Atrial flutter

[gokf]

Hi all. I have just come home from hospital after bad palpitations. My cardiologist thinks that I have atrial flutter and is concerned. I had an ablation july 2018 and 2 subsequent cardioversons, the 2nd in dev 2018. He now thinks my recovery was bad because of the flutter. I am now taking apixaban and unfortunately cannot do anything for 4 weeks. He wants to do an investigation procedure and another ablation. He said that flutters can seriously damage the heart which is really frightening and difficult to cure. Has anyone had this and any tips. Thank you all.

[BobD Volunteer]

I have always understood that atrial flutter is actually easier to treat by ablation than fibrillation as it is in the right atrium and no transpetal puncture is required.

[gokf in reply to BobD]

Thank you for your reply. It seems rather confusing and frightening.

[cuore in reply to BobD]

Sorry, Bob. You can also get atrial flutter in the left atrium. I had flutter in both atria. For the left atrium, I had perimitral atrial flutter which was ablated via ethanol injection of the vein of Marshall. Yes, I agree treating atrial flutter in the right atrium is easier. I have had ablations for both, left and right.

[BobD Volunteer in reply to cuore]

I should have said normally. There are always a few exceptions.

[cuore in reply to BobD]

I would have preferred not to have been an exception. I have a remodelled heart with extensive ablation from three ablations. I was one of the most complicated cases at the six month persistent stage (defined by the first ablation). But, I am in sinus, granted with the help of Propafenone.

[Physalis]

I think catheter ablation for AFib can be a lot quicker nowadays. Mine only took an hour and has been successful. Even 60-70% success can't be sneezed at.

[gokf in reply to Physalis]

Thank you, you gave certainly eased my mind.

[Jalia]

I've suffered badly with A flutter over the years and had an ablation for this 7 years ago which helped alot. I'm not cured though.

Like Bob I always understood that A flutter was easier to treat and had a higher success rate

[gokf in reply to Jalia]

Thank you, sounds hopeful.

[gokf]

Thank you for this, certainly eased my mind.

[Finvola]

My cardiologist told me that Atrial Flutter ablation usually has a success rate in the 90% range as it involves only breaking the flutter circuit and is usually in the right atrium.

[gokf in reply to Finvola]

Very reassuring. Thank you.

[jobristol]

I had a flutter ablation October 2017, in August 2019 Atrial Fibrillation started had ablation for that January this year and they checked to make sure everything was all still ok where flutter ablation was done. Everything was fine and although problems with AF, flutter has never returned! So yes, flutter is easier to fix with ablation!

[gokf in reply to jobristol]

Brilliant , that is reassuring. Just hope the ablation does not get cancelled due to covid. The cardiologist was worried that could happen, fingerscrossed. Thank you.

[Shcldavies]

Flutter is one of the most easiest and successful ablations you can get. It is true that flutter can damage your heart but you have to have it for a long time for permanent damage to occur, though it can take some time to fix itself after a bout.

It is also one of the easiest to stop with a cardio version. There are really bad types of flutters and also some that are not noticed. See my Dec 2018 and 2019 posts on my experience with flutter and an ablation they may give you a better understanding of what to expect.

[gokf in reply to Shcldavies]

Thank you for your reply, reassuring.

[Ppiman]

I think perhaps that you should phone your GP for clarification. What you've been told is certainly different from what I was. I understand that atrial flutter usually only causes further problems if the heart rate becomes affected by tachycardia, i.e. beating permanently at a rate of over 100bpm.

I was treated for persistent atrial flutter by ablation in June last year. It is a fault in the electrical conduction of the heart's upper-right chamber or atrium, which causes the top of the heart to "flutter" or beat very rapidly at somewhere around 300bpm. I understand it is difficult to pick this up on a standard ECG without the use of a special injection of atropine during the tracing process, which allows the flutter to show as a very regular, rapid "sawtooth" shaped trace.

Luckily, the heartbeat that matters is the pulse that you feel in your wrist or neck and this arises not in the top atria but in the bottom chambers of the heart, the ventricles. The over-fast flutter beat in the atria is reduced as the electric signals pass through the atrio-ventricular ("AV") node at the top of the ventricles. Sadly, the node cannot create a smooth reduction but only a step-wise one that only allows the heart to beat at a fixed ratio of the original ~300bpm, e.g. at a half, third, or quarter of that, i.e. 150 / 100 / 75 / 60 / 45 bpm and so on.

I gather different people react individually to atrial flutter, with some feeling very poorly and others hardly noticing. I felt very weakened and debilitated by it and couldn't walk far without feeling like I might pass out, although that never happened. I'm still not sure to this day just how much of what I felt was caused by the atrial flutter, and how much was caused by the intense anxiety it brought on. Thankfully, however, all of this was resolved by the ablation.

I have never heard that, in itself, atrial flutter can "seriously damage" the heart. What, I gather, can do this is any long-term, untreated tachycardia that might be brought on by the arrhythmia. Mine became stuck at 150 bpm and needed a combination of bisoprolol and digoxin to bring that down to a safe 60bpm.

Steve

[gokf in reply to Ppiman]

My rate was over 100 bpm for 3 days in tachycardia. I took Bisoprol and digoxin to bring it down.

[Ppiman in reply to gokf]

From what I’ve read, a persistent pulse rate of 100 is what’s treated as tachycardia but isn’t in itself necessarily dangerous.

What is true is that both fibrillation and flutter are sometimes the result of other heart abnormalities, which do need to be investigated by, for example, ECG, echo and MRI/CT scans. I would always ask for a stress MRI if my problem recurred.

Steve

[gokf in reply to Ppiman]

I also have dilated cardiomyopathy, and the AFib and A flutter are caused by my dc. Thank you for you reply

[Ppiman in reply to gokf]

Bad luck - hopefully it’s mild. I wonder which came first and caused what?

Steve

[gokf in reply to Ppiman]

Dilated cardiomyopathy came first, and then 5 years later AF .

[Hidden in reply to Ppiman]

This is very clear, concise & informative post.

I have a paroxysmal flutter diagnosis and over the last nine months have had Bisoporol increased from 1.25 to 10 to combat this, with no success.

Should I now push for an ablation. My heart is apparently otherwise sound, "good LV function" and "at least trivial mitral regurgitation."

I have a copy release report from Coronary care two months ago after an overnight stay which says that Bisoporol can be increased to 10 and "if it doesn't control matters he could be considered for ablation"

Advice at the moment is to take the medication and call 999, if and when, I feel bad. My latest A&E visit was four hours then discharged. I am perplexed. I don't want to be an A&E pest, but live alone and in a real quandary as what to do next time I have an episode.

Can you comment?

[Ppiman in reply to Hidden]

I've replied at more length on a different thread, I think. I found a small dose of bisoprolol and a tiny dose of digoxin worked when I had atrial flutter and tachycardia last year.

Steve

[gokf in reply to Ppiman]

Hi Steve. I take 125mg Digoxin and 5mg Bisoprol daily. When I have the flutter I take an extra 5mg Digoxin. Interesting that you take Bosoprol as well. . I will try that. I am having a telephone consultancy on the 22nd December.

[Ppiman in reply to gokf]

Hi - I really struggled till I was prescribed the digoxin (my dose was 125 mcg not mg - is that what you meant?). I was fearful of it when I read the list of potential side effects, but I needn't have been worried. Apparently, it's one of the oldest drugs. I was very grateful for it. I hope you get things resolved, soon, too!

Steve

[gokf in reply to Ppiman]

Yes mcg. When I have been in hospital Digoxin is what they use to get me back to sinus rhythm. Thank you for your reply.

[KMRobbo]

I had fast rate AFIB and had a succesful PVI cryoablatio. Jan29 2018. Then 9 days later I developed re entrant atrial flutter, rate controlled with the diltiazem I was taking for the AFIB, to 140bpm. As no flutter had shown on my ECG nor through the cryo ablation my EP surmised it was promoted by the flecainide I was also taking for the AFIB.

I was asymtomatic in AFib, even at 243 Bpm, but was breathless just walking from lounge to kitchen in flutter. Very symptomatic. I spent the next 3 weeks mostly lying down. I had a second ablation for flutter on the 26th Feb 2018. My flutter was in the right atria, so I was advised it is a much simpler procedure, (no transeptal puncture, no Oesphagus risk, nor phrenic nerve risk so even safer also. ). I understood there are some areas in the right atria that cannot be ablated but mine was fine. The procedure is 95% succesful rather than the 70% of afib. My EP virtually guaranteed it would not return, and happily my ablation was succesful and flutter has not returned.

I was tired after 3 weeks in the flutter, and my muscles had atrophied owi g to all the lying down/ inactivity over the three weeks plus the week of groin recovery postablation. However after a regime of daily walking, which turned into running after a few months , then my heart proved to be undamaged by the experience. So don't worry yet

I sincerely hope you can get sorted out similary.

I was 58 no other co morbitities at the time. Not medically trained, just recounting my experiences.

Best wishes.

[gokf in reply to KMRobbo]

Thank you for your reply, very interesting to hear your experiences., also reassuring.

[dwright12]

I had atrial flutters and choose to have an ablation (2018). I was told that flutters is easier to fix than aFib. I was having great success after ablation, but feeling like was going to pass out is now the issue. I have implant monitor in my chest and found out I have PAC's. Get a second opinion for your own piece of mind.

[gokf in reply to dwright12]

I am going to have a procedure to check what is going on before an ablation. Good luck with your PAC's.

[mikelocke]

I have had AF for fifteen years or so. A couple of years ago, Aflutter joined the team. In consultation with the heart electrics guy we agreed on doing an Ablation for the flutter.

A year ago I had the ablation, just a breeze. Twenty minutes and all done, nothing to it. Never had a flutter since.

As ectopic1 said in the first reply, treat fibrillation with medication and flutter with ablation. Don't worry too much about it.

[cuore in reply to mikelocke]

I never heard of that. My EP said, " we now know that drugs will hardly fix the problem."

Since you have had AF for 15 years, how long are your episodes or are you persistent?

[mikelocke in reply to cuore]

Medication (flecainide ) totally held my AF at bay for 12 years or more. Then the flutter started for short runs a couple of times a week. Since the ablation the flutter has gone. I continue with the medication to control AF but I have a very slow heart rate ( around 45-50 bpm) and get short bouts of PAC’s two or three times a week. No AF or flutter. I have a consultation coming up with my EP to determine the next step. The medication is doing the job but maybe a pacemaker will solve the bradycardia problem.

[cuore in reply to mikelocke]

That's most interesting that Flecainide kept you in sinus for all those years and is still keeping you in sinus. I had no such luck with Flecainide even after my second ablation. I have a heart rate similar to yours and am on Propafenone. I function well, so I don't even think of a pacemaker.

[cuore]

I am a little confused here. Your 2018 ablation would have been done by an electrophysiologist, yet a cardiologist is calling the shots now? My tip would be speak to the electrophysiologist that did your ablation. Whether you develop something else after your ablation is largely dependent on how extensive your ablation was. Unfortunately, I do not have the reference ready where I read that.

To label your recovery "bad" and "flutters...difficult to cure" definitely warrants a second opinion. Did your cardiologist tell you what this investigative " procedure is? I am not impressed with this cardiologist.

Flutters can be either in the left atrium or the right. They are more common in the right with a 95% cure rate which my renown EP said when I offered 90%. Flutters in the left atrium are more difficult to ablate.

I have had ablations for both left and right. For the left, I had pari-mitral atrial flutter which was ablated by ethanol injection of the vein of marshall.

In the hands of a good EP, you will be absolutely fine.

[gokf in reply to cuore]

I will be having EPS studies first. It was a cardiologist who did my first ablation, he originally came from Barts Hospital and is our top cardiologist here in Exeter, very experienced. Thank you for your reply.

[cuore]

In terms of AF, my EP told me that "drugs will hardly fix the problem."

I have heard that the success rate for pulmonary vein isolation is higher than your figure especially with the newer mapping systems and catheters, and also if the episodes were relatively short. Generally, a second ablation would be required if there is a reconnection.

[cuore]

That's news to me. I didn't know a cardiologist could do ablations. I thought they had to be electrophysiologists to do ablations.

[fabjabfab]

#I know everyone is different# but I had a PVI and CTI ablation at the same time. Followed by an EP study which showed a flutter and while he was in there my EP zapped that as well. Afterwards and I quote he said “oh the flutter was the easy bit” so by definition I have assumed the other stuff (AF and AT) was the bit I should be worrying about. Due to have my next Zio patch fitted on Wednesday to see how successful the procedures were. I remain optimistic, apart from the post surgery complications unique to me I have not experienced any of the symptoms I had before. My husband now jokes that my heart no longer flutters when he enters the room 🤦‍♀️