Atypical left atrial flutter post-ablation

[Lizty]

Feeling much, much better after ablation three months ago, but EP thinks I may have developed the above condition. I finally found an article {see abstract below} which gives some insight into what he was saying at my follow-up appointment. It is not definite and I am having to have more tests to check......Thought others might be interested even though it is an unusual - but curable - outcome.

Atypical left atrial flutter after intraoperative radiofrequency ablation

Duru F1, Hindricks G, Kottkamp H. Author information

Abstract

Curative treatment of chronic atrial fibrillation (AF) remains a challenging task for electrophysiologists. Eliminating the initiating triggers by focal radiofrequency ablation in a subset of patients with paroxysmal AF and modifying the maintaining substrate by performing linear lesions within the left atrium in patients with prolonged episodes of AF are among the alternative approaches for management of these patients. Recently, a new intraoperative treatment procedure aimed at eliminating left atrial anatomic "anchor" reentrant circuits by induction of contiguous lesions using radiofrequency energy under direct vision was introduced. However, atypical left atrial flutter may occur during follow-up after intraoperative ablation of AF. These arrhythmias most likely are due to discontinuities in linear lesions; therefore, they can be successfully mapped and ablated in a subsequent percutaneous catheter ablation procedure. We report and discuss the case of a patient who underwent successful intraoperative ablation of chronic AF, but who developed atypical left atrial flutter postoperatively. Three-dimensional nonfluoroscopic electroanatomic mapping revealed a gap in the linear lesion line connecting the left upper and right upper pulmonary vein orifices. Ablation at the exit site of the breakthrough was successful.

[Hidden]

The article, which could be rewritten in a sentence of real English, just confirms how primitive ablation treatment actually is. Burning away heart muscle by eyeballing an image and guessing how much tissue needs to be scarred to hopefully deal with the problem is hardly cutting edge medical treatment ....well I suppose it is cutting but that is usually the default option for doctors when they don't know what else to do. When are we going to move from what is the equivalent of Victorian blood letting to solutions that cure the condition and restore normal function to otherwise healthy heart tissue?

[CDreamer in reply to Hidden]

Bit harsh Byonic! Many, many people find this a very successful treatment and personally I would MUCH rather take this treatment than injest poisons on a daily basis for the rest of my life.

Maybe someday in the future a less invasive and less harming treatment will emerge and maybe we will all learn that we can all live healthier and happier lifestyles without these treatments,

[Rellim296 in reply to CDreamer]

I'm with you here CDreamer. I'm hugely grateful for what my EPs have done for me and really pleased I'm no longer taking large amounts of antiarrhythmics.

[BobD Volunteer in reply to Hidden]

Why don;t you tell us what you really think?

[teach2learn in reply to BobD]

Hahaha! I'm with CD and Rellim!

[Finvola in reply to Hidden]

I suppose the answer to your question Byonic, is when knowledge, techniques and complete understanding of the condition allow such movement. Fortunately or unfortunately we have to live in the age we are in with its medical advantages and limitations.

In the meantime, ablation offers respite from debilitating symptoms and restores quality of life to a level which enables sufferers to function normally - for that I am grateful if I should ever need to go down that path.

That does not mean that research is stalled and that electrophysiologists are gaily doing nothing to improve therapy and treatment but just opting for the default option.

It puts things into some perspective if you think that 20-odd years ago you took drugs or suffered - or both - and risked stroke into the bargain.

[MS444 in reply to Hidden]

Do you have AF? What type? Any associated problems? Have you had an ablation? Was it successful? are you taking drugs for the condition now? Answering all these question would make your perspective clearer!

[CDreamer]

Hi Litzy and thank you for posting, interesting. Pleased you are feeling better and hope you are able to have this treated.

[Rellim296]

Thank you, Lizty. I found this very interesting and a bit of an insight into the complexities of the ablated heart. I think I might have a discontinuity in a linear lesion somewhere! It makes me think I might just not say I'm good enough as I am, thank you, but opt for a further 'stab in the dark', if it's offered. I had three-dimensional mapping during my third ablation. I don't get flutter but I'm suddenly back to getting AF that then drops the irregularity and turns into SVT.

I'm glad you are improved and hope that you'll get it sorted soon.

[Lizty]

Interesting variety of replies! Just to say that prior to my ablation, I was so unwell that I couldn't hold a conversation of any length without becoming breathless. My busy, active, interesting life was slowly grinding to a halt. When this condition becomes chronic you become, in effect, a part invalid. I am enormously grateful to my EP and all those who are spending money and time to help us discover how to manage this debilitating condition. Maybe there will eventually be less invasive approaches...my EP hinted at that last time we spoke...

Thanks for the good wishes. Off out now for Sunday lunch, a brisk stroll and some lively gossip!

Hooray!

[BobD Volunteer in reply to Lizty]

LIzty, thanks for your original post on this. No doubt most of us old hands knew this anyway but it is always good to see it in print. I keep reminding people that treatment of AF is REALLY NEW science. Twenty years ago you would not have had too many options and would most likely have been told to go away and get on with your life. Eleven years ago when I had my first ablation it was still something new but as time goes on results improve along with the technology involved. I am quite sure that one day in the future we will find a cure for AF but for now am glad I have had the chance of a better quality of life.

I gave a talk in 2008 about my experiences and commented that you could compare ablation techniques with aviation. If the first RF ablation in '94 equated to the Wright Brothers first ever flight then at that time I felt we were about the First World War in aviation terms. Now I feel we have reached the monoplane era but we haven't yet invented the jet engine and we are a long way from going supersonic.

We will get there I'm sure but probably not in my lifetime.

Bob

[PeterWh in reply to BobD]

In fact on one of the narratives prepared by the Royal Brompton and Harefield Trust said that catheter ablation has basically been around for 15 years.

[PeterWh]

We have to put things in both time and a knowledge perspective. Things that were done in hospitals 100 years ago would now be considered barbaric. Some even from 50 years ago. Testing and research that was done on humans regarding operations and medicines years ago would never be remotely allowed.

Someone 50 years ago would never have dreamed that a robot would be used for catheter ablation (the Hansen robot). The initial ablation were all by hand and the mapping was very basic. Even in 15 short years things have developed significantly to improve people's chances and quality of life.

[souljacs4]

Davy Thom put a really interesting post on here about five or six days ago about a new treatment being tried at the Royal Brompton by Dr Sabine Ernst. I think it was on the cardiomyopathy UK website I read it and it sounds very promising. I would like to think there are on going trials for new treatments the only problem is I don't think that AF is taking as seriously as it should .

[Finvola]

Thank you for posting Lizty - I'm glad for you that things are going so well.

Enjoy your lunch and gossip.