Cardioversion only, or ablation for flutter.

[pablojack]

I am a 68 year old male, new to the forum, and looking for advice on the above choice.I have had asymptomatic level 1 heart block for about 3 years, usually triggered by aerobic exercise. This results in a HR of 46bpm. I am usually unaware of this unless accompanied by ectopics when I become aware of the difference. Pre flutter I saw 2 rhythms: around 70bpm and the aforementioned 46bpm, some time after exercise. Lately I have developed atrial flutter, again asymptomatic. This has been confirmed by ECG and halter. I now see 3 rhythms: 140bpm, usually with exercise, or even contemplating exercise, with lots of ectopics plus the aforementioned 70/46. Again the 46 only appears after exercise. Pre flutter the slower rhythms usually included ectopics but now these rhythms are very smooth now for some reason. On a recent holiday. no exercise, my HR appeared normal for a week. For this reason my cardiologist thinks I may have been in flutter for some time since I had been avoiding exercise until the turn of the year. The plan is cardioversion in 2 weeks but I am wondering whether to go for ablation on the basis that it may provide a longer term solution. I don't see a downside to cardioversion but my atrium is already moderately enlarged and I understand it may normalise if the flutter can be eliminated. Alternatively even a successful cardio version may be temporary and I may not be aware of a return to

flutter, I now exercise 3 times a weak, including a 4 mile thirty minute run on each occasion. No reaction apart from the 140bpm and later bradycardia. My BP is normal

and am not diabetic.

Sincere apologies for the long post but there appears to be a lot of expertise on this forum.

Jimmy mac

[BobD Volunteer]

Hi Jimmy, cardioversion will not cure anything. It may well put you back into normal sinus rhythm for a period but it will not deal with the underlying reasons for your arrhythmia. Ablation may be able to do this although it is important to look on it as ongoing as it may need to be repeated. Ablation for flutter is much easier and quicker than that for atrial fibrillation and may well prevent escalation into AF. You do not mention if you are on anticoagulation which you will need prior to ablation ( three months usually) so nothing is going to be instant.

Go to AF Association main website for some major reading on the subject.

[pablojack in reply to BobD]

Many thanks Bob,

I realise that cardioversion is not a cure but my cardiologist appears to favour a conservative approach. He says that I could be back in normal rhythm for up to 5 years after cardioversion. However as I am learning more about the subject I am starting to favour ablation even if I have no symptoms. Who knows what can happen in 5 years. I am on anticoagulation in anticipation of the cardio version in 2 weeks. Meantime I will review any other responses to the post ( and study the AF website) and take up my cardiologists offer of a referral to an EP. I will probably go ahead with the cardio version though since this may be the first chance to speak again to the cardiologist. I could then stay on anticoagulation awaiting ablation.

[adriatico in reply to BobD]

It seems that anticoagulation requirements prior to ablation for some reason are not the same everywhere.

Major NY hospital where I am scheduled for ablation requires minimum of seven days on Eliquis (apixaban) prior to ablation.

[tibetan36]

Hi Pablojack

It seems to be a common pathway by cardiologists to try Cardioversions first then progress to ablations. Everyone is different,. The CV could put you back into NSR for how long?....nobody knows. The ablations work for many people and not so well for others. I've been through the lot in five years with an AV Node ablation as the last resort last October. My heart rate is now controlled by a pacemaker......so when resting my pulse is 60bpm and speeds up when I'm exercising. I now have lots of energy and feel much better. I told my cardiologist they should have done this procedure first lol.

Remember that this does not cure the AF...it still happens in the Atria....I had a pacemaker check a couple of months back and the cardiologist noted the atria was quivering at 300 bpm. The ventricles were a nice steady 65bpm.

Keep researching especially the AFA website to bring more awareness about your condition.

Cheers

Barry

[cuore in reply to tibetan36]

Your response raises some questions for me. You have had an AV node ablation but the atria are "quivering at 300 bpm." Does that mean you also have had pulmonary vein ablations as well as rotors in areas of the atria and these ablations have not worked?

[tibetan36 in reply to cuore]

Yes! You're correct.

[Mike11]

I think you need to see an EP privately as I bet he will tell you the cardioversion won't work, but it's the only electrical work cardiologists can be trusted to do

[TonyRands]

If you go for the cardioversion, then try to be put on a beta blocker which may increase your chances of staying in sinus (AF society booklet page 11). After my cardioversion I stayed in sinus till I stopped taking bisoprolol (at the GP's suggestion). For my next DCV the cardiologist is insisting I stay on it, possibly indefinitely.