Normal ventricles/fluttering atria?

[DKBX]

When one has atrial flutter/afib and is on a rate control beta blocker (like metoprolol tartrate) as well as a rhythm control sodium channel blocker (like flecainide) … can the atria still be fluttering/fibbing but the ventricles pumping normally? In other words, can one have a normal pulse and a Kardia reading that says NSR but still feel as if the heart is in flutter/afib?

[BobD Volunteer]

Probably not unless you have had pace and ablate. That said I often have feelings that are unexplained by pulse rate. I suspect that on occasions the two sides of the heart go out of synchronisation and the pulmonary side does not match the main pumping side but that is only my take on it.

[Finvola]

There were a few posters who described their slow Atrial Flutter - I think heart rate was reported in normal range. My understanding of this is that the atria were fluttering at a fast rate but conduction of signals to the ventricles was much slower than usual in AFlutter.

[Hidden]

I agree with Finvola. Slow atrial flutter (AFL) is easily confused with sinus rhythm clinically. Divisors of an atrial rate around 300 result in a regular ventricular rate of 150,100, 75 and 60 approximately. The atrioventricular (AV) nodal block can be fixed or variable.The original Kardia will only pick up AFL in leads II and III. The six lead has greater diagnostic capability.

Flecainide can provoke atrial flutter which is why a rate limiting drug like a beta blocker is commonly prescribed.

Please understand that none of the above necessarily has any bearing on your situation. I don’t feel able to answer your questions fully. I am not a doctor but I have had AFL with ventricular rates of around 60 and 75.

I would say that it is possible to have a regular peripheral pulse, but to be aware of your atria beating quickly and regularly (fluttering).

I think you need to consult with your EP about your symptoms and medication. You could forward a Kardia lead II rhythm strip.

[David1958]

The mind can play tricks on you with what seems like AF. I have not had that feeling for a long time now, but when I was on the medication I certainly felt like something was going on but everytime I checked my pulse, it was normal. I chalked it up to muscle twitching. Once I identified it as such, it would diminish and go away. Once the mind realizes that it cannot trick you it gives it up for awhile. I believe we can think ourselves into AF or what seems like it. It is hard to avoid it because it such a troubling condition.

[DKBX in reply to David1958]

Yes. I think gas bubbles, hunger pangs, etc. Just about anything gets the blame, the adrenaline pumps, and the real thing starts up. “Triggers” may just be correlations rather than cause&effect.