I had another visit to A and E yesterday evening following PAF at about 1800 which started after drinking a glass of coldish water (although there had been more than usual ectopics during the day). Top speed reached was 145 bpm although much of the time it was around 100. The episode lasted for about 3 hours. The doctor at A and E said that the ECG showed some atrial flutter and identified the relevant pattern on the ECG for me. I know very little about atrial flutter except that it is a fast regular pattern, carries the same stroke risk as AF and probably isn’t something you’d want to have. My questions are: does having AF *and* aquiring atrial flutter mark a worsening of the condition or make it more dangerous/problematic?
Atrial Flutter, PAF and another visit... - Atrial Fibrillati...
Atrial Flutter, PAF and another visit to A and E.
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37 Replies
•
BobDVolunteer
Flutter can induce fibrillation and I think they are often close together. Flutter shows as a saw tooth trace on ecg.
• in reply toBobD
I had a series of slow heavy beats before the AF and apparently part of the ECG showed flutter in the ambulance. Will have to get this investigated. I don’t know what if any the implications are for my proposed ablation for PAF.
Flutter is in the right atrium usually so can be dealt with either on the way in or out if necessary.
• in reply to
Mixed AF/AFL during the same episode suggests “atypical” atrial flutter of left atrial origin. If so, this might be a little more complicated. Your EP may be able to tell from the ECG taken at the time.
ncbi.nlm.nih.gov/pmc/articl...
• in reply to
Don’t like the sound of “more complicated”! 😞
• in reply to
Nothing that your top notch EP at Bart’s can’t handle, particularly with the advent of 3D mapping.
Sorry to hear that you have had another hospital visit, I hope you are feeling better now. For me the arrival of flutter in December prompted me after 30 years of struggling to finally make the decision to have an ablation. I had managed SVT and AFIb( quite badly 🥴) but the flutter was on another level, I was extremely symptomatic and felt like I was dying. I just couldn’t imagine living my life with the threat of that happening again. Also after the episode ended my heart just didn’t settle down the same and things definitely seemed to have changed for the worse for me.
How did you feel during the episode, apparently some people can’t distinguish between the two but that certainly wasn’t my experience. I’m not sure if it makes the problem any more dangerous but they did tell me in a&e that it can be harder to get you out of flutter. Are you taking any medications, I ask because my EP thinks that because I was taking flecainide without a beta blocker that could have caused the flutter.
Take good care 😊
• in reply toKellyjelly
The strange thing is that I have very little by way of symptoms like breathlessness etc. Apparently, this doesn’t mean that it is anybless dangerous. The irregularity stopped after about 3 hours. I don’t think the consultants are aware of the flutter so Inwill need to contact them. Thanks for your reply.
Kellyjelly• in reply to
I think it’s just luck of the draw if you are symptomatic or not and you are right the presence of symptoms make very little difference to the condition overall. Did you get a copy of the ecg’s done in the ambulance and in a&e? They will be incredibly useful to show your consultant. My EP has said that if us really important to get copies of everything, the more evidence they have when things go wrong the better.
• in reply toKellyjelly
Thanks for that tip. I have just rung the cardiologybdeor and they will send copies to the St Bart’s EP so that he can have a look at them. I also left a message with the St Barts answerphone.
Gowers• in reply to
Samazeuilh - what treatment were you give in A&E?
• in reply toGowers
No treatment as such. They did blood tests and 2 ECGs. I went back to sinus rhythm and so was discharged at about 2300.
Gowers• in reply to
Good to hear you went back into SR without the need for medication.
Due to AF were you fast tracked through A&E?
I went once (not by ambulance) but had a wait of 3-4hours so by the time I was seen and had bloods/ecg & done I was back in SR
• in reply toGowers
I had a slight chest pain which was almost certainly indigestion (it has been discussed with doctors many times before). I explained that to the ambulance crew and A and E but they insisted on fast tracking.
“Typical” flutter usually arises from the right atrium; fibrillation from the pulmonary veins and left atrium. Flutter ablations are very successful. Yes to more problematic, no to the first two in my non medical opinion.
• in reply to
Do you know if the ablation for AF is different form that for flutter? Thanks for your reply.
Brizzy5000• in reply to
I have had ablation for Atrial Flutter and AF at the same time last year in Bristol, nearly a year later and I feel great no AF or flutter since.
Short answer, yes I think so, in terms of location. Energy sources include radio frequency, cryo and laser : catheters tips are typically single point, multielectrode or balloon tip. Choice presumably reflects operator preference and judgement.
Pulmonary veins (isolation or ablation), and foci in the left and right atrium can all be dealt with in a single procedure. I had all three at once for my first procedure (for PAF), which lasted 6 hours.
I will probably start anticoagulation shortly- I am now resigned to the fact that I will have to have it; I was hoping at one at one point that it might be possible to delay it for a year or so.
• in reply to
What changed your mind?
• in reply to
Earlier during the year my PAF episodes were less frequent; perhaps naively, I thought that lifestyle changes could reduce the burden to the point where the doctors would no longer feel that an ablation was needed, at least for a few years.
Gvvgvjtf• in reply to
I have had 3 ablations, the last one 14 months ago. I had AF and flutter randomly which I ignored over the years, until I went into full heart failure and almost passed away. It seems the AF had caused my left ventitrciular to collapse, giving me an EF of less than >10%, causing multi organ failure. I was put on the transplant list. During this time, I met a Doctor who studying the effect of AF on heart failure, and even though an ablation was considered incredibly risky he was willing to do my first ablation, 4 years later on (my birthday today) and I'm living a normal life, healthy with an EF of <55%. Point I'm trying to make, the ablation may seem to be scary, but it's a quick safe procedure and the alternative can be a lot more scary. I was normally up and about within hours of the abalation and back to normal within days. Good luck with yours, I am sure it will change your life for the better!!!!
What an inspiring story! I have been watching the TV series 'surgeons on the edge of life' showing people taking incredible risks to heal and be healed. Much better, as you say, to take a small risk before things deteriorate.
I've been watching those programmes , those surgeons are jyst amazing along with the "team" working alongside them - my cardiologist is based in the QE Birmingham where I have been given great care
I found the one showing the spinal operation quite unnerving because I have had a similar operation and although I've seen it on TV etc before never in such detail 😰 No wonder the surgeon tried to put me off...... The aneurism was pretty scary as well because my husband had a AAA which was very difficult and he nearly died from loss of blood. They mentioned the cost of the spinal op as £20,000 or more - I know my instrumentation cost 15,000 so more seems likely, all on the NHS, fantastic!!
• in reply toGvvgvjtf
Well, I have to take anticoagulation for 3 or 4 months first. So there is a while to wait.
I have short runs of flutter caused by Flecainide which controls my AF. My cardiologist said that, if necessary, he would recommend ablation for flutter as it can have a 98% success rate.
He said flutter ablation is much easier than AF ablation as, firstly, it is usually only in the right atrium so it is not necessary to puncture the septum and secondly, flutter is usually in a circuit which can be broken, rather than the scattered foci of AF which involves more complex treatment.
• in reply toFinvola
Problem is I seem to have PAF *and* flutter!
But can they deal with PAF and flutter with the same ablation? I was told that my procedure would only be about 45 mins to 90 minutes at most. I guess that may have to be reassessed.
CDreamer• in reply to
Yes they can, with some provisos and your individual circumstances but as Bob says, often the 2 occur together, and can be but not always are, ablated at the same time.
I have had both and all I can say is that I am more symptomatic around AFl than AF. They never got around to ablations the Fl as I had an emergency during the procedure however, the AF ablation was successful and I haven’t really had Fl since.
I’ve always been the exception - it seems my AF induced the AFl.
• in reply toCDreamer
The thought if 2 separate ablations is grim indeed...
As I said in my earlier post they have to go through the right atrium to get to the left so can do flutter on the way in or out depending on what the EP finds.
I started with fib, and on my third or fourth visit to A+E flutter was spotted by a nurse passing by my bed.
I had an ablation and both flutter and fib were RF ablated.
2 years NSR and counting 
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