Afib or A flutter

[David21]

I have had PAF for over 20 years but largely controlled by max. Dose Flecanaide. Recently it has really kicked back in. My questions are: - what exactly is the difference between Afib and Aflutter ? - How does the EP determine this (2 years ago my GP had not even heard of EPs!! ) - Are the treatments different? - I'm aware there are risks with ablations, can anyone elaborate on these please? Thanks

[rosyG]

Hi,

They are different but sometimes co-exist/follow each other.

Flutter is in the right atrium and is said to be easier to ablate as the septum (wall) into the left atrium doesn't have to be pierced for access to the pulmonary veins i the left atrium- which is where A Fib tends to come from and be ablated

Succèss rates are very high for flutter. They are both electrical signal faults!!

[Finvola]

AFlutter causes a rapid regular beat whereas AF is irregularly chaotic. Flecainide can convert AF signals to AFlutter which has the potential to cause a high heartrate (300bpm) if the atrial signals are all conducted to the ventricles. This is known as 1:1 conduction.

Usually Flecainide is prescribed with a beta blocker to avoid 1:1 and slow the heartrate to 2:1 or 3:1.

AFlutter has a distinctive regular ECG pattern of saw tooth peaks which the EP can interpret.

[David21 in reply to Finvola]

Many thanks to rosyG and Finvola for your speedy replies. Ablation risks?

[Hidden in reply to David21]

Risks for ablation are pretty low

[Wasp1954]

As I understand AF is a heart that beats rapidly with an irregular rythym and Atrial flutter is a heart that beats regularly but at an abnormal high rate. If you’re symptomatic you don’t know the difference, they are both similar and debilitating . After 14 years of diagnosed PAF I had an ablation just before Christmas. All went well for a month and then I woke with a real bad PAF episode that had me end up in A&E. Apparently it’s common to have episodes as the heart heals post ablation. They treated me with an infusion of Amiodarone in Resus which fixed the AF but put me into atrial flutter! Took four days in hospital to get my heart rate down from 170. They did not attempt cardio version electrically due to the recent ablation. I am now on 200mg Amiodarone daily and 10mg bisoprolol. I feel ok but not 100% as I did have weird side effects - nightmare (I don’t usually dream), poor taste and breathlessness! I do not like being on this Amiodarone and am waiting for a second appointment with my EP.

[David21]

Thanks. Hope you get it sorted

[crustychin]

I too was on max Flecainide for many years until it just did no good in my case, I was then put on Amiodarone, considered a dirty drug because of it building up in the body, this however worked like magic, and still does after being on it for thirteen years. Amiodarone, however, in many cases removes elasticity from the lung tissue after 3-4 years. I was then prescribed a (then new) drug called Dronedarone, in my case this was disastrous, and was immediately put back on Amiodarone, and will have to stay on it for life as there seems to be no alternative. AF in the early days is very frightening, but, since going on Amiodarone I have never had a recurrence. I was diagnosed AF about thirty years ago and am now 79, so keep your pecker up David, and ask your Consultant if Amiodarone pr Dronedarone could help in your case.

[crustychin]

An addendum to my reply is to find what triggers the attacks, in my case it is Coke, whether with sugar or not.

[David21 in reply to crustychin]

I think with me it is alcohol when I have a virus