Atrial fibrillation (AFib) is a common heart rhythm disorder characterized by a rapid, irregular heartbeat. This condition can lead to blood clots, stroke, and other heart complications. Stent placement, also known as Percutaneous Coronary Intervention (PCI), is a procedure used to open blocked coronary arteries and restore blood flow to the heart muscle. While PCI is a life-saving intervention for coronary artery disease, it carries a risk of complications. This article explores the relationship between stent placement and the onset of AFib, including its prevalence, mechanisms, and management.
Prevalence and Risk Factors
Atrial fibrillation is a known complication following cardiac procedures, but it is not common for all patients undergoing stent placement. The incidence of new-onset AFib during the hospital stay following PCI is reported to be around 1.3%. The long-term incidence after discharge falls around 1.1% over several years of follow-up. It is important to note that 5% to 10% of patients already have pre-existing AFib when they present for their stent procedure.
The risk of developing new AFib depends on individual health factors. Advanced age is one of the strongest predictors, with a significantly higher risk for patients over 56.5 years. Patients with co-existing heart conditions are also more susceptible to developing the arrhythmia after the procedure. These conditions include heart failure, previous heart attack, or diabetes. Additional factors that increase the likelihood of new AFib onset are the extent of underlying coronary artery disease and a history of previous PCI.
The Mechanisms Linking PCI and AFib Onset
The development of AFib after stent placement is generally caused by the underlying cardiac disease and procedural stress, not the stent itself. A primary trigger is the acute inflammatory response following a heart attack and the subsequent PCI procedure. The body’s response to the injury involves the release of inflammatory markers, such as cytokines. These markers interfere with the heart’s electrical stability and can promote the development of fibrosis in the atrial tissue.
Procedural factors and changes in heart function also play a role. Hemodynamic stress—temporary changes in the heart’s blood flow and pressure during the intervention—can strain the heart muscle. This stress, particularly on the left atrium, can cause atrial remodeling or stretching. This creates an environment where irregular electrical signals are more likely to occur. Additionally, catheter manipulation during the procedure or temporary irritation of surrounding structures can sometimes act as a trigger for electrical instability.
Identifying Symptoms and When to Seek Care
Recognizing the symptoms of new-onset AFib is important in the days and weeks following a stent procedure. The most common symptom is a sensation of a fluttering, racing, or pounding heart, often described as palpitations. Other signs include unexpected shortness of breath, lightheadedness or dizziness, and extreme fatigue or weakness.
Patients should contact their healthcare team immediately if these symptoms appear or worsen after returning home. While mild chest discomfort and slight palpitations can be normal temporarily, a sustained, irregular, or rapid heart rate is a warning sign. Timely diagnosis is necessary because AFib significantly raises the risk of stroke due to blood pooling and clotting. A quick medical assessment, often involving an electrocardiogram (ECG), allows for prompt management to control the heart rate and prevent blood clots.
Post-Procedure Management and Prognosis
When AFib is diagnosed after stent placement, management focuses on two primary goals: controlling the heart rhythm and rate, and preventing stroke. Rate control is often achieved using medications such as beta-blockers or calcium channel blockers. In acute situations where the patient is unstable, cardioversion—a controlled electric shock—may be used to restore a normal heart rhythm.
Stroke prevention requires the use of blood-thinning medications, called anticoagulants. Since stent patients also require antiplatelet medications, a balance must be struck between preventing stroke and minimizing bleeding risk. Current practice often favors a dual-therapy regimen: an oral anticoagulant (typically a DOAC) combined with a single antiplatelet drug. This limits the duration of triple-drug therapy to reduce the chance of serious bleeding.
The prognosis for new-onset AFib after PCI is variable. In many cases, the arrhythmia is transient and resolves as the heart heals from the acute event. However, new AFib is associated with a higher risk of adverse outcomes, including increased mortality and other complications. Even if the rhythm normalizes, the episode signals a vulnerable heart and indicates a higher long-term risk for future AFib recurrence, necessitating ongoing monitoring.