Can Flutter Return After a Successful Ablation?

[terryw]

If one has had an ablation for Flutter and been advised that one is 'cured', what are the chances of it returning, and if so any ideas why e.g. Flecainide?

Thanks for any information. TerryW

[BobD Volunteer]

Cured is an emotive world which I seldom use to be honest. All treatment for these conditions are only ever about improving quality of life although flutter ablations are usually more successful than those for AF

[terryw in reply to BobD]

BobD Thanks for the reply. I have been identified with Flutter after a 24 hour ECD. I had a successful Ablation for Flutter in 2010. Through this web site I read an article by Dr John Mandrola MD. It stated that medical professionals have difficulty in differentiating Flutter and AF (I have had personal experience of this fact!), that the Flutter operation is easier with fewer risks, that 'Flutter ablation prevents recurrences of Flutter', and that the proble with Flutter ablation is the recurrence of AF. He is also stated that rhythm control drugs like Flecainide can make Flutter worse. At the moment I gathering information together for my next visit to the Cardiologist, ( and maybe an Electrophyiologist!).TerryW

[cuore in reply to terryw]

I believe I read Dr. Mandrola"s article. He stated that he was writing about the right atrium atrial flutter, and not flutter in the left. When the flutter is in the left atrium, specifically , mine is perimitral atrial flutter, the flutter is hard to ablate. I had an ablation for this flutter 3 months and 20 days ago and the flutter is still recurring on and off. I even had a nine day episode of the flutter. As this was my second ablation, there is now a discussion that I may need a third.

I have asked to get off Amiodarone as I have been on it for almost nine months ( started after first ablation). Flecainide 200mg daily has been proposed. I am in the process of working out the details.

[terryw in reply to cuore]

Hi cuore. Thanks for that . I am now contacting the Hospital that did my ablation to see if it was left or right atrium. Next I am need to know where the current flutter resides.

I have been on Amiodarone and for me it was effective but nasty (breathing problems). I have been on Flecainide for probably 13 years and it has served me well. It still leaves the issuse in Dr. Mandrola's article about Flecainide causing Flutter.

Good luck with your challenges! terryw

[cuore in reply to terryw]

This site should arm you with lots of information about atrial flutter:

academic.oup.com/eurheartj/...

[terryw in reply to cuore]

many thanks. terryw

[Hidden]

Yes it can return. I had a flutter ablation in 2013 which helped enormously. However I have had a return but not on the same scale. I have found that taking Magnesium Taurate over the last few months has reduced my symptoms considerably and have had no AF to speak of for nearly 11 months.....a record for me in recent times.

I don't think that there is such a thing as a cure

Sandra

PS I don't take Flecainide...doesnt work for me....i take Disopyramide

[terryw in reply to Hidden]

Yatsura. Thanks for the reply, and the pointer about Disopyramide. I also take MagnesiumTaurate. My reply to BobD sets out some of my dilemma. TerryW

[CDreamer]

Cured = being free of any disease after treatment for a period of 5 or more years. You can be free from symptoms but technically not cured.

I had 2 ablations in 2013 & 2014 for both AF and some for AFl as I was very symptomatic. Episodes of AF returned Sept 2016 and AFl recently so the answer is yes.

It is a bit random and very individual as to whether or not it returns - hence not advisable to use the word cured!

[terryw in reply to CDreamer]

HI CDreamer. I did put 'cured' in italics. If you see my reply to BobD and my comments about John Mandrola MD reference to 'atrial flutter ablation prevents recurrences of flutter', and the problem with atrial flutter ablation is not recurrence of atrial flutter; it is recurrence of atrial fibrillation'. If you add the comment, 'The diagnosis of atrial flutter can be tricky' then you will understand that I am always cautious with medical arrithmyia diagnosis. I have already experienced two senior Consultants disagree over an ECG and whether AF or Flutter.Thank you for your reply. I actually thought it was you who drew my attention to the DR John article. TerryW

[CDreamer in reply to terryw]

Could well have been. My understanding is that Fib often follows Flutter - I know several people who have had ablations for Flutter - which is easier and quicker as originates in the right atria therefore no hole in septum to punch through to the left atria which to ablate the Fib - but only to find that Afib came a few years later anyway. The more I get into this the more I realise that arrythmias seem to be totally random and the older you get the more likely and the more complexbestw wishes. x

[KMRobbo]

I had an AF (left atria) Ablation on the 29th January - great no problems, however I remained on my drugs which included 50Mg flecainide twice daily.

9 days later my heart went crazy, very arrhythmic (pounding in chest) , worse symptoms than ever including breathlessness. Went to A&E and the initially diagnosed AF so increased the flecainide to 100Mg twice daily to cardiovert - result even worse arrhythmia and more breathlessness. Second ECG after the increased symptoms it was advised it was FLUTTER not AF.

My EP was involved and he stated the flecainide makes flutter worse, Reduced flecainide back to 50mg (Flecainide necessary as it was still only 2 weeks post AF ablation) with the result that the arrhythmia reduced (more regular heart beat) but the heart rate went up to 130+ resting.

26 Feb - a second ablation for flutter on the right atria - flutter removed back to normal NSR

Definitely (for me anyway) flecainide INCREASE made the flutter worse.

However I am still on 50Mg flecainide as I am still only 6 weeks after AF ablation. No issues with the flutter having had the ablation and being on the 50Mg dose (other than the normal flecainide side effects!).

I am also on 200Mg diltaztem throughout on order to rate control if the rhythm control of flecainide fails).

So my interpretation on this (based on me, sample size of 1) is that flecainide above a certain dose can make flutter worse if you have it, but that it probably does not cause it.

However I do expect to be off all drugs including flecainide in 2 months of the AF ablation has worked. (according to my EP).

Cheers

[fairgo45 in reply to KMRobbo]

KMRobbo i dont want to put a downer on things but after having a/fib / a flutter and 3 ablations over the last 20 years i can say with some authority that a Cure is not a word i would use and being off drugs abit of a pipe dream but good luck with your journey

[terryw in reply to KMRobbo]

Hi KMRobbo Thanks for the information. I am sorry to hear

about your experiences. I tolerate Flecainide reasonably well but if this is

Flutter them I am going to have to consider an ablation for it. Generally I have

decided against the ablation route as I have persistent AF, but with Flutter

lower risk and bigger gain is worth a try. TerryW

[kbog]

Having lived through diagnosis of afib and daily episodes of increasing length for a couple of months, and tried a few different therapeutic approaches during that time, I think I have some useful info for you. After my episodes got super frequent, my doctor encouraged me to start daily meds. Propafenone had given me a metallic taste in the mouth and made me feel “wired” at higher doses, so I was put on flecainide 50 mg twice a day and metoprolol 25 mg once a day. It helped at first, in terms of giving me some days without episodes, but I began to experience breakthroughs after a while. Once after getting to 13 days with no episodes (hooray!) I went into afib on the way in from the parking garage to the cardiologist’s office. She noted after reviewing the EKG that I was actually experiencing atrial flutter, not afib, and said that flecainide often changes afib to flutter. She also told me I could take up to two more flecainide pills to try to convert to NSR. I did this (took another 100 mg flecainide) an hour or so later and it made me feel awful within 30-45 minutes - heart rates spiking to 190 just sitting there; head rushes and flushes of heat when I got out of the car to pick my kids up from school; feeling like I was going to maybe pass out. This was unlike my usual afib symptoms, and I attributed it to the drugs, not the afib. The afib did not go away, and the next morning I tried an increased dose again and had similar issues. It was terrifying. My symptoms from the afib were less severe than from the drugs, so I just returned to the 50 mg dose twice a day and waited to convert to NSR (something that had always happened for me within 28 hours). For the first time I went A WEEK without converting. On the low dose of the flecainide I did not have the worrisome symptoms, and they seemed to make the afib more tolerable / less acute. Saw an EP a few weeks later and she also told me that I was in atrial flutter rather than afib. When I told her I attributed the troubling heart rates and scary side effects to the higher dose of flecainide, she also told me that flecainide often “converts afib to flutter” and that the side effects I was experiencing were the proarrythmic ones that can allow a 1:1 AV nodal conduction ratio from the atria to the ventricles. She said one of our options was to do a flutter (CTI) ablation to get rid of the flutter and then continue to depend on the flecainide to keep the afib under control. We did this at the beginning of February. I was in flutter when they began the ablation, and they were able to “achieve bidirectional block” during the ablation, so it was called an unqualified success. However, a week after the ablation, I started to experience PACs and runs of SVT. Another week after that I had an episode of afib again for about 4 hours. The EP sugggested I need to increase my flecainide dose. I was able to do so without experiencing any of those scary symptoms I had when originally increasing my flecainide dose, because the flutter ablation eliminated the possibility of that 1:1 AV nodal conduction. So, now we move on to figuring out the right dosage and schedule for taking flecainide to keep the afib under control. In my case, the return of symptoms was not evidence that the flutter ablation didn’t work, but rather of my separate issue of afib (which I knew would have to continue to be managed with drugs). If and when we can’t get the afib under control with drugs, I may yet choose an ablation for afib (which I understand to be more of a gamble than the flutter ablation, in terms of chances of success on the first try).

Good luck - hope this is helpful.

[KMRobbo in reply to kbog]

Kbog

These arrhythmias are mind boggling!.

For me I had already had the Ablation for AFIB and then maybe the flecainide promoted the flutter??

Possibly should just have stopped the Flecainide and seen if the flutter stopped??

However I think the EP said I was in a loop so perhaps this was not possible.

Too late now as I have had the ablation for the flutter as well!

Well I just hope everything is covered now!

terryw

I think I initially tolerated the flecainide, but the consultants insisted I took a rate control med as well. I do not tolerate beta blockers (at least the two I tried) so am on Diltiazem and this at 200mg gives me brain fog and much reduced exercise intolerance. 120-Mg Diltiazem gave me much less brain fog, a bit less exercise intolerance but the only time I tried it I had an issue where I went into fast AFIB and the consultant put me back on 200mg.

Hence why I decided on the AFIB ablation.

best wishes both

[jondeanp]

Interesting comments. My initial diagnosis was Afib. I had a successful DC cardioversion. After 2 years i experienced the same symptoms, took myself off to A&E. It was confirmed i was in AFib and I persuaded them to treat me (ie in the 48hour window). I was successfully cardioverted by flecainide.

I was prescribed flecainide as a PiP in case the symptoms returned. My symptoms returned after 4 months, i took the flecainide but it had no affect. When i did get back into the hospital this time i was diagnosed with Aflutter.

Did the flecainide turn my Afib into Aflutter? I'm actually hoping that the flutter was always there and caused the AFib

I had a flutter ablation 5 weeks ago and all seems well so far. Fingers crossed

[terryw in reply to jondeanp]

Hi jondeanp. Life is interesting with AF/Flutter! My understanding is that Flutter is induced by another arrhythmia and that Flecainide provides the ‘hooks’ for it to hang on to. At the moment I need to be sure I have Flutter (I have seen a Cardiologist and the Electrophysiologist (who did my ablation!)) disagree over an ECG). If it is Flutter why after an ablation that had supposedly stopped the recurrence of Flutter was I not told to change the Flecainide drug for AF if this was a risk? Good luck TerryW