Atrial Flutter

So... has anyone here HAD AF which has moved to a flutter, or had a flutter that develops into AF?

I'm interested to know which way round it was or if they're both happening at the same time or if you've had one but not the other.

I've got a near-on 4 year history of pAF, with various cardioversions and two ablations. After a stressful start to 2017 I have my heart rate stuck at about 120 resting. Regular, no major presentation of fast pAF.

Echocardiogram done. 3 visits to Medical wards in 3 weeks done. 24 hour tape due soon. NSTEMI Miocardial infarction ruled out. Amiodrone 200mg started as a last resort when everything else has failed AS WELL AS Bisoprolol 10mg.....

This is the time when things look like they're going to get worse before they get better, which we've all experienced before.

Like I say, I'm interested with the whole AF/Flutter journey people may have had out of curiosity really.

10 Replies

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  • I started with paf had an ablation then started with flutter..so had cardioversion ....nsr...then back to paf and flutter now down for an urgent ablation as last one 3 months ago didnt work

  • Yes I have had AF that developed into Flutter a couple of times and have had 2 Flutter ablations and 4 AF ablations.

    From what I remember couldn't really tell the difference but of course it showed up on the ECGS.

    Right now I gave been in SVT since 4 this morning and I am exhausted but it is slightly better than having AF.

    Pete

  • jedi - just want to say that it's good that NSTEMI was a false alarm - any good news is welcome.

  • Flecainide is a Class 1c sodium channel blocker, which can cause slow atrial flutter. If the AFL conducts one to one to the ventricles this can lead to sudden cardiac death, which is why Flecainide is usually used in conjunction with a rate control drug as a safety backup.

    I started out with AF, went on Flecainide (with Diltiazem for rate control), then developed atrial flutter which deteriorated until I eventually had to go on Amiodarone. I then had a CTI ablation to prevent the flutter so that I could get off the Amiodarone and control the AF with Flecainide again.

    cpr.sagepub.com/content/13/...

    "Caution should specifically be exercised with the use of class 1 antiarrhythmic drugs in monotherapy in patients with AF. These drugs may prevent AF recurrences. They can, however, convert AF into slow atrial flutter, which may conduct one-to-one to the ventricles during situations of high sympathetic tone. Impregnation of the ventricles with the class 1 drug will lead to broad QRS complexes (resembling VT) and profound negative inotropic effects leading to cardiogenic shock and even sudden death. Class 1 drugs can be initiated for the prevention of AF episodes after previous evaluation has shown adequate ventricular rate control during exercise. Prophylactic ablation of the flutter circuit must be considered in athletes in whom therapy with class 1 drugs is indicated. The ‘hybrid’ therapy of class 1 drugs and the ablation of flutter may obviate the need for maintenance therapy with bradycardic agents"

  • Good to know thanks for the info!

  • AF with AFl diagnosed 2007 - ablation 2013 made things worse - ablation 2014 eliminated both - although the ablation was stopped through complication before AFl was ablated but it has never returned (?????)

  • I had both Flutter and AF. I was unaware that I had boith until various ECGs proved it. I was asymtomatic throuhgout, thankfully, even when counting a HR of 170. I had one ablation in January, no cardioversions, and the outcome has been positive to date.

    The decription I have had post ablation is that the AF was occuring in the left Atrium at th esite of the pulmonary veins into the chamber and the flutter was a regular ctivity in the right Artium. Both delat with during the same procedure. Just like Pacman, for those old enough to remember simple computer games!

  • The usual site for AFL is the cavo-tricuspid isthmus in the right atrium, so being as the leg veins emerge in the right atrium, CTI ablations are very quick and easy compared with a PVI, because there's no need to pierce the atrial septum. I was in the cath lab for about 40mins for my CTI, compared with 5-6 hours. The actual work only took about 20 mins.

  • I had PAF, treated with Propafenone (same class as Flecainide), had episode of AF and Flutter with suspected MI, Diltiazem added, then had pauses of up to 5 sec, had ablation for AF and Flutter, all Arrhythmia meds stopped straight after.

  • AF to flutter in a year.

    Had ablation for both 2 months ago. fingers crossed

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