Treatment for Atrial Flutter: Has anyone been... - AF Association

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Treatment for Atrial Flutter

JudyMarieC
JudyMarieC

Has anyone been treated successfully for atrial flutter? I awoke yesterday morning with a pulse of 90 (my heart rate is typically 60s-70s). I've gotten used to the occasional episodes of afib and atypical flutter which usually resolve in a couple of days. But this was different. No matter what I did (relaxing, extra metoprolol and my usual dose of flecainide) nothing changed the rate - it stayed between 88-92. I spoke with my EPs nurse today who said that atrial flutter will frequently lock in at a certain rate and that it's very resistive to metoprolol and flecainide. Since it was a Friday afternoon, I won't hear back from the doctor until Monday. She said he will probably recommend a cardioversion. I'm not a fan of cardioversion - had one and the afib returned rather quickly. I'm wondering if anyone has found a treatment that works.

37 Replies
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Flecainide causes atrial flutter.

AFL is difficult to treat with drugs, but the good news is that it's a lot easier than AF to treat with ablation. Flutter ablation (CTI) takes about 30mins compared with 4-6hours for AF ablation (PVI), and the success rate is about 90% compared to 60-70%.

I had a flutter ablation, and it enabled me to come off amiodarone and go back on flecainide.

JudyMarieC
JudyMarieC in reply to ectopic1

Thank you - good information.

ectopic1
ectopic1 in reply to JudyMarieC

It was the flecainide that was causing my flutter, so increasing the dose wasn't helping any. In 2014 I had to go on amiodarone, and that scared me enough to get off the pot and have an ablation. They were going to do a PVI and take me off the meds altogether, but they changed their minds and did a CTI so that they could switch me back to flecainide for the AF.

JudyMarieC
JudyMarieC in reply to ectopic1

Thanks for your reply.

cuore
cuore in reply to ectopic1

They did not do an AF ablation(PVI-- pulmonary vein ablation) to take you off the meds altogether which was Amiodarone pre ablation and is Flecainide post ablation for you, but instead did atrial flutter ablation only (CTI -cavotriscupid isthmus ablation for typical flutter in the right atrium with 95% ablation success in most lilterature). -- I believe I got that right.

I don't understand. I thought the purpose of ablation (without symptoms discussion) was to be free of arrhythmia and drugs ( if possible) not to live with arrhythmia and meds. I haven't heard of a purpose of an ablation merely to be to switch drugs to still keep you in arrhythmia.

Am I missing something? What stage of AF are you in? Also, if you have had a CTI ablation and you take Flecainide only, the typical flutter won't come back? What about developing atypical flutter like perimitral flutter (PMFL)?

ectopic1
ectopic1 in reply to cuore

I have AF, for which I was put on flecainide, but in some patients flecainide causes AFL, as with me. I was offered a PVI to fix the AF and get off the meds altogether, but just as they did that my AFL seemed to settle down a bit, so I spent about a year dithering what to do.

OK for a while, but then in 2014 it all went pear shaped, and I had to go on amiodarone, and since it's toxic, that was enough to make my mind up about the ablation. However, when I got back to the EP he'd changed his mind, and told me that instead of doing a PVI for the AF, he'd do a CTI to fix the AFL so that I could come off the amiodarone and go back on flecainide for the AF.

The flecainide doesn't cause AFL any more, because that's what the ablation was for.

cuore
cuore in reply to ectopic1

So since the 2014 ablation for atrial flutter, you still have paroxysmal AF which is being treated with Flecainide? Or, since it's 2020, are you in permanent AF?

I'm still missing something. Why wouldn't the EP also do AF ablation along with atrial flutter ablation? I had both at the same time for the third ablation, and now I have been almost a year and a half in sinus.

For my first ablation which was very long, my heart swelled, so the superior right pulmonary vein couldn't be totally ablated, so I had to have a second ablation to finish the job.

ectopic1
ectopic1 in reply to cuore

I asked them why they didn't do the PVI, but they won't answer the question because the reason is spite. When I was first diagnosed with AF they lied about it, they knew I had AF, but they insisted that I'd never been taken to A&E, and that they'd never seen any arrhythmia. In between offering the PVI and withdrawing it they'd realised there was a complaint in the offing.

Since then I've been refused treatment for tennis elbow, had my bowel deliberately damaged, and had two broken fingers neglected until it was too late to set them. All in revenge for complaining.

This summer I've been on an urgent referral with suspected cancer, and I've been procrastinating because I couldn't decide whether cancer or the NHS are the biggest risk. I still have paroxysmal AF which is controlled with flecainide, although for how much longer I'm not sure, so I might soon have to decide whether I'm going to trust them to go poking around in my heart again.

cuore
cuore in reply to ectopic1

I am so, so sorry to hear your story. I felt something was amiss when only one arrhythmia was ablated. If you have the money, and since you are so close, I would suggest Bordeaux, France. That's where I went when my experience in Canada was unsatisfactory. I am now in sinus rhythm.

It sounds as if you area close to persistent which you want to avoid lest you need to have several ablations, which by the sounds of it they won't offer you if they wouldn't address your fingers in a timely manner. Can you not go to another hospital?

I have heard that cancer also has a limited time for early diagnosis.

You have a lot on your plate. I do wish you the very best.

ectopic1
ectopic1 in reply to cuore

Thanks.

In practice, there's little to be gained by changing hospitals/GP, because they all see the same medical records. This summer I've been trying to get independent advice privately, but every company I contacted either ignored my emails or told me to go and ask the NHS.

sandoval22
sandoval22 in reply to ectopic1

My flutter ablation took alot longer than 30 mins, more like 2 hours and I was awake the whole time. Not a pleasant experience.

I had atrial flutter 2 years ago - 150bpm for three days so was hospitalised and had a cardioversion. That lasted a couple of months then I went back into AFlutter then my first episodes of Atrial Fibrillation. I had an ablation that fixed the flutter but not the AF, then another ablation fixed the AF too. I’ve been pretty good since then (18 months).

JudyMarieC
JudyMarieC in reply to Kaz747

Good to know - thank you.

I had an ablation last June for atrial flutter that was resistant to bisoprolol. That said, when I was given digoxin, that did lower my heart rate but I was feeling pretty terrible all round, nonetheless. I was very grateful for the operation, which, apart from one bout of fibrillation a week or so after it, and continuing ectopic beats (palpitations) has proved a success, so far.

With atrial flutter, I’m told, the heart rate is most often a fixed ratio / fraction of the speed that your atria are beating (or “fluttering”) at, which is around 300bpm. So you might have, for example, 1/2, 1/3, 1/4 of this as your pulse (in your case, 1/3).

Steve

JudyMarieC
JudyMarieC in reply to Ppiman

Although I said I wouldn't have another ablation, it looks like that might be the way to go. Thank you for your response.

Ppiman
Ppiman in reply to JudyMarieC

I feel for you, Judy. It’s not the tachycardia that is likely your problem but the way flutter makes you feel. In my case I was truly debilitated.

If the fibrillation I suffered a week after my flutter op last year had continued, I was told I might well have to have had a second ablation; at the time, I was down for an emergency cardioversion, but, thankfully 5mg bisoprolol returned me to NSR within an hour or so.

I gather, as Bob says, that the procedure for atrial flutter is altogether much easier and safer for the EP to do. This is because that arrhythmia usually occurs in the right atrium where the catheter arrives from the leg vein - and the success rate is close to 100%.

Steve

JudyMarieC
JudyMarieC in reply to Ppiman

100% sounds good to me! I'll be anxious to see what the EP says on Monday. One good thing about having a pacemaker is that I can send a transmission and they'll be able to see exactly what's going on so he should have some options ready for me.

Ppiman
Ppiman in reply to JudyMarieC

Best of luck with your consultation. At least you'll be well armed with solid information from this site! ;-)

Steve

BobD
BobDVolunteer

Atrial flutter is easliy treated by ablation. That said any rate below 100 is not generally considered a problem.

Have been treated by ablation 7 years ago which helped a lot .

Hi! Yes I had Atrial flutter and AF - often went in and out of them both in A&E. cardiologist decided to ablate the flutter as the AF was sorted pretty easily with Flecainide. Successful

Flutter Ablation 2 years ago and had neither flutter or AF since (fingers crossed) Good luck

jondeanp
jondeanp in reply to Lynnels

I was first diagnosed with AF and cardioverted successfully. I had another episode 2 years later which was diagnosed as AF and cardioverted with Flecainide. I was given flecainide as a PIP but during a later episode the PIP had no effect. When I went to the EP I was then diagnosed with Flutter. I was offered an ablation for both AF and flutter but elected to have just the flutter treated.

I have been in NSR now for over 2 years. 🤞

JudyMarieC
JudyMarieC in reply to Lynnels

Are you still on flecainide? I've been reading that it can cause flutter so I'm wondering if I should stay on it if I'm offered an ablation for flutter.

jondeanp
jondeanp in reply to JudyMarieC

I am on no meds whatsoever following my last ablation 2 years ago

JudyMarieC
JudyMarieC in reply to jondeanp

Good to know - thanks.

Lynnels
Lynnels in reply to JudyMarieC

No I’ve not needed it. I do have it as a PIP but that’s more as a security for me than a need.

Hidden
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Yep, I had an ablation 3.5 years ago for fib and flutter, nsr since

I do not have this but on my pre-ablation talks back in February I met a person who had been successfully treated with ablation for Atrial Flutter and 10 years later he is still fine.

That gives me some hope. Based on the comments I've received, I'm leaning towards an ablation. Thank you.

I had an ablation for atrial flutter last April, when I was going in and out of AF and Flutter, and though I had episodes of AF several times afterwards, no flutter, and the AF has gone as well, at least for the time being, so good luck!

Thank you. I hope you continue to feel well.

I forgot to write that I was taken off Flecainide on the day of my ablation.

I couldn't find any literature substantiating your statement " it's very resistive to metoprolol and flecainide. " When I was diagnosed with atrial flutter, my GP prescribed metoprolol. Is your EP nurse saying it was the wrong med?

JudyMarieC
JudyMarieC in reply to cuore

I don't really know. I just know that taking both meds wasn't helping me at all. I hope to ask the doctor about it when I talk to him tomorrow.

My experience of atrial flutter was a pulse of about 120 BPM but atrium was fluttering at 400. Felt good for nothing. Was out on bisoporal but caused breathing problems. I'm asthmatic. June 2019 had a cardio version and have been in normal sinus rhythm ever since, touch wood. Still taking apixaban for some reason.

It's good to know that a cardioversion worked for you. I might opt for one if I'm given a choice of treatments.

If it hadn't worked I would then have been offered an ablation apparently. Good luck with whatever treatment you decide upon.

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