diagnosed with a-flutter. Nuclear stressed saw no issues, echo turned out fine also. Have only had three episodes and the EP wants to ablate. Should I not try to control with drugs first?
to ablate or not: diagnosed with a... - Atrial Fibrillati...
to ablate or not
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Greenoreos2
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24 Replies
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Hi Greenoreos,
I’m sure others with far more experience will be along soon but, as I understand it a-flutter is a pretty straightforward arrhythmia to treat with an ablation as it doesn’t require crossing into the left atrium. I also understand the success rate is much higher, think I read somewhere it’s around 95%. If I were in your shoes, I would try all the usual lifestyle changes first and, if they don’t help I would seriously consider the ablation route over the drug route in this instance, particularly as a-flutter is quite hard to control with drugs, I gather.
As I say though, more knowledgeable types than me will chip in soon, I’m sure.
All the best to you, TC
I think it’s down to your choice and how symptomatic you were when those episodes occurred. I always found Flutter far more symptomatic than AF and from the people I know who started with Flutter, many ended up with AF as well because they went the drugs route, progressively more frequent and troubling episodes and for that reason alone, I would strongly recommend going for the ablation earlier rather than later.
As Threecats says - the ablation for Flutter is much more straightforward and usually quicker.
Good Morning Greenoreos2, you may find our 'Atrial Flutter Patient Information' Booklet helpful here: heartrhythmalliance.org/afa... it mentions that sometimes doctors recommend ablation as the first treatment for Atrial Flutter and that it is highly effective. The procedure is shorter, safer and more successful than ablation for Atrial Fibrilliation and can often be undertaken as a day case. The booklet also explains about the drug treatments as well as cardioversion for Atrial Flutter. If you have any questions or would like some further advice or support please feel free to contact our Patient Services Team on 01789 867 502 or email info@afa.org.uk
I don’t know what the answer is but my cardiologist recommended Ablation as soon as he a clear diagnosis of AFIB and because I had at done right away I was told it supposed to improve the results.I jumped on it immediately and happy so far that I did,don’t know how the group feels
As has been stated, AFlutter ablation is much easier to ablate and has a considerably higher success rate. Having suffered hugely with A flutter( as well as AF) , i would advise going with the ablation and get this sorted thereby hopefully avoiding the drug roundabout.
Im guessing it would depend if the flutters are constant or intermittent?
they are intermittent
I developed renentrant Atrial flutter post AFib ablation, caused by the flecainide I was still taking for the AFib in the blanking period.
Apart from the high heart rate typical 165bpm, I was asymptomatic in AFib. In AFlutter I was breathless on any minor physical activity. Eg walking to the kitchen for a brew. In flutter I was a constant 140bpm as I was rate controlled by the diltiazem I was taking for the AFib. I was like that for a month whilst another ablation was arranged . That ablation I was advised was statistically 90% plus successful and was informed that if successful it was very unlikely it would return. I was also advised it was an easier and much safer procedure on the right side of the heart so no going through the septum. My ablation was 100% fine and I have not has flutter since. (Feb 2018).
Please note flutter can very rarely appear in the left atria . I have no knowledge of that.
The fact that you are asking the question (and without more info) I would say postpone the ablation for a year but go on the waiting list. If the drugs don't work at least you are in the queue, if they do you can always decline the offer when you are called.
I had this in 2019, but mine was, by then, persistent and very symptomatic. I was told it was very difficult to treat with drugs and beta-blockers did very little, even with 10mg bisoprolol. Eventually I was tried on digoxin (flowing a tip from a very helpful member, here). This worked well and reduced the heart rate well, although sometimes too well. The ablation was the best thing, though, even though two years on I still get some milder arrhythmia issues, there is no AFl.
Steve
not in my opinion,flutter is resistant to medication and gets worse the longer you have it. The strain on your heart increases with the rapid rate.
Ablation is 95/99% effective and quick to do. I had mine done,along with AFib 13 weeks ago,after long episodes of both ,NSR since x
I was diagnosed with Paroxysmal Afib over ten years ago. I have been taking Flecainide ever since. I once considered getting an ablation. My Cardiologists reply was plain and simple. " You responded to Flecainide very well. It has kept your afib in check. Why would you prefer to allow someone to burn holes in your heart, instead?" He then explained that one out of three ablations result in failure. He also said, that there is a lot of money to be earned, by those who espouse the procedure.
Thank you. Ten years is a long time. And I am thinking after much research that some people like me do well on it. In fact its considered a lifetime medication, whether its something taken every day or only when there's an incident. Since mine are Paroxysmal, and in the past happened like every month or every other month (I can feel it when it happens) then maybe I could be taken down to using it only when needed. Talked with someone last night in fact whom, while taking flec every day made her miserable, is not taking it "pill in the pocket" for onset since (and I didn't know this before) flec kicks in 2-4 hours after the attack starts! Read this on a blog about afib from someone who has it:
"Some patients who only have infrequent episodes of atrial fibrillation, called paroxysmal atrial fibrillation, may not need to take flecainide every day. They may be able to use what is called the “pill-in-the-pocket” approach.
This is where you carry your medication with you at all times, but only take a dose when you feel heart palpitations that signal that you are having an episode of atrial fibrillation.
Studies have found that this can be very effective for some patients. It can minimize the risk of side effects, keep medication costs down, and help you feel more in control of your atrial fibrillation. This approach can also reduce ER visits and hospital stays.
The most commonly used dose of flecainide for a pill-in-the pocket technique is 200-300mg for a single dose.
It’s not right for everyone, so talk to your doctor to find out if your might be a candidate for the pill in the pocket technique and to find out which doseage of flecainide is best for you."
I never heard of that before and I wonder if this would be good for someone like me.
I originally took 50mg twice daily, then I had occasional outbreaks, so five years ago the Doc upped my dosage to 100 mg daily. I haven't had one since. My Doc here in Germany has said, it might be an idea to lower my dosage again, I'm not so sure. .However I often have days where I feel very out of it. Have just started wondering if that could be the flec. By the way, when I took it for the first time in the Hospital, my afib abated withing twenty minutes of taking the first dose. As far as the pill in the pocket approach, I would be scared to take such a high dose, even just once
NHS surgeons are paid same rate whether they prescribe drugs or perform surgery.
I was sucessful at controlling AFib and Flutter on Flecanide and small dose biso. But it got me in the end! After 2 x5-6 weeks of 24/7 arrthymias ,I was very glad to be shoved up the queue to ablation. 100 % NSR except for one short episode due to stupidly getting dehydrayted.
I too was suspicious of ablation until I just did not respond any more.
If it keeps you steady ,brilliant. It ddcwork for for years.
Best wishes
I would try meds first. My mother who has Afib the hospital suggested ablation. I went against it. They put her on Multaq and now she off that also. She currently on metoprolol. One doctor told me the best remedy is keep the magnesium, vitamins and electrolytes at optimal levels. Do breathing exercises and reduce stress and anxiety. Acupuncture is another option
I take flec and metoprolol. I used to be on multaq (recently) and had to stop. Made me VERY sick. I also began using Magnesium about 2 months ago, but for sleep. I'm not sure if I'm in the right dose range, hoping they look. I just this week began the Mediterranean diet and as soon as I get my new drs okay, will be back in cardio rehab.
Hey! I began using Magnesium for sleep and it worked well. What I didn't know is that Mag. is great for those with afib but they said it was more for in-hospital intravenously to help convert. Of course those were medical papers and studies for in-hospital treatment. Do you know what the safe dose of magnesium would be for afib?
my mom was previously taking 450mg of magnesium. Now she takes 300mg. We get her magnesium checked during her routine blood work. Which is whenever her doc order blood test.
Also we get her electrolytes blood test done to make sure they are optimal. Electrolytes and magnesium both are important for afib.
Regarding flec I have no knowledge about this tablet.
I think some answers on here are confusing afib with aflutter . I was diagnosed with permanent aflutter in 2006 tried all drugs nothing worked only cardioversion which I had many times. I had an ablation in 2008 which has cured the aflutter but found out I suffer from proxy afib and still do after an ablation in 2010. My understanding is that aflutter doesn’t respond well to drugs but ablation is very successful compared to Afib and that proved right for me.
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