Hi all. My heart rate is haywire today. From 140 regular down to 60 irregular. Up and down all day. Ecg showed possible atrial flutter.

[ETHEL103]

Is this a fib. Haven't had diagnoses yet after 2 months.

[rosyG]

Flutter is regular and AF irregular so maybe a mixture- sorry you are having problems

[Hidden]

Can you photograph your ECG and add it to your post?

[ETHEL103 in reply to Hidden]

No I paid for a private cardio appointment Sat and he asked to keep all my notes to show to colleagues. Typically I had been totally fine in his office. Later that day the high heart rate started. Been high and the irregular for hours now.

[bugswhiskers in reply to ETHEL103]

I had the same symptoms as you're having last year, and it was very uncomfortable, but I was lucky enough to have an ablation that has put things right at least for the time being.I hope you get your problem sorted out.

[The_Lord_is_with_Us]

I had AFIB-like arrhythmia with irregular rhythm -- even the Emergency doctor said I had AFIB. However, when I consulted with the EP ... she said NO, you have atrial flutter.

If you need an ablation ... flutter is the easier of the two to repair. With higher success rate, I believe, too.

[Ppiman]

I gather that the unique saw-like trace of atrial flutter won't show without an injection being given during an ECG trace. Flutter causes a fixed heart rate to occur, something that is a fraction of 300bpm, such as 150, 100, 50 and so on. The heart jumps between these rates with no smooth climb or fall.

A variable irregular pulse is not atrial flutter but fibrillation. For me, persistent atrial flutter was completely debilitating and I'm thankful for my ablation in 2019.

Steve

[cicek in reply to Ppiman]

Years ago I was diagnosed with PAF. Then started being in constant AF = back to PAF and so on. Now I think I am in permanent AF because its been constant for at least a month now. My heart rate can go from 150 - 100 -140- 88-70 without any climbing slowly. Just flips from one to another so I guess you are right, this is fibrillation.

[Ppiman in reply to cicek]

If it flips, I think that is supposed to be atrial flutter, with fibrillation being anything but a fixed rate. I have read that what happens in flutter is that the top right chamber or atrium is "fluttering" at about 300bpm, but that the heart's pacemaker slows this beat down en route to the ventricles, allowing them to pump at a safer rate but always a fixed fraction of 300.

Mine never stopped until my ablation and temporarily weakened my heart a little to, making life very tough indeed (although I have to say that anxiety also played a major part such that I couldn't separate the two and know which was the worst).

Steve

[cicek in reply to Ppiman]

Thanks. Looks like GP for me. Was offered an ablation a few years ago and managed to hold off but guess the time has come. 🤭

[Ppiman in reply to cicek]

It may be. It seems to depend on whether the arrhythmia (i.e. flutter, fibrillation or tachycardia) is weakening the ventricles (the bottom of the heart that pumps to the body and lungs), and whether the valves are still able to do their job. In my case the flutter and tachycardia had brought on a temporary slight seepage from one valve and reduced the flow of oxygenated blood to the lungs and body.

An elderly friend has had persistent afib for very many years and, well - if I'm as well as he is at 87, I won't be complaining.

Steve

[cicek in reply to Ppiman]

Thanks again. All sounds a little more hopeful. I would still like to avoid ablation for as long as possible.

[Hidden in reply to Ppiman]

I think you are right about atrial flutter (AFL) but I believe things start to get complicated when you add in the concept of variable block. So you could have periods of 2:1 (150), 3:1 (100) 4:1 (75) and 5:1 (60), alternating with each other. AFL with 1:1 conduction gives a rate of 300 which is why a rate control med is often given with rhythm control drugs, which can have pro arrhythmic effects.

AFL with variable block can be characterised as “regularly irregular”, to distinguish it from AFib which is “irregularly irregular”.

It gets even more complicated when you factor in that the rate range for the flutter focus in the right (or less commonly) left atrium is 250-350 with an arbitrary mean of 300. Sorry for rambling on. Bit sad I know when I could be watching Megs and Hal on catch up...

[Ppiman in reply to Hidden]

Megs’s dad’s interview in today’s Times is enlightening.

That was interesting stuff, though. Following my ablation, the flutter is sorted but I still get lots of ectopic beats and occasional tachycardia for no apparent reason. Finding things out, especially with the pandemic restrictions, is just not going to happen.

Steve

[ETHEL103 in reply to Ppiman]

Yes I was referred to cardiologist at my local hospital 5 weeks ago. I call every week but he's not looked at it yet even tho my GP put urgent on it. Very frustrating.

[Ppiman in reply to ETHEL103]

It’s frustrating and in my view someone unforgivable that we are in out have been placed in this situation. But covid has been a nightmare for doctors and the NHS, one that no one really can grasp or deal with.

A private consultation is also a possibility at about £180.00 but even they are being done by Zoom, at least for the first one.

Steve

[cuore in reply to cicek]

The definition of permanent is when you and the operator agree that there is nothing more that can be done. The definition of persistent is constant AF for a period of more than seven days requiring intervention to get back to sinus.

The key word you have used is constant which may be interpreted as 24/7. It is this period before the first ablation that the heart remodels rapidly compared to paroxysmal AF. In my case, I was six months persistent before my first ablation, and had I not had an ablation at that stage, I never would have been able to return to sinus.

You have posted recently, and I did answer your post. At that time you were going to book an appointment with the GP. You did yourself no favours to delay your ablation to get to the persistent stage. And, because of your delay plus the waiting time now to get an ablation, I do wish you well in needing only one ablation. But, it appears now the odds are not in your favour to have only one ablation because the rogue signals at the persistent stage have spread beyond the pulmonary veins. I wish you the best and do let us know how you fare.

[cicek in reply to cuore]

Thank you cuore. I am sorry if I missed your previous comment and did not reply. I am going to see my GP but he is the one that told me last time that I could be in permanent AF. They were his words. I did that time revert to NSR. I had not been checking my rates because `I had no feeling whatsoever which I normally get when my AF kicks in. I only began checking around three weeks ago when I started using an Apple Watch. Heart was all over the place so decided to check it regularly. Not been in NSR since but have no feeling whatsoever. Because my PAF has been so manageable and I haven't been to see an EP Consultant more than twice, I decided it was very manageable for me and just continued with the same meds rather than have an ablation. I had no idea how quickly it could turn to this and each day been expecting it to revert. Only kidding myself I guess. Thanks again for your advice. I will keep you informed.

[cuore in reply to cicek]

You did answer my post, and please no "sorry." It was your welfare that I was concerned about because I did not want you to follow my route to be left in persistent due to many factors among which is waiting time. Yes, the PAF stage can be very manageable with meds. But, the persistent stage is a whole new ballgame, not that it cannot be manageable with meds, but because it does lead to permanent AF very quickly. In one year, the terminology becomes long standing persistent, and beyond that it is a matter of time before the heart gets so remodelled that it cannot return to sinus. And, if you are going to have an ablation, why have so many areas burned when you can have just the areas around the pulmonary veins?

In terms of your GP's use of words, I believe he just took a short cut by going straight to permanent rather than saying you are persistent which will lead to permanent. Getting bogged down in semantics is really not where it is at. Getting to see an EP to decide your course of action is the focus. Now that you've had your wake-up call, you should have a smooth ride.

[cicek in reply to cuore]

Hi. Contacted my GP today but was told to wait for a routine appointment because it was not an urgent matter. Guess that's told me! It might not be urgent to a medic but when I start getting dizzy and see my heart rate at 157 it's very scary.

[cuore in reply to cicek]

Allow me to disagree with your GP. ( How long is the wait time for a routine appointment?) It is an urgent matter. Although it is not life-threatening; it is life debilitating (your heart is remodelling fast). When you have reached the persistent stage, time is of the essence to see an EP who is the key to booking an ablation if that is the route that you want to choose.

In my case, my GP kept me for a year to get me to persistent. At day 12 persistent, I saw the GP. It took another 42 days to see a cardiologist which I saw on day 54 ( almost two months). Remember the heart is remodelling during this time. From the cardiologist, it was going to take another 5 months to see an EP which I had reduced to three months by complaining to the manger of the cardiology department.

So, two months for cardiologist plus three months for an EP got me to 5 months persistent. Then I was told by the EP, it would take another 3 to 6 months and beyond for an ablation. Adding the 5 months (cardiologist and EP) + 6 months latter waiting time + 1 (another month for beyond) equals ONE YEAR if things run smoothly. At one year, one is in long-standing persistent with the percentage of success of having only one ablation more than low.

I packed it in; booked myself into Bordeaux, France (which took one month) and had the ablation at the six months persistent stage. I was one of the most complicated cases at the six month persistent stage by a world renown EP, and if I had not had the ablation at the six month stage, I never would have been able to get back to sinus.

If your GP is not going to take your situation seriously, and especially when you start to get dizzy and your heart rate is 157, go to A & E. Hopefully, there you will be taken seriously and will be routed to an EP quickly. Good luck to you.

[cicek in reply to cuore]

Thank you again. I have just got over being upset at the doctor's attitude passed on of course by the receptionist. I will keep a check on my heart which definitely is never going back to NSR now. Fortunately it is only going up to very high rates when I am walking. Bounces around all day the rest of the time but I do get plenty of lower readings. I am going to try and remain calm and if anything changes at all before my telephone appointment I will call it in as an emergency. I do have to think that a year ago my doctor would have seen me at the surgery quickly for this problem. How things have changed. Patients fears and feeling don't seem to enter the equation. I do realise times are difficult for doctors and I understand all the extra pressure they are under but they still have to understand that what might not seem urgent to them certainly does to the patient.

[cuore in reply to cicek]

What you really want ,if your goal is ablation, is a referral to an EP. All a GP can do is tweak rate control meds because a GP is not licensed to prescribe rhythm control meds. Cannot you not then convey to your GP via your receptionist that all you want is a referral to an EP because you are in persistent AF? I doubt the receptionist understands the importance of time when one is in persistent AF. For that matter, some GPs don't either.

I compliment. you for remaining calm. That is a very good course of action. Added stress is not good for AF. So you do have a telephone appointment booked with your GP.

[cicek in reply to cuore]

I told them I thought I would just need a referral but it's like asking for the world at the moment. GP's particularly seem to be so set against seeing patients but are happy for the receptionists, HCA's and Practice Nurses to do it. Sorry, tried not to moan - only a small one.🤭

[cuore in reply to cicek]

😊To give you encouragement that things will get better.

In my opinion, you are on top of the game. To be insistent to get a referral you might want to point out to your GP this article by Dr. Hassiaguerre who invented the modern ablation technique:

afsymposium.com/library/201...

Specifically refer to the section :

"First of all, we have compared different subsets of PERSISTENT AF based on continuous AF duration. The number of targeted regions increases with the duration of continuous AF: from three to four in the first six months of AF, four to five in months six to 12 of AF, and six to seven in long-lasting AF."

Then tell your GP the more you are left in persistent without a referral to an EP the more rotors are being developed, and right now in these first six months of persistent 3 to 4 are being developed.

Hopefully, this rude awakening will speed up the referral process.

[TracyAdmin Partner]

It would be advisable to contact your doctor to discuss further

[Karendeena]

Sounds like it to me that's exactly how my heart behaves and I have afib and flutter

[ETHEL103 in reply to Karendeena]

Thanks for your reply. Do you mind me asking what meds you are on for it please. I'm on Digoxin Verapimil and atixaban. Yet to see a consultant.

[Karendeena in reply to ETHEL103]

Hi there, I am on apixaban as a blood thinner and Sotalol 40mg twice per day which seems to have a good control over the rate. My episodes still come but are very slow now and I just feel the flutters. The Professor I am under took me off Flecainide and bisoprolol and said Sotalol would have been the first choice for me if he had diagnosed me. Professor Ng is a top EP in Leicester

[ETHEL103 in reply to Karendeena]

Thankyou for replying. I'm just not sure about the Digoxin. Hopefully I will actually get to see a specialist soon. Been 2 months now. Doc is great but as he told me yesterday he is not an expert.