Afib and aflutter

[SewingMa]

I’m new here and looking for similar conditions and ideas to cope. I had Afib for 20 straight months. After 5 cardio and 1 ablation I finally was out of Afib which lasted about a year. Then into aflutter which has turned out to be more debilitating than Afib. Ive had cardioversions and ablation that were unsuccessful getting me out of aflutter. Next step is AV node ablation with a watchman implanted. I’ve read many of your comments on failed AV node ablations. Anyone have success?

Also, anyone have issues with leg muscles during Afib and aflutter? What did you do to overcome?

[CDreamer]

Hi SewingMa and welcome.

I haven’t seen any posts about ‘failed’ AV node ablations? I wonder if you are confusing with cryoablation or RF Ablation of the atria to stop AF/AFl?

I hope I’m not trying to teach you to suck eggs and I apologise if you already know this stuff but just for clarification, this is my understanding and experience of AV node ablation:-

An AV node ablation is when all else fails to relieve symptoms of AF/AFl and I agree, Flutter was more debilitating for me but usually easier to ablate as in the right atria than AF which originates in the left. Unusually I developed AFl after AF but normally the other way around I was told.

AV node ablation is, in the UK, is 2 part procedure. First a Pacemaker is implanted. After 6 weeks implantation and checks to see that all is well, the AV (Atrial/Ventricle node) which conducts the electrical signals from the atria to the ventricles is ablated. This leaves you 95% dependant upon Pacemaker to pace both ventricles to pump blood around your body.

This is not intended nor will stop the AF/AFl. But what it WILL do is ensure your pulse is steady and regular and when that happens you should see a vast improvement in your symptoms.

After I had 2 ablations for AF - first made things worse, second stopped AF for about 3 years but it gradually crept back until I was in AF more than NSR and very symptomatic, I was not left with any alternatives as I couldn’t take drugs and another ablation wasn’t an option so I decided to go for the Pace and Ablate option, described above.

What actually happened was that after the Pacemaker was implanted I had no more AF, zilch. I then decided to delay the AV node ablation to see if this was a solution for me and it was! That was in 2018 and I still have the odd episodes of various arrythmias but longest lasted 2 hours, most I don’t even notice - the Cardio Physiologist tells me what happened when. All the episodes happened when I had infections ie: Pneumonia or COVID or UTI.

Pace and Ablate is a big step as there is no going back so you need to be clear about the implications and that it won’t always stop the AF/AFl so if it continues after the Pacemaker implant, it’s unlikely to. Is that what you were hoping for? That it would stop the AF/AFl?

Once the AV node is ablated and your pulse remains steady - then you should see an improvement in symptoms such as fatigue, breathlessness etc.

Here’s a Pace and Ablate story from the AFA heartrhythmalliance.org/afa...

And here is link to the FactSheet on P&A. Bear in mind it’s written for UK Patients. heartrhythmalliance.org/res...

Hope some of that helps and please let us know how you get on. Best wishes CD.

[SewingMa in reply to CDreamer]

Thank you so much for the info. The ab node is actually what I referred to. I’ve had pacemaker since 2012. The ab node is to relieve AFl as cardioversion, ablations and meds have not stopped it in over 3 months now. No AFIB, thank goodness. I have extreme weakness in my legs and am now using a cane or rollator. The issue started when I was in AFIB for so long. Before AFIB I was very active with my grand kids and still employed. Had to take early retirement as a result. I’ve been to many Doctors who do not know what the issue is. I’ve actually mentioned to my cardio I think my legs are not getting enough blood. He was not concerned. So frustrating. I take Eliquis and was surprised when the Doc mentioned a watchman, but I did have a blood clot in left atrial appendage when in AFIB. It took over 8 months to resolve with meds.

Yes, I am from Texas, USA.

[CDreamer]

PS - What is your problem with your legs when in AF/AFl? As my BP would crash so low I couldn’t even sit upright when in AF/AFl but I would imagine if it’s weakness or cramps it will be lack of oxygenated blood getting to the legs.

Oh - and you don’t say where you are from but guessing somewhere in N America? Watchman Device is rarely recommended here in the UK but I know more commonly done in the US.

[MummyLuv]

Have you discounted surgical ablation? It is worth considering alongside this option to decide which is best for you. This is the US but a similar procedure is carried out here at Sheffield via NHS and the keyhole heart clinic in London.

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