Post-Procedural Arrhythmia

Heart surgery and heart procedures involve tissue close to the heart's electrical system. Incisions, stitches, catheters, inflammation after surgery, changes in fluids and electrolytes, and physical stress can disrupt how electrical signals are generated or conducted. As a result, the heart rhythm can become too fast, too slow, or irregular. This is called post-procedural arrhythmia.

Common Types

Postoperative atrial fibrillation is a common type, especially after coronary bypass surgery or valve surgery. It usually appears on the second to fourth day after surgery, and the rhythm often returns to normal within a few days to weeks. Atrial fibrillation in general is covered on the Atrial Fibrillation page.

Conduction disorders, such as bundle branch block or atrioventricular block, can appear after aortic valve replacement through a catheter (TAVI), valve surgery, or closure of a hole in the wall between the heart chambers. Some improve on their own, while others require a pacemaker. This block is covered on the Atrioventricular Block page. After atrial fibrillation ablation, some patients develop atrial flutter or atrial tachycardia, which may settle down or require a repeat procedure. In children after congenital heart surgery, a tachycardia arising from the AV node area can occur and is treated in the intensive care unit.

Why It Still Needs Attention

Although often temporary, post-procedural arrhythmia can prolong the hospital stay, lower blood pressure, and increase the risk of stroke. Postoperative atrial fibrillation also signals a risk of atrial fibrillation coming back later in life. For this reason, the heart rhythm is monitored after the procedure, and the doctor weighs blood thinners and a schedule for rhythm follow-up after you go home.

Some arrhythmias only appear after the patient goes home. Before discharge, the team usually explains the warning signs to watch for, how to check your pulse, and when to come back. If you have a pacemaker or an implanted recorder, your rhythm data can also be checked remotely. Similar arrhythmias can occur after major surgery outside the heart, such as lung surgery, although less often.

This page covers arrhythmias caused by a procedure. An overview of all types of rhythm disorders is covered on the Heart Rhythm Disorders / Arrhythmia page.

After heart surgery or a heart procedure, your rhythm is usually monitored continuously for several days. If the monitor shows a change or you notice symptoms, a 12-lead ECG is recorded to confirm the type of arrhythmia.

The team then looks for triggers: potassium and magnesium levels, oxygen levels, signs of infection, fluid in the sac around the heart, or valve and pumping function on echocardiography. After TAVI or valve surgery, the ECG is repeated to see whether a new bundle branch block or AV block has appeared. After you go home, the doctor may use a Holter monitor, a long-term recorder, or remote pacemaker monitoring to make sure the arrhythmia has not come back.

After going home from heart surgery or a heart procedure, contact the doctor treating you or make an earlier appointment if you notice an irregular heartbeat, a pulse that feels very slow, dizziness, or fatigue that keeps getting worse, even if the symptoms are mild. Bring notes of when the symptoms occurred and your pulse readings or smartwatch recordings, if you have them.

Go to the emergency room right away if:

• You faint or nearly faint
• A very fast heartbeat does not stop and comes with weakness, shortness of breath, or chest pain
• Signs of stroke appear, such as facial drooping, slurred speech, or weakness on one side of the body
• You develop a fever, worsening chest pain, or shortness of breath after surgery