My background is 3 years post stroke (probably caused by heart rhythms); 12 weeks at around 120 beats per minute and running; listed for ablation, to be undertaken at Birmingham.
Letters between various consultants have now gleamed that they think its atrial flutter; that I will undergo a 'atypical flutter ablation' through 'left side if need be - a Carto case'?
I ve attempted googling and my head glazed over with medical jargon. Does any one have a laymans' explanation of what this means, particularly the 'atypical'? If its too technical, or a bridge too far to explain, then no worries - I can wait til my 'number comes up'.
Thanks in advance.
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mrhappydays
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I had that exact diagnosis! It just means instead of anticlockwise circuit it's clockwise! I just had a CTI line ablation done last week. Finito he said ( 'he' being the highly regarded Proff Dhanjal from St Thomas's)CTI line basically is a line across the circuit path to break the circuit. 95-99,%success. Meds don't do much for flutter .
Type I atrial flutter, also known as common atrial flutter or typical atrial flutter, has an atrial rate of 240 to 340 beats/minute. However, this rate may be slowed by antiarrhythmic agents.
The reentrant loop circles the right atrium, passing through the cavo-tricuspid isthmus – a body of fibrous tissue in the lower atrium between the inferior vena cava, and the tricuspid valve. Type I flutter is further divided into two subtypes, known as anticlockwise atrial flutter and clockwise atrial flutter depending on the direction of current passing through the loop.
Anticlockwise atrial flutter (known as cephalad-directed atrial flutter) is more commonly seen. The flutter waves in this rhythm are inverted in ECG leads II, III, and aVF.
The re-entry loop cycles in the opposite direction in clockwise atrial flutter, thus the flutter waves are upright in II, III, and aVF.
Type II (atypical) atrial flutter follows a significantly different re-entry pathway to type I flutter, and is typically faster, usually 340–350 beats/minute. Atypical atrial flutter rarely occurs in people who have not undergone previous heart surgery or previous catheter ablation procedures. Left atrial flutter is considered atypical and is common after incomplete left atrial ablation procedures. Atypical atrial flutter originating from the right atrium and heart's septum have also been described.
Morning! Yes at present I am,because I also had AFib. Just had an ablation to sort both out and will stay on meds until the blanking period is over ( approx 12 weeks)I feel great,no blips or anything else.
I'm on anticoagulation for life as AF/ other Arrthymia can return unexpectedly for any of us,regardless of what proceedure we have . University of Birmingham research strongly recommend it. After having a TIA in 2017, thankfully no effects, I'm keen on this!
But early yet but I wonder how your recovery will compare to previous ablations. I have had three ablations in 20 months and now have atypical AFL just five months after the last one. I can't quite facel all that recovery again yet as it takes me about this long to feel pretty well again...Good health
Thank you. This is my first ablation for both AFib and Aflutter. So far so good. I feel great and am having to remind myself not to do too much. Fingers crossed .Best wishes xx
Good morning, I was admitted to hospital & had a diagnosis of atypical flutter, which I started with 8 weeks ago now & like you still running at approx 120bpm despite increase in bisoprolol and addition of digoxin, to no avail. I have a telephone appt next Friday with my cardiologist/EP (different hospital to the one I was admitted to) and am waiting to see the way ahead for me
As far as I understand it atypical atrial flutter is often associated with structural heart disease, especially in patients that have undergone cardiac surgery or extensive catheter ablation for the treatment of AF.
Yes but when I was in hosp I had both afib & aflutter on (separate) ecgs. When my bpm goes above 125 it smooths out to flutter but below 125 it's as lumpy as hell! I found an article recently explaining why this happens at 125bpm - I'll have a search for it again.
CARTO is a type of mapping & navigation system in ablation.
Johns Hopkins University says-
What are the different types of atrial flutter?
Atrial flutter is classified as typical or atypical (non-typical) depending on the location of the short circuit — the pathway that allows the electrical signal to move too fast around the heart. While the symptoms are similar, the treatments may differ.
Typical atrial flutter is localized to the right atrium. This type of atrial flutter can be cured with a short outpatient catheter ablation procedure.
Atypical atrial flutter refers to atrial flutter arising in the left atrium. Most types of atypical atrial flutter can also be treated with catheter ablation, but the procedure is longer and more involved.
Short and sweet -- A "typical" aflutter ablation is on the right side of the heart where most aflutter originates. It is a relatively minor and quick procedure with 95% success rate. An "atypical" aflutter ablation is when the flutter originates on the left side of the heart. It is a more complicated procedure and longer procedure.
A bit more complicated-- At one time I was in your same situation. And from what my ep told me, they would not know whether or not to do a right (typical) sided ablation for my flutter or a left (atypical) sided ablation until I was actually on the table when they would try and provoke the flutter to see where it's coming from. That is probably why they used the language "if need be".
More complicated-- Often it's really hard to tell from ecg's whether it's really flutter or afib, or perhaps a mix. And if their probing leads them to the left side of the heart, you may end up with essentially a partial or full PVI.
Sounds like they know what they're doing but you can always ask them to clarify.
No medical training here, but what I have gleamed through research and from my ep, so take that into consideration.
As background, I had both aflutter and afib. So the textbook choice was: (1) to have either a more minor right sided (typical) aflutter ablation first and then, if the afib was still problematic, have a left sided PVI for the afib at a later date; or (2) Have both at the same time.
I told my ep that I didn't want a PVI at this point, so just let's treat the aflutter.
Here is a condensed version of the conversation:
ME: "So let's just treat the aflutter on the right side and see how it goes."
EP: "Not so quick. I will not know until you're on the table if your flutter is coming from the right or left side. Probably the right, but no guarantee. If it's coming from the left, I need your permission now, to go to the left side and do what needs to be done which may be a partial or full PVI".
ME; Hmmm
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Post script: So far I've had neither, however my afib which was not very frequent when I talked to the ep is now frequent. So, there's really no choice at this point. If/when I have an ablation, they will do a complete PVI on the left side and then clean up any flutter on the right side if needed.
I wouldn’t worry what the doctors call it, they know what they’re doing and they can sort it out for you.
I had an ablation for atypical flutter about eighteen months ago. Really pleased that I did. All went well. Very occasionally I get short runs of rapid heart beat but they literally last for seconds and I really only notice them at night.
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