Five Lost Years: Could Hidden Arrhythmia Explain Symptoms After Valve Replacement?

For five years after her aortic valve replacement, a patient in the HeartValveSurgery.com community knew something wasn't right. Her EKGs and echocardiograms looked normal, but she never felt like herself.

Then doctors discovered an electrical problem in her heart that routine testing hadn't caught. The day after undergoing a catheter ablation to treat the condition, she told her husband, "I can't believe I got myself back!"

Her experience raises an important question for heart valve patients: Could an undiagnosed heart rhythm problem explain why some patients never feel better after an otherwise successful valve procedure?

Five Years Without Answers

In 2019, at age 65, our reader underwent transcatheter aortic valve replacement (TAVR) to treat her bicuspid aortic valve disease. Although her routine follow-up tests appeared reassuring, she continued to feel unlike her old self. Rather than questioning her recovery, she accepted how she felt.

"I didn't know that I was supposed to feel better than I did so I never pursued a cause," she explained.

Five years later, doctors diagnosed her with atrioventricular nodal reentrant tachycardia (AVNRT), a type of rapid heart rhythm. She underwent a catheter ablation to treat the condition and described a dramatic improvement the very next day. Her question to HeartValveSurgery.com was simple: How many other valve patients are living with an undiagnosed arrhythmia without knowing it?

What Is AVNRT?

Atrioventricular nodal reentrant tachycardia, or AVNRT, is a heart rhythm disorder caused by an abnormal electrical circuit near the heart's atrioventricular (AV) node.

Normally, electrical signals travel through the heart in an organized pattern, coordinating each heartbeat. In some people, electrical impulses can travel through pathways with different conduction speeds near the AV node, allowing a signal to circle repeatedly and trigger a rapid heartbeat.

AVNRT is the most common type of paroxysmal supraventricular tachycardia (PSVT), a group of rapid heart rhythms that originate above the heart's lower chambers. Episodes often begin and end suddenly. They may last seconds, minutes, or longer.

Although AVNRT is generally not life-threatening, it can cause uncomfortable or debilitating symptoms, including palpitations, fatigue, shortness of breath, dizziness, lightheadedness, and a sensation that the heart is suddenly racing. For some patients, these symptoms can significantly interfere with everyday activities and quality of life.

Dr. Gerdisch Says…

We wanted to learn more about AVNRT, so we reached out to Dr. Marc Gerdisch, Director of Minimally Invasive Surgery at Indiana University Health in Indianapolis, Indiana.  As you may know, Dr. Gerdisch is a heart valve and heart rhythm expert who has successfully treated many patients in our community. Here are his thoughts on this topic:

AV nodal reentry following transcatheter aortic valve implantation is rare. It appears to be related to injury to the AV node at the time of TAVR implantation. That said, The AV node is not very near to the implanted valve. It is in fact closer to the right atrium. Instead, the more common rhythm disorder after TAVR is related to injury to the left bundle branch of the ventricular conduction system. This passes through the tissue immediately under the valve at the place where the right and non-coronary cusps meet. As such, it is vulnerable to compression when the transcatheter valve is implanted.

Left bundle branch block occurs in about 50% of TAVR patients. In addition to changing the pattern of electrical excitation for the ventricles, the injured left bundle branch can serve as a substrate for altered conduction velocities and result in ventricular tachycardia. Like AVNRT, this is a rapid or fluttering rhythm that causes symptoms for the patient. Probably, for AVNRT to occur after TAVR implantation, the patient would have dual AV nodal physiology to begin with. That is a condition that is present in as much as 25% of people but only occasionally results in AVNRT.

My point is that AVNRT following TAVR is likely to remain rare because more than one factor probably needs to exist to create it.

Why Can AVNRT Go Undiagnosed for Years?

One of the biggest challenges with AVNRT is that episodes can come and go.

A standard electrocardiogram (EKG or ECG) records the heart's electrical activity during a brief period. If a patient isn't experiencing an episode during the test, the tracing may appear normal. Similarly, an echocardiogram evaluates the structure and function of the heart, including its valves, but it cannot reliably exclude intermittent electrical rhythm problems.

That means a patient can have reassuring routine tests and still experience an arrhythmia that hasn't been captured. The symptoms can also be mistaken for anxiety, aging, deconditioning, or the lingering effects of a cardiac procedure. Research confirms that delayed diagnosis is a real challenge.

In one study of 800 patients undergoing catheter ablation for supraventricular tachycardia, researchers found an average delay of 6.6 years between the first tachycardia episode and diagnosis.[1] Another report described 12 very elderly patients who had experienced palpitations and had been treated for anxiety or panic attacks for years before AVNRT was identified.[2]

These studies were not specific to heart valve patients. However, they illustrate how a treatable rhythm disorder can remain unrecognized for extended periods. For our reader, the delay was five years.

What Does Research Show About Arrhythmias After TAVR?

Heart rhythm abnormalities following valve procedures are well documented.

Much of the clinical attention has focused on atrial fibrillation, abnormal electrical conduction, and heart block that may require pacemaker implantation. However, other types of tachycardia can also occur. In a 2022 Swiss study, researchers used implantable cardiac monitors to follow 100 patients undergoing TAVR for approximately one year.

The findings were notable:

• 31% had a previously undiagnosed arrhythmia detected.

• 19% had atrial fibrillation detected.

• 10% experienced sustained supraventricular tachycardia.

• 2% experienced sustained ventricular tachycardia.[3]

Importantly, all 10 patients with sustained supraventricular tachycardia were asymptomatic, and these episodes did not require changes in treatment. The study did not establish how frequently AVNRT causes persistent symptoms after TAVR. Nevertheless, it demonstrated that continuous monitoring can identify heart rhythm abnormalities that may not otherwise be detected during routine follow-up.

An important distinction: There is currently insufficient evidence to conclude that TAVR or surgical valve replacement routinely causes AVNRT. The electrical pathways involved may have existed long before the valve procedure. The more relevant question is whether an intermittent arrhythmia could be contributing to symptoms that remain unexplained after treatment.

Could TAVR Actually Trigger AVNRT?

An intriguing 2025 case report published in HeartRhythm Case Reports raises the possibility that TAVR itself could contribute to the development of AVNRT in certain patients.

In the study, titled "New-Onset Atrioventricular Nodal Reentrant Tachycardia After Transaortic Valve Replacement: Is There a Causal Link?", researchers described a 71-year-old man who developed new palpitations approximately three months after undergoing TAVR. He had no previous history of heart rhythm problems.

Following his valve replacement, doctors observed changes in his heart's electrical conduction, including a new left bundle branch block and a prolonged PR interval. An electrophysiology study subsequently identified AVNRT.

The patient underwent catheter ablation and experienced complete resolution of his palpitations at approximately 12 weeks of follow-up. The researchers proposed that changes in electrical conduction caused by TAVR might have created conditions that allowed AVNRT to develop, potentially involving injury to electrical pathways near the AV node.

However, the authors acknowledged that the precise mechanism remained uncertain. While their findings suggest a possible causal relationship between TAVR and AVNRT, a single case report cannot establish that TAVR caused the arrhythmia or determine how frequently this might occur.

Still, the report reinforces an important message for heart valve patients: new or persistent symptoms after TAVR deserve appropriate evaluation, even when the replacement valve appears to be functioning normally. Read the full 2025 medical study on AVNRT after TAVR. [4]

New Research Highlights the Value of Heart Rhythm Monitoring

A 2026 study published in Circulation: Cardiovascular Interventions provides additional evidence supporting the importance of post-TAVR rhythm surveillance.

Researchers analyzed 1,217 patients who underwent TAVR and were discharged without a permanent pacemaker. Of these patients, 211 received systematic 14-day ambulatory ECG monitoring, while 1,006 did not receive systematic monitoring. After one year, the researchers reported a significant difference in a combined outcome of sudden cardiac death, arrhythmia-related fainting or near-fainting, and stroke:

1.9% of monitored patients experienced one of these events, compared with 6.6% of patients without systematic monitoring.[5]

The researchers concluded that broader use of ambulatory monitoring after TAVR may help identify electrical complications and improve outcomes. However, the study was observational rather than randomized. It demonstrates an association, not proof that monitoring itself caused the better outcomes. It also focused on early post-TAVR surveillance and did not specifically investigate AVNRT or symptoms persisting for years.

Even with these limitations, the findings reinforce an important principle: some potentially significant heart rhythm abnormalities require testing beyond a routine office EKG.

The Good News: AVNRT Is Highly Treatable

For patients diagnosed with symptomatic AVNRT, effective treatments are available.

One option is catheter ablation, a minimally invasive procedure in which an electrophysiologist uses specialized catheters to identify and interrupt the electrical pathway responsible for the abnormal rhythm. Catheter ablation is often highly successful and can provide lasting relief from recurrent AVNRT.

In the German Ablation Registry, which included more than 3,200 patients undergoing AVNRT ablation, immediate procedural success exceeded 98% across age groups, including patients older than 75.[6] More recent research provides encouraging findings for even older patients. A 2026 study involving 106 patients aged 80 and older reported an acute procedural success rate of 98.1%.[7]

However, complications were more frequent in these very elderly patients than in the broader population treated at the same center. Reported complications included heart block, bleeding or vascular problems, and fluid around the heart. One patient required a permanent pacemaker.

Therefore, while catheter ablation can be highly effective, it is not risk-free. Treatment decisions should be individualized based on the patient's symptoms, other medical conditions, and procedural risks. Medications or observation may also be reasonable alternatives for selected patients. An electrophysiologist can help determine the most appropriate approach.

Still Not Feeling Right After Valve Replacement? Here's What You Can Do

If you are months or years beyond your TAVR or surgical heart valve procedure and still don't feel as well as expected, consider discussing these steps with your cardiologist.

1. Track your symptoms.

Document episodes of rapid heartbeat, palpitations, unusual fatigue, dizziness, or shortness of breath. Note when symptoms occur, how long they last, and whether they begin or end suddenly.

2. Ask whether additional testing is appropriate.

A properly functioning replacement valve is encouraging, but persistent symptoms may have several possible explanations, including heart rhythm disorders, heart failure, anemia, coronary artery disease, or other medical conditions.

Ask your care team whether additional evaluation could help identify the cause.

3. Discuss longer-term heart rhythm monitoring.

Depending on your symptoms, your cardiologist may recommend a wearable ECG patch, an event monitor, or, in selected circumstances, an implantable loop recorder. Monitoring duration and device selection depend on how frequently symptoms occur and the suspected rhythm abnormality.

4. Consider an electrophysiology consultation.

If an arrhythmia is suspected or identified, an electrophysiologist can evaluate the heart's electrical system and discuss treatment options.

One Important Question to Ask Your Cardiologist

"My valve appears to be functioning properly, but I'm still experiencing symptoms. Could an intermittent heart rhythm problem be contributing, and would ambulatory ECG monitoring help investigate it?"

That simple question could start a valuable conversation. Patients experiencing fainting, chest pain, severe shortness of breath, or a sustained rapid heartbeat accompanied by concerning symptoms should seek urgent medical evaluation rather than waiting for a routine appointment.

Sometimes, You Need to Look Beyond the Valve

Our reader spent five years believing that the way she felt after valve replacement was simply her new normal.

It wasn't. Her experience doesn't mean that every patient with lingering symptoms has AVNRT, or that every unexplained symptom is caused by an arrhythmia.

But it offers an important reminder: A normally functioning replacement valve doesn't necessarily explain everything happening in your heart. If you've undergone TAVR or heart valve surgery and still don't feel right, talk with your cardiologist. Sometimes, finding the answer requires looking beyond the valve itself.

For one HeartValveSurgery.com reader, discovering and treating a previously undiagnosed heart rhythm problem made a remarkable difference.

After five long years, she finally felt like herself again.

Keep on tickin!
Adam

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Medical References

[1] Shabbir M, et al. "Radiofrequency Catheter Ablation for the Management of Paroxysmal Supraventricular Tachycardias: Experience at AFIC & NIHD." Pakistan Armed Forces Medical Journal.

[2] "Atrioventricular Nodal Reentrant Tachycardia in Very Elderly Patients: A Single-Center Experience." Journal of Innovations in Cardiac Rhythm Management. 2020.

[3] Nozica N, et al. "Assessment of New Onset Arrhythmias After Transcatheter Aortic Valve Implantation Using an Implantable Cardiac Monitor." Frontiers in Cardiovascular Medicine. 2022.

[4] Chopra N, et al. "New-Onset Atrioventricular Nodal Reentrant Tachycardia After Transaortic Valve Replacement: Is There a Causal Link?" HeartRhythm Case Reports. 2025;11(3):252–255.

[5] "Systematic Ambulatory ECG Monitoring for Preventing Life-Threatening Cardiovascular Events Following TAVR." Circulation: Cardiovascular Interventions. 2026.

[6] Hoffmann BA, et al. "Ablation of Atrioventricular Nodal Reentrant Tachycardia in the Elderly: Results From the German Ablation Registry." Heart Rhythm. 2011.

[7] Engelke H, et al. "Ablation of AV Nodal Reentrant Tachycardia in Octogenarians: Safety and Efficacy in a Large Comprehensive Single-Center Analysis." Journal of Cardiovascular Electrophysiology. 2026.