After being admitted for flutter, they did an echo cardiogram (not the TEE), and the practitioner said they suspected my problem might be left atria which is unusual at about 10% of cases of flutter... I read now that getting at the left atria involves puncturing the septum and is a more difficult procedure......
Questions:
Can this puncturing and left ablation be done by catheter or is a chest entry required ?
If the valve is involved, can the pathway from that be ablated or am I then into an open chest operation ? I feel strong, and they say (after stress tests) that my plumbing is excellent. I shovel a ton of topsoil at a time, I climb onto the roof and sweep my own chimney. I am never out of breath, not overweight and usually excellent blood pressure etc etc etc.. So I can't think the valve is diseased, but perhaps the electrical pathway ? Age 71
Any lefties out there ? After only one flutter, (6 weeks ago), if it turns out I am a lefty, should that affect my decision on whether to have ablation....Is it just too heavy an op ?
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allserene
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When they ablate in the left atrium they use catheters that are fed from the groin.
They do not need to open up your chest and operate in the surgical way.
The catheter is fed into the right atrium and as you say they make a hole between the two chambers to access the left atrium to enable them to carry out the ablation.
Relax......
I’ve had it done six times and am still here to tell the tale. However for me it was better than under GA rather than sedation.
Thanks Pete... I assume they have to remotely sow up the cut in the septum with dissolving stitches ? Does this make it a longer procedure or any more complexities ? They must have to avoid scar tissue from previous cuts when they do yours... Wow 6 times ..you are a hero !
They don't stitch the hole in the septum, they just leave it, and it will heal in a few weeks. Since the new blood is in the left atrium, and the old blood is in the right atrium, some of the old leaks into the new and will sometimes cause visual migraine. It happened to me, and each instance lasted about 20 minutes. It stopped doing it after about 2 weeks. The ablation procedure usually lasts about 2 hours.
As Pete has explained ,to access the left atriium they go in via the groin into a vein and since all veins arrive in the right atrium then they go through the SEPTUM into the left. (Think your spell checker got in the way there. )
Since you have had an echocardiogram any valve problems would have been discovered so I think you can rest easy on that front by the way.
Atrial fibrillation occurrs in the left atrium so most of us who have had ablations for AF have had this procedure. The only thing to remember is to read our fact sheet on recovering (AF Association website under patient resources) so you are not alarmed by things like the migraine aura which the transeptal puncture often produces. Of course as this heals so then will any aura vanish.
Thanks Bob..I happily edited the spelling coz I am a Field Marshal in the apostrophe Police ....(carrot's! ..aaagghhh)...lol I thought my valves must be ok coz I do heavy lifting and shoveling and DIY and car maintenance and don't get out of breath etc.. Am I correct in thinking most flutter is right atria most afib is left ? ...and that the right one is much easier to do ? How can they tell which one is flaky anyway from the outside with just an echo-cardiogram ? ....
I'm a bit older than you but still building race engines and I do get out of breath and need my boys to lift heavy blocks onto the work bench!
Not really sure who they can tell from a mere ecg but as you say left is AF right is Flutter usually. They look completely different on ECG by the way.
When they do an echo cardiogram they can measure the ejection fraction and any valve regurgitation and this is usually on the report. For example "trace mitral regurgitation" but be aware that a lot of what they see is subjective according to the operator so what one may list as trace, another may put as mild.
Quick meal now and back to finish this gearbox. I do wish people wouldn't take things apart and the realize they don't know what they are doing. If I were a business I would charge extra when people have meddled.
Last time I lifted a complete engine out on my own (ford popular 100E....1172 cc) with no block and tackle, was 1972. I swung it round and tore my back up. 5 weeks on the floor laid on my back in agony, plus 20 years recurring back problems. My doc said when I got old, my back would stiffen and become inflexible and I would have no more pain. My back has been strong with no pain for 25 years now ... Weird thing the human body...
ok So as I understand it, echos are good for seeing plumbing problems, but in order to really trace an electrical path gone wrong, they have to get in there with the catheter thingy and ping the various spots.... So when the tech said she thought she could see something in the left atria performance, it wasn't electrical. it was the the rhythm and blood shifting which is the RESULT of the electrical problem, whereas a valve problem would be seen... She did leave herself room to say it 'might' be left, so there is still a chance it's right side...... Any views anyone on whether a left side flutter(not afib) is worse or better for the long run prognosis ?
Tell me more ...if they rip open a hole in the the septum, how does it get closed ? I once took my ferret to the vet as a rat had made a 1 inch wide gap in its skin.. The vet said it closes on its own...Are septums the same as ferrets in this regard... ?
Thanks Pete.. that explains it.. no need for clips and stitches..... A self closing hole...like my mouth when her indoors gives me that look... I really cared for that ferret but shot it accidentally when it stuck its dusty head out of hole and I thought it was a rat.. "They shall not grow old as we who are left grow old" seems to be some consolation; but one that I never did get....
Must be my Milwaukee wife's sprache that is rubbing off on me... She 'throws' cameras in the trunk and 'tosses' the suitcases in the back seat. I correct her of course and say "it's 'place' "... No change... . Thank you for entertaining the idea that I am not nuts... My credit control manager used to tell her staff "He isn't nuts, there is always a reason for it"... I used to sit on top of the filing cabinets and plan the overview of the new office lay out... I knew what they were thinking lol ! The age of the English eccentric is not yet over. Not till my septum is 'ripped' apart anyway...
Live long and prosper fellow eccentric and Grammar Guru! Hope you feel.more informed now following the excellent comments,which I can't add much to,other than I have flutter too,and it is suspected may be a lefty too,see EP next week. It occurs very rarely,much less than my AFib. Let us know how you get on. X
I'd've thought it sounds like you could do your own with a length of fluxless solder and a hot poker, à la Ranulph Fiennes...
As a classic car man you'll understand that what most of us have is a distributor that's tracking to the wrong ht lead. What the ablation does is to find the tracking route and block it. Like you might rub it with emery cloth, or, sometimes burn across the track with a hot soldering iron.
My main idea for you is to ask the question around whether you want to go down this route, given that your problem has only surfaced once, and a while ago, and that in between you've been fine. I'm not advising, but just wondering. I've had af episodes every couple of weeks, and sometimes every day, for hours at a time and over 13 years and am still chugging on without surgery.
MOT test (no equivalent in Wisconsin where bald tyres and flapping rusty panels are just fine), is a good analogy, and I have spent more time fixing stuff on the car that I broke while 'maintaining' it, than I have with all the jobs that went well first time. You know the feeling when a bolt head twists off. I will quiz the EP on whether a 'one and done' episode is common, or whether I am bound to progress to more and more episodes of flutter and then inevitably afib. If the latter is the case, I would rather get it fixed now at age 71, than when I am Prince Philip's age... Actually that was flip remark coz I have had diagnoses of Multiple Sclerosis, Malignant prostate cancer, and now flutter, and it feels like someone is out to get to get me ! I am lucky really coz the prostate got zapped with cyberknife to a dried raisin with a PSA reading of 0.7, the MS has only hit me twice since 1998 (typically 6 weeks), and now I have a flutter (April 2019) with one episode to date (converted with betas....)..My dad used to say that if I fell in the sewage works, I would come out smelling of roses, and that he knew blokes like me in the army... When I read cases on this forum, I realise I only have a toe in the swimming bath of afib... So I take your point and I will slow down with the ablation (especially if it's left side), and make sure it is the perfect timing and the risk is justified if I do it... I got really lucky with cybernife that can leave you in nappies (diapers) for life......
I need to find out more about whether lefties like us are harder to fix
Seems they go into the right atria for regular afib, so it's not that much more strange of a job, though piercing/slashing/blasting their way through the septum and then letting it heal (and scar) on its own, sounds a bummer (that's a medical expression for 'involving a degree of extra complexity).. Presumably they diagnosed that by the blood flow pattern on your (and my) echo-cardiogram... Yes we need to dig more into what causes atypical and what are the additional factors ...and before we go for ablation... Could be being lefties makes us more artistic... It sure means our EP is 90% less experienced at doing it...
Aren't we lucky! I've been in arrhythmia for about 10 days, and I'm reluctant to take flecainide after learning here that it can make flutters worse. I'm trying other methods - stress reduction, magnesium, CoQ10 before I try the flec. The last time I used it it didn't work anyway.
I use metopropol Beta blockers and at the last 150 beats incident, I took a 50mg (I usually take 25 mg twice a day), plus a 25mg 6 hours later, and I was ticking at 61pulse again 6 hours later.... Good that they are so powerful on me that I can get back to NSR with just them, but bad that they can
A: Stop my heart with a slight overdose (as the hospital proved)
B: send me to 170 Systolic and 150 pulse with 2 missed 25 mg tablets
They are going to be a big issue when I eventually want to get off em..
Spent all morning shoveling trailer loads of wet topsoil and feel great on the 25s
Thanks for sharing that! I was taking Metoprolol but stopped taking it in December when I kept becoming short of breath. That stopped when I stopped taking it. I've been thinking about trying it again to see if it makes a difference with the current episode.
I felt absolutely awful on 50mg... Like heavily sedated with zero energy. Just wanted to slump on the settee... After 3 days I asked the Doc if I could move to 25 and he said ok.. Even then it takes 2 or 3 weeks for it all to settle to where I feel no effect. My worry now is that if my body gets used to 25s and they aren't strong enough to stave off a flutter... Time will tell. So far so good... I am 196 lbs and 6ft, so someone who is smaller with a higher metabolism may be even more sensitive to dosage.. It's complicated !
I generally don't tolerate beta blockers. Bisoprolol was the worst - I thought I had asthma because I couldn't walk 20 ft. without having to sit down and catch my breath. The metroprolol didn't bother me for several months. I have glaucoma and one of the drops my eye doctor gave me is a beta blocker called Timolol. I believe it's what put me into afib this time. It happened first when she increased my dose from one drop in the morning to one morning and evening. Two weeks later I was in afib. I stopped using it, went back to NSR, tried the drops again and even using only one drop sent me back to AF. I looked up the prescribing info and side effects and arrythmia is one of the most common! I think my doc must not have looked at my history very well.
Trouble with this business is its so easy to make false associations...and so east to miss correct ones... 20 seconds before my first flutter, I drank half a pint of really cold sports drink. Now I leave em at room temp, but who knows there may have been no link. Everything is under suspicion but sometimes the evidence gets to be indisputable... I try not to let the same dog bite me twice
wow everyone really is different..... I am still hoping I am a 'one and done' event with flutter, but opinion on this forum seems to be that without ablation, flutter/fib is always progressive eventually .. and sometimes with ablation too. I also hope I am really a quick and easy righto flutterer, so they dont have to go banging holes and black and deckering into the left... Been watching too much "this old house'...
Atypical left atrial flutter here too. Was actually not near the valve but near one of the pulmonary vein connections to the atrium.
In february I went into my second ablation fully fluttering and the ablation at that spot stopped it instantly; and now, 4 months after this second attempt of a full PVI and CTI ablation at the same time I am cured of all. No more flutters nor fibs. None!
Great ! The forums are weighted towards people with extra problems or failed procedures, so it lifts my spirits to hear of a successful procedure...It's right to listen to people who have had 7 fails because we must be aware of all the surrounding possibilities, but we are only doing this stuff to have success eventually and we must keep the optimism alive ! Thank you !
Good for you! I too love to see people who've had successful ablations. I'm very reluctant to try it since I've had afib for so long -- 9 years -- and chances are great that at least the first one won't help. And my symptoms aren't as bad as many others - I usually am unaware that I'm in afib and I don't have anxiety about it.
The decision to do it or not is awful. When I elected for Cyberknife on my prostate , I was warned that I could end up with my bladder and guts trashed and wearing diapers for life. It worked out fine with no adverse consequences, and killed my malignant cancer and toasted the gland to a raisin, but I feel like I have stretched my luck and I will be very cautious about an ablation and not just do it without asking a lot of questions....
Medical decisions can have such long-term ramifications. It sounds like you were given accurate information so you could make a wise decision. I always think the person making the decision about surgery should be told what his/her life will be like if the risk comes to pass. Everyone knows there's a risk of infection with any surgery, but what if you get a MRSA infection? You will have to be on serious IV antibiotics for weeks or months, most likely having to spend 1--2 hours a week in an outpatient facility, with the possibility of the medication causing permanent kidney damage and/or hearing loss. That's a significant life changing risk if you're looking at an elective surgery.
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