Hair transplant with an arrhythmia: atrial fibrillation, blood thinners or a pacemaker

Which heart rhythm problems are we talking about?

An arrhythmia means the heart beats too fast, too slowly or irregularly because of a fault in its electrical activity. The word covers very different situations, from brief bouts of palpitations to conditions that need an implanted device, and the way a transplant is prepared varies accordingly.

Among these conditions, atrial fibrillation (AF) needs particular attention. The upper chambers of the heart beat in a disorganised way, which allows blood clots to form and raises the risk of stroke. AF can come and go in episodes, known as paroxysmal AF, or become persistent or permanent, and treatment may include an anticoagulant to lower that risk.

Atrial flutter and supraventricular tachycardia, for their part, cause episodes of a fast heartbeat. A heart that beats too slowly, for example because of a block in the electrical conduction between the upper and lower chambers, is treated with a pacemaker, while an implantable cardioverter defibrillator (ICD) protects against life-threatening ventricular arrhythmias.

Isolated ectopic beats, the early beats felt as a thud or a skipped beat in the chest, are covered in a separate article on ectopic heartbeats and hair transplants. The table below sums up what the medical team looks at first in each situation.

Situation	Main point checked
Atrial fibrillation	Stability and anticoagulant
Flutter or tachycardia	Date of the last episode
Pacemaker	Date of the last device check
ICD	Management during the session
Arrhythmia under investigation	Diagnosis before any date

Rhythm stability: what your cardiologist checks

The cardiologist who looks after you knows the history of your condition, your past episodes and your treatment, which puts them in the best position to judge how stable it is. Their assessment relies at least on a recent electrocardiogram (ECG), which records your heart rhythm. Because AF episodes can start and stop on their own, a trace lasting a few minutes may miss them, and your cardiologist then decides whether a longer recording, worn while you go about your day, is needed.

Depending on your situation, other tests such as an echocardiogram or blood tests complete the assessment. What the surgeon mainly needs is the conclusion, in a dated letter that sets out the diagnosis, the date of your last episode, your current medicines with their doses and the cardiologist’s view on the procedure, including the use of adrenaline in the local anaesthetic and the plan for any anticoagulant. The surgeon judges whether the procedure is feasible from these documents, before you commit to anything.

An ECG can also reveal an arrhythmia nobody knew about, because AF sometimes causes no symptoms and is found during tests for something else. An abnormality found in this way is investigated first, and plans for the transplant resume once the diagnosis is clear and treatment has been adjusted. Your heart rhythm is only one of the criteria in this medical screening, which covers the full range of hair transplant contraindications.

In which situations should the procedure be postponed?

A hair transplant is planned surgery with no medical urgency, so nothing requires a date to be kept while your rhythm is not under control. Postponing is the right decision when the arrhythmia has only just been found and not yet investigated, when episodes have recently returned or when a treatment has just been changed.

The same applies after a cardioversion or an ablation, until the check-up your cardiologist has planned has taken place. Unexplained fainting or blackouts, an anticoagulant plan that has not been settled, or an implanted device whose check is out of date are also reasons to move the procedure.

During the delay, your cardiologist settles your treatment, a new ECG or longer recording then checks that episodes are under control, and an updated letter allows the surgeon to review your request. Choosing the right moment is part of the preparation that lowers risk, alongside the checks set out in our article on how safe a hair transplant in Turkey is.

Adrenaline and lidocaine: what the studies say for an irregular heart

For a patient with an arrhythmia, local anaesthetic raises two questions: the effect of the adrenaline often added to an anaesthetic such as lidocaine, and how much of the solution is absorbed over a long session. Adrenaline narrows the small blood vessels, which reduces bleeding and keeps the anaesthetic where it was injected for longer, but the fraction absorbed stimulates the heart and can speed it up. Our article on hair transplant anaesthesia describes the usual protocol and the comfort measures available.

A randomised trial published in 2020 measured this effect with a Holter monitor in 102 patients having hand surgery under local anaesthetic, with or without adrenaline. No major arrhythmia, such as atrial fibrillation, ventricular tachycardia or ventricular fibrillation, was recorded, and minor arrhythmias, such as early beats or atrial tachycardia, seen in 66.6% of patients did not differ significantly between the two groups. In the adrenaline group, a faster sinus rhythm during the injection was noted in 2% of patients and needed no treatment.

People with a history of arrhythmia had, however, been excluded from that trial, so its reassuring result cannot simply be applied to your situation. The amount absorbed matters too: in eight healthy volunteers who had no surgery, lidocaine from a dilute solution injected under the skin of the neck reached its peak level in the blood after an average of 5.8 hours, against 12 hours in the thighs. The authors warn that absorption curves can overlap when an injection above the collarbones is added to one given earlier.

The scalp also lies above the collarbones, and over several hours it receives repeated injections between the donor and recipient areas. Ask the surgeon what adrenaline concentration they plan to use, whether it can be lowered or the injections slowed, and how the cumulative dose for the day is tracked, then pass the answers on to your cardiologist. Any pain you feel during the session should be reported straight away so that the team can check the anaesthetic and adjust it.

Atrial fibrillation on blood thinners: what changes for the transplant

In atrial fibrillation, an anticoagulant prevents clots forming in the heart and lowers the risk of stroke. Its trade-off is a higher risk of bleeding, which is why every surgeon needs to know you take one.

A transplant creates many small incisions across the donor and recipient areas, while stopping the treatment would remove the heart’s protection against clots. The doctor who prescribed the anticoagulant, usually your cardiologist, weighs up these two risks with the surgeon, and the article on taking aspirin or blood thinners before a hair transplant explains how that decision is made and which written plan to obtain before travelling.

This anticoagulant should never be stopped on your own initiative, even for a few days, and it belongs in the list of medicines you send with your very first message. Medicines that slow the heart, such as beta blockers, and rhythm-control medicines should not be stopped without your cardiologist’s agreement either.

Pacemakers and ICDs: specific precautions

A pacemaker corrects a heart that beats too slowly by sending electrical impulses, while an implantable cardioverter defibrillator monitors the rhythm and, when needed, delivers a shock to stop a dangerous ventricular arrhythmia. Having either device means preparing for two questions: the condition of the device and the interference that could occur during the procedure.

The main issue is electromagnetic interference, produced in particular by electrosurgical instruments. A pacemaker may mistake these signals for heart activity and stop pacing, and an ICD may read them as an arrhythmia and deliver an unnecessary shock. A review published in 2024 explains that the risk depends mainly on the distance between the operating site and the device or its leads, and on the path of the current: bipolar mode, used away from the device, carries less risk than monopolar mode.

Before you travel, ask whether an electrical coagulation device may be used during your session and pass the answer on to the pacemaker or device clinic that follows you. The same review advises having the device checked before a procedure if the last check was more than 12 months ago for a pacemaker or more than 6 months ago for an ICD. Add to your file the device identification card, which states its type, its leads and the date it was fitted, along with the report from your last check.

With an ICD, the shock function is sometimes suspended during a procedure exposed to interference, using a magnet or reprogramming. According to the same review, this then requires continuous rhythm monitoring and reactivation by the team that looks after the device as soon as the procedure ends: if it is being considered, check before you travel, with that team and the surgeon, that these conditions will be in place. For a pacemaker, the NHS says you can go through airport security, but staff must not pass a handheld metal detector over the device and you can ask for a hand search instead, showing your pacemaker ID card.

Monitoring your rhythm during the session and back home

When you arrive at the clinic, report any episode since you sent your file, however brief, as well as any missed dose, because this information can change the decision on the day. Take your morning medicines according to the written instructions from your cardiologist and the team, and bring the packs with your prescription.

The 2020 trial found routine ECG monitoring unnecessary for hand-surgery patients without a history of arrhythmia, and your history is exactly why it makes sense to ask, before you travel, how your rhythm will be monitored during the session and who decides to pause if an episode occurs. To frame them, rely on the expected length and the stages of the procedure, from extraction to implantation, set out step by step in our complete hair transplant guide.

Tell the team immediately if you notice unusual palpitations, discomfort in your chest, breathlessness, dizziness or feeling faint, or if your ICD delivers a shock. If sedation is being considered on top of the local anaesthetic, discuss it beforehand, because it changes the monitoring and your ability to report these symptoms.

Once you are home, the NHS advises calling 999 if you have a fast or irregular heartbeat together with chest pain, breathlessness, fainting or dizziness, weakness or numbness on one side of the face or body, blurred vision, confusion or difficulty speaking. Palpitations that keep happening or get worse without these signs are a reason to see your GP.

Can heart rhythm medication affect hair loss?

Some cardiovascular medicines are among the possible causes of telogen effluvium, a diffuse shedding caused by many hairs entering the resting phase at the same time. A literature review published in 2020 lists beta blockers, ACE inhibitors and heparin among them, and notes that the shedding usually starts around three months after the medicine is started, while a change of dose can also set it off.

This type of shedding is different from androgenetic alopecia, which gradually thins the temples and the crown and which a transplant treats by moving follicles taken from the back of the head. If your hair loss sped up a few months after a heart medicine was started or adjusted, tell the surgeon: acute telogen effluvium settles in the great majority of cases, which would make a transplant premature.

That is no reason to stop your beta blocker or your anticoagulant, because only your cardiologist can judge whether a suitable alternative exists for your heart. The decision to go ahead with a transplant is made once the cause of the shedding is clear.

Your transplant in Istanbul, from first file to return home

Your file, with your scalp photos and heart documents, reaches us remotely. A free quote within 24 hours, with no obligation, comes back from our team, while the surgeon flags whether a test is missing. It is best to settle the questions about anaesthesia, anticoagulants and device settings before you book your flight.

In Istanbul, every journey between the airport, the clinic and your 5-star hotel is made by VIP transfer. An English-speaking patient coordinator is your point of contact throughout your stay, so mention your rhythm condition as soon as you arrive. The NHS also flags practical points for people with atrial fibrillation, such as travelling abroad with medicines and changes to health or travel insurance. Istanbul is three hours ahead of London in winter and two hours ahead in summer, so ask your cardiologist whether to shift the times of any medicine taken at fixed hours.

To see where the procedure, the first aftercare steps and the flight home fit into your stay, read the programme for a hair transplant in Istanbul. Once you have flown back, our team reviews your healing and regrowth from the photos you send, under the 12-month post-operative follow-up, carried out remotely. Also give your cardiologist or device clinic the report of the session, especially if an episode occurred or the shock function was suspended, so they can decide whether a check is needed.

Sources

Asghar, F., Shamim, N., Farooque, U., Sheikh, H., & Aqeel, R. (2020). Telogen effluvium: A review of the literature. Cureus, 12(5), e8320. https://doi.org/10.7759/cureus.8320

Farkash, U., Herman, A., Kalimian, T., Segal, O., Cohen, A., & Laish-Farkash, A. (2020). Keeping the finger on the pulse: Cardiac arrhythmias in hand surgery using local anesthesia with adrenaline. Plastic and Reconstructive Surgery, 146(1), 54e-60e. https://doi.org/10.1097/PRS.0000000000006902

Kim, M., & Kwon, C. H. (2024). Perioperative management of patients with cardiac implantable electronic devices. Korean Journal of Anesthesiology, 77(3), 306-315. https://doi.org/10.4097/kja.23826

NHS. (2025, January 13). Atrial fibrillation. https://www.nhs.uk/conditions/atrial-fibrillation/

NHS. (2026, March 30). Pacemakers. https://www.nhs.uk/tests-and-treatments/pacemaker-implantation/

Rubin, J. P., Xie, Z., Davidson, C., Rosow, C. E., Chang, Y., & May, J. W., Jr. (2005). Rapid absorption of tumescent lidocaine above the clavicles: A prospective clinical study. Plastic and Reconstructive Surgery, 115(6), 1744-1751. https://doi.org/10.1097/01.prs.0000161678.10555.53