement, seek immediate medical attention. Contact your healthcare provider or emergency services, especially if symptoms like chest pain, severe shortness of breath, or fainting occur. Early evaluation leads to prompt diagnosis and management.
Diagnosis involves an electrocardiogram (ECG or EKG), which records the heart’s electrical activity to confirm an irregular rhythm. A Holter monitor, a portable ECG device worn for an extended period, may capture intermittent episodes. Blood tests and an echocardiogram (an ultrasound of the heart) assess overall heart health.
Management for new-onset AFib after stent placement focuses on controlling heart rate, restoring normal rhythm, and preventing blood clots. Medications may be prescribed to control heart rate or help the heart return to a regular rhythm. Blood thinners (anticoagulants) are often recommended to reduce stroke risk, a complication of AFib. Lifestyle modifications, such as managing blood pressure and cholesterol, and regular medical follow-up are important.