Stent implants – increase in AF?

I have recently had two stents implanted due to clogged arteries (mid-October). I’ve suffered from paroxysmal AF since 2013, but before the implant, AF episodes were very rare and short lived (about twice a year; typically a matter of hours), possibly due to taking flecainide and bisoprolol. (I also had a cardioversion in 2016 which seemed to help.)

Since the implant, incidents have become much more frequent (about once a week, although still short-lived). I’ve increased my dose of flecainide to try to control this (within my cardiologist’s permitted range). Since the implants I’ve also been taking clopidogrel and aspirin to control the clotting risk. I also started Atorvastatin just prior to the procedure.

I’ve been advised that the implant of stents can trigger an increase in AF episodes for existing afibbers – usually for about 6 weeks.

I’m curious to know if other afibbers in similar circumstances have experienced a similar increase in AF episodes and, if so, how long it took for things to get back to normal.

Thank you.

I had a stent placed in the LAD artery 10/3/22, and then had afib (12 lead) on 11/14/22! Since 11/14/22 nothing. I’m pretty sure my afib wasn’t entirely due to the stent, and my afib history is long and varied, nonetheless interesting.

Well, it surely could be. The heart, like anything else in the body, is part of a system of organs and supporting tissues. When one part of the body is 'invaded' or injured, even if in beneficence by a professional, there are signals that something has gone wrong, and your body will react. Your heart is part of the system.

Thank you both for your helpful comments.

Flecainide is contraindicated when you have CAD, stents or CBAG. Ask you ep for Sotalol or another drug in the same class as Sotalol. Keep your risk factors for CAD under control, especially dyslipidemia. Atorvastatin should be at dose, i.e. 20 to 25 mg to keep LDL < 70mg/dl and triglycerides < 100mg/dl. Also keep blood pressure under control with medication and low sodium diet. The following are risk factors for CAD: high blood pressure, dyslipidemia, diabetes, smoking, overweight, stress, sleep apnea, age and decreased physical activity. Keep all of them under control otherwise your stents will get blocked or another stenosis will happen and if they are distal to the stents then a CBAG is required. So you see the big pictures. CABG is a big risk surgery just behind heart transplant as risk assessment. Also I guess you are under DOAC too so you have triple therapy so your risks of bleedings are considerable. One more reason to keep blood pressure under control to avoid brain bleeding. Just as FYI, not to scare you. CAD is the source and consequence of Afib. Both promotes progression of the other. So you need to control strictly both conditions to avoid them to progress in their course.

Many thanks for your comments, all noted. Fortunately, my LDL and triglycerides figures are well below the figures you referenced and BMI, BP and AHI (sleep apnea) figures are within the healthy range, so fingers crossed CAD progression should be kept in check or slowed down a little. Thanks again.

Let me chime more on CAD. The role of exercise is critical here. By exercise I mean just simple walk at your rhythm or a brisk walking that you tolerate depending on your physical condition without any chest pain. Do it for minimum 150 minutes per week. Personally I walk an hour a day even I don't have CAD.
Let me explain the medical benefits of it. Below the blockage(s) the coronary arteries try to dilated to compensate the lack of blood oxygen and a network of collateral vessels get developed too to bypass the blockages when you exercise. Think like that. Imagine you are on the highway and things get congested so you take an exit to bypass the congestion and get back to the highway at the following entrance. These dilations and the collateral network make a difference between life and death, between a real heart attack and an acute coronary syndrome. Without the collateral network of vessels, studies showed it will take 20 minutes for the blood clot to cause a heart attack, which means death of cardiac tissue. With the collateral network, it takes 4 hours to cause damage. So you have time to call 911 and EMT will ping the hospital and let the cardiac surgeon or the interventionist cardiologist know that you are on your way to the hospital for them to prepare the cath lab of the OR. All of it can be done under 4 hours. Dont forget they have to drive to the hospital too.

Next recommendation is the fasting period. If you can have early dinner around 4/5 PM and fast for 16 to 18 hours, it would be very beneficial for CAD. Let me explain it. While fasting the body will use fat in the blood first to produce energy because the source of glucose has been already exhausted. When they use fat in the blood, it brings down the level of fat in the blood and stop the fat plaques from forming and attach to the arteries. Also studies show high dosage of Atorvastatin can help dissolve the plaques too. Hope it helps

Thank you for your further helpful comments. I entirely agree with your thoughts on exercise. Every other day I cycle around the parklands that encircle our city - approx 10 miles over 90 minutes or so. On most of the other days I spend around 60 mins in the gym doing cardio and weight work. Your suggestion regarding fasting sounds really interesting. Hope to give it a go! I've been on Atorvastatin for a couple of months and my LDL is now 46 - very pleased.