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Atrial fibrillation, or AFib, is the most commonly treated arrhythmia, or heart rhythm problem. The Centers for Disease Control and Prevention (CDC) estimates that more than 12 million people in the U.S. will have AFib by 2030. It’s a serious condition because left untreated it increases your risk of blood clots, heart failure, and stroke.

There’s a lot you can do to prevent and control AFib. But one cause of AFib — heart valve problems — can require surgery. And surgery to fix other heart problems can also trigger what’s known as post-operative AFib.

Here’s what you need to know about AFib if you have heart valve problems or need heart surgery.

What Is AFib?

AFib is when the upper chambers of your heart (atria) beat out of sync with the lower chambers (ventricles). If your heart beats too fast, too slow, or in an irregular rhythm, you could have atrial fibrillation.

Can a Heart Valve Problem Cause AFib?

There are 2 types of AFib: non-valvular and valvular.

In general, non-valvular AFib is the kind you can control with lifestyle changes and medication. Risk factors for developing non-valvular AFib include high blood pressure, diabetes, obesity, smoking, heavy drinking, and chronic stress.

Valvular AFib, on the other hand, is related to valvular heart problems, such as mitral valve stenosis or having artificial heart valve. An estimated 4% to 30% of people with AFib have valvular AFib. It’s a wide range because doctors don’t agree on when heart valve problems are the cause of AFib.

Symptoms of valvular AFib

Whether you have non-valvular or valvular AFib, the symptoms are often the same. The main symptom is feeling like your heart is fluttering, racing, or thumping. Other symptoms can include:

• Chest pain or pressure.
• Dizziness or lightheadedness.
• Excessive tiredness or weakness,
• Heart racing when sitting still.
• Shortness of breath and anxiety.
• Faintness or confusion.
• Fatigue when exercising.
• Sweating.

Oftentimes, you don’t even know you have AFib until you see your doctor for something else or you get an electrocardiogram (EKG).

Complications From AFib

AFib increases your risk of blood clots, heart failure, and stroke. In general, AFib causes some 158,000 deaths in the U.S. each year.

If you have valvular AFib, you’re at an even greater risk of blood clots than those who have non-valvular AFib. That’s because having mitral valve stenosis or an artificial heart valve already increases your risk of blood clots.

Treatment for AFib

If you have AFib, it’s important to get treatment. Treatment options include:

Medications for AFib

To treat your AFib, your doctor will first use medications. These include:

• Anticoagulants and antiplatelets. AFib increases your risk of blood clots. So it’s often treated with blood thinners and similar medications that keep your blood from clotting.
• Medications to slow and control your heart rate. Most people feel better once their heart rate resets. These medications include beta blockers, calcium channel blockers, and digoxin.
• Medications to control your heart rhythm. If you need additional medications to control your AFib, your doctor can use an anti-arrhythmic drug. These include sodium channel blockers and potassium channel blockers.

Nonsurgical and surgical options for AFib

If medications don’t work or you can’t take them, there are other options. These include:

• Electrical cardioversion. For this outpatient procedure, doctors use a machine to deliver a low-voltage electric current to your heart. This can help restore your heart’s normal rhythm.
• Catheter ablation. This minimally-invasive procedure attempts to isolate the tiny parts of your heart that are sending abnormal electrical impulses and causing AFib. Doctors insert thin wires called catheters through a vein up into the heart. Electrodes at the end of the wire deliver heat, which can destroy the tissue causing the AFib.
• Surgical ablation. For this option, also called the maze procedure, surgeons create scar tissue with small incisions, radio waves, freezing, or microwave or ultrasound energy. The scar tissue blocks the abnormal electrical signals that cause AFib.
• Left atrial appendage closure. This procedure lowers your risk of stroke. A surgeon implants a device known as the WATCHMAN™ into your heart to close off the part of the heart that most commonly forms stroke-causing clots.
• Implanted devices. A surgeon puts a device, like a pacemaker or an Implantable Cardioverter Defibrillator (ICD), in your heart to monitor your heart’s rhythm. If they detect abnormal rhythm, they deliver an electric shock to restore normal rhythm.

Heart valve surgery and AFib

For those with valvular AFib caused by a faulty aortic or mitral valve, heart valve surgery can repair or replace damaged heart valves. Oftentimes, your surgeon will correct AFib during surgery for other heart issues.

It’s not uncommon to still have AFib after heart valve surgery. AFib after heart valve surgery increases your risk of heart failure and dangerous blood clots known as thrombo-embolisms.

When heart valve surgery doesn’t fix your AFib, your doctor can consider other surgical options.

AFib after heart surgery

You can also develop temporary AFib after heart surgery. AFib is the most common complication after heart surgery, according to the American Heart Association. It affects from 20% to 60% of heart surgery patients, found a study published in the journal Acta Anaesthesiologica Scandinavica.

Can aortic valve replacement cause AFib?

After open heart surgery, a third to half of all patients develop AFib. Several types of open heart surgery can trigger AFib. This includes aortic valve replacement, where your surgeon replaces a narrowed or leaky aortic valve.

Other types of open heart surgery that can trigger AFib include:

• Coronary bypass surgery.
• Mitral valve repair or replacement. Your surgeon will either repair or replace a leaky or narrowed mitral valve.
• Heart transplant.

Risk factors for AFib after heart surgery

It’s unclear why someone develops AFib after open heart surgery. But risk factors for AFib after heart surgery include:

• Obesity.
• Older age.
• Genetic predisposition for AFib.
• High blood pressure.
• Heart failure.
• Chronic obstructive pulmonary disease (COPD).
• Thyroid problems.
• Surgery on a heart valve, such repair or replacement of aortic valve or mitral valve.
• Pneumonia after surgery.
• An electrolyte imbalance after surgery.

How serious is AFib after heart surgery?

Developing AFib after heart surgery leads to longer hospital recovery, more time in intensive care, and worse long-term outcomes, according to UpToDate. Along with the usual increase risk of stroke and heart failure, AFib after surgery can increase your risk of infection, kidney dysfunction, and brain dysfunction.

AFib typically develops within 7 days after open heart surgery. But it can also take up to 90 days to notice AFib symptoms.

In some cases, AFib is temporary, only lasting a few days. Then it goes away on its own.

For others, AFib after heart surgery is permanent. It doesn’t go away. In this case, you’ll need to receive treatment for the condition.