What Causes Atrial Fibrillation Following Heart Bypass Surgery, and How Is It Treated?

After bypass surgery, atrial fibrillation is a typical consequence. It frequently passes quickly and causes no problems, although there could be additional hazards.

Using a blood supply from another area of your body, a coronary artery bypass operation, sometimes referred to as bypass surgery, entails rerouting blood flow around a blocked artery in your heart.

The abnormal beating in the upper two chambers of your heart is the hallmark of atrial fibrillation, or AFib, an irregular heartbeat. Heart rate spikes are common after it.

One typical side effect of bypass surgery is arrhythmia. Although it is frequently transient, evidence indicates that it may be linked to increased risks of cardiovascular problems, including stroke, both in the short and long term.

Here, we look at the causes of AFib following bypass surgery and discuss management options.

What causes AFib after bypass surgery?

The most frequent side effect of heart surgery is AFib. AFib frequently occurs following bypass surgery for a variety of complicated reasons, including:
  • physical strain and cardiac inflammation brought on by the surgery
  • after surgery, modifications to your sympathetic nervous system
  • limited atrial blood flow (ischemia)
  • abnormalities in your blood's electrolyte and other substance levels
  • the emergence of sepsis, a dangerous consequence
  • changes in blood flow in your heart
  • medication side effects

How common is AFib after bypass surgery?

In the US, about 200,000 people receive coronary bypass surgery annually. The most frequent complication, known as AFib, affects 15–45% of individuals. Usually, it disappears in six weeks.

According to certain studies, individuals with AFib may have a 2-4 times higher risk of stroke.

What are the symptoms of AFib after bypass surgery?

Symptoms of AFib include:
  • a rapid heartbeat, occasionally over 100 beats per minute
  • dizziness
  • shortness of breath
  • heart palpitations
  • fatigue
Sometimes AFib has no symptoms at all, so you might not even be aware that you have it.

Who gets AFib after bypass surgery?

After bypass surgery, the incidence of developing an arrhythmia seems to be higher in those with specific medical disorders or other risk factors.

Researchers found the following risk factors for developing atrial fibrillation (AFIB) following bypass surgery in a 2021 assessment of studies:
  • being an older adult
  • having high blood pressure
  • undergoing a longer surgery
  • having preexisting kidney failure
  • have greater serum creatinine levels before surgery
  • having reduced haemoglobin levels before surgery
  • whose left ventricular ejection fraction is lower
  • requiring a second procedure
  • after surgery, using inotropes, a kind of drug that aids in cardiac contraction
  • having renal failure following surgery
According to studies, persons who have bypass surgery and develop AFib typically do so two to three days after the treatment.

Complications of AFib after bypass surgery

Individuals with AFib may have a longer-term elevated risk of stroke and other cardiovascular problems.

In a 2021 study, at a median follow-up time of 4.5 years, researchers looked studied the long-term prognosis of 7,368 individuals in Sweden who experienced AFib after bypass surgery between 2007 and 2015.

The researchers discovered that there was a higher chance of:
  • 18% of people had an ischemic stroke (95% confidence ranges from 5–32%)
  • by 16% (95% confidence ranges from 5–28%) of thromboembolic events
  • hospitalisation due to heart failure by 35% (95% confidence intervals from 21–51%)
  • 316% (95% confidence intervals from 276–360%) of cases of recurrent AFib
According to other research, patients who experience post-surgical AFib have a roughly four-fold increased risk of stroke in the years that follow the procedure.

How is AFib after bypass surgery diagnosed?

Using continuous cardiac monitoring (telemetry) or a normal 12-lead ECG, doctors can detect AFib.

About 75% of patients have postoperative AFib diagnosed by doctors using telemetry. To detect irregularities in your heart rhythm, telemetry entails continually monitoring your heart rate for several days.

How is AFib after bypass surgery treated?

Oral anticoagulation is advised by current international recommendations for AFib that develops following bypass surgery.

For patients who acquire AFib after surgery, the 2023 ACC/AHA/ACCP/HRS recommendations for diagnosing and treating AFib strongly advise the following treatments:
  • The guidelines advise using beta-blockers to control heart rate; if they are ineffective or cannot be given because of a health issue, calcium channel blockers should be used instead.
  • drugs that regulate heart rate or heart rhythm, which are advised as a first line of treatment
  • direct current cardioversion, which involves giving the heart a regulated shock
  • If a patient has experienced AFib for longer than 48 hours and has not received anticoagulant medication, antiarrhythmic medication therapy is advised.
In addition, the guidelines advise physicians to continue using anticoagulants for 60 days following surgery, unless difficulties arise.

Furthermore, if anticoagulant drugs have not been effective in controlling a patient's heart rate, clinicians can evaluate the patient's cardiac rhythm 30 to 60 days after surgery and determine whether direct current cardioversion would be helpful.

Can you prevent AFib after bypass surgery?

The best ways to avoid AFib following surgery are still being investigated by researchers.

Beta-blocker use before heart surgery has been linked to a lower incidence of AFib. For patients who have a high risk of developing AFib, doctors may also prescribe the antiarrhythmic drug amiodarone.


Can atrial fibrillation be cured?

For AFib, there is no proven treatment. By reducing risk factors, blood thinners, medication, and ablation, the rhythm can be managed.

Can the heart repair itself after atrial fibrillation?

One type of atrial fibrillation that starts abruptly and fades away on its own is paroxysmal. Patients should still receive care and observation, though. Atrial fibrillation is typically irreversible, meaning that no amount of medication or non-surgical therapy will fully restore a normal heart rhythm.

Can I live a long life with atrial fibrillation?

The good news is that you can still live a long and active life if your AF is well-treated, even though it's a chronic condition. You can take several measures to assist you to control your condition, reduce your risk of stroke, and ease your concerns.


One of the most frequent side effects of bypass surgery is AFib. It frequently passes quickly and causes no problems. On the other hand, those with AFib may have a higher chance of stroke or other cardiovascular issues.

Certain drugs, such as amiodarone and beta-blockers, may lower your risk of developing AFib following surgery. It's crucial to discuss the best ways to get ready for your procedure with your surgical team before it happens.

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