I a have question about Aflutter. My brother who has just been diagnosed with MND ( motor neurone disease) developed Aflutter. He had an ablation under sedation for it 4 days ago. Yesterday his heart was jumping about all over the place. Is this part of the healing process? I had heard that Aflutter ablation is simpler and is cured straight away. He left the hospital with a HR of 70 bpm. I had an RF ablation for arrythmia so don't know if it is also a bit bumpy after (like it was for me ) while scar tissue forms. Or has he perhaps developed Afib?
I'd be grateful for any of your Aflutter feedback.
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It's not unusual for an aflutter ablation to uncover underlying afib, so that might be what is going on, but unless you have an ekg, "jumping all over the place" does not have much meaning. Could be many things. You might want to invest in a home Kardia advice and document exactly what is going on so you can share with your doctor.
Thanks for replying . The post was about my brother not me. He developed Aflutter after he was diagnosed with MND. But it may be a good idea for him to get a Kardia to inform the cardiologist .
I'm trying to get a straight answer from my ep on this very question. The literature on typical aflutter ablation recovery is sparse compared to afib recovery. The procedures are not the same at all. Jim
The mechanics of making scar tissue is the same even if the septum is not punctured. Scar tissue take time to form so there will always be some recovery period.
Yes, of course there will be some recovery period, but the specific issue at hand is will that recovery period include typical aflutter like the recovery period for a PVI may include afib. This is not at all clear to me yet from scouring the literature and getting anecdotal from forums like this. The other thing is that aflutter can also come from the left side (atypical flutter) which will not be cured by a typical flutter ablation (right side). Jim
I'll try to explain Jim. the process of ablation is designed to create scar tissue which acts as a block to an electrical impulse across which it can't travel. Since scar tissue is the result of damage caused by (in this case) heat from RF radiation then it does take time to form. Until then the impulses are free to cross. As the area to ablate for flutter is less than for AF then the time frame may well be less but equally there may well still be a recovery period.
Thanks Bob, but again, I do not dispute a recovery period. My point was specific to the recurrence of typical flutter after a successful typical flutter ablation. Some ep's apparently have told their patients there is no blanking period. Others may have said the opposite. While the afib blanking period is well documented, I have not seen much literature either way specific to a blanking period with aflutter ablation.
What you say sounds like a logical extrapolation from afib ablation data, but extrapolations do not always work in medicine. If you have any literature to this specific point, please post. My jury is not in one way or the other, still looking. Jim
Yes it is confusing. If you look at Steve's reply his dr told him there is no blanking period after AFL ablation so if the medi
cs can't agree it is not easy for the rest of us to get a real answer. But all in all I favour the idea of ( as Bob said) a shorter blanking period but nonetheless a blanking period while scar tissue forms. But also that it can provoke Afib after in some cases.
A typical aflutter ablation uncovering underlying afib is well documented and common. The point in contention was whether there is a so-called blanking period after a typical aflutter ablation where typical flutter occurs. So far, we have heard different opinions here, some second hand from ep's, some from members, and the opinions are conflicting. So far, no studies or literature. I am still waiting for another opinion from my ep to add to the mix. Compare this to the blanking period after an afib ablation, where there is universal agreement and much supporting literature. Sometimes there is no simple answer.
Yes I just saw your post from 5 days ago. So in fact it is a bit of a misty area. I told my brother that it is normal while scar tissue forms but it's true the jury is out. Some people say there is no blanking period after Aflutter ablation but I think there must be as there is still scar tissue that needs to form . I think my brother is an a- typical case as the disease affects muscles so he may have developed other rhythm problems as hist heart is affected by the MND
I like "misty". To clarify, "atypical flutter" is a specific medical term, referring to aflutter coming from the left side of the heart. It does not get cured by what is termed a "typical aflutter ablation" which is done on the right side of the heart. Unless they can reproduce the flutter in the cath lab, there is no way of knowing which side of the heart it is coming from. Jim
A little beyond my pay grade, but I'll answer as best I can. Yes, a lot of the times the doctor isn't sure where the aflutter is coming from, so in an ideal scenario, the ep will try and reproduce the flutter before ablating. In this scenario, if they find it coming from the right side, they will ablate only the flutter line. This is called a typical aflutter ablation. On the other hand, if they find the flutter coming from the left side, they will cross over to the left and do what may amount to a PVI. A much larger and more time consuming procedure which may involve a different kind of sedation.
In practice, however, they may not be able to induce anything, so they perform what is called an empirical typical aflutter ablation. By "empirical" we mean, based on the supposition (rather than proof) that the flutter is coming from the right side. Empirical ablations are performed with afib all the time where they can't trigger the afib but ablate anyway.
Or, let's say they ARE able to induce the flutter on the left side, but they are not equipped or staffed or given advance consent for the larger left-sided atypical ablation procedure. Then they might just stop the procedure at that point and reschedule the atypical ablation for another time, probably combining it with a full PVI.
In part because of this, if you have both afib and aflutter, the current trend is to at least do a PVI, with differing opinions by ep's whether or not to ablate the flutter line empirically, or only do it if the flutter can be reproduced.
I had right side flutter and yes there is certainly a blanking period and even beyond that (eg during Covid), possible mini episodes of being ‘unsettled’. Bob’s advice is excellent and so long as it is typical flutter, then things should settle down. Always keep in touch to report any episodes to your arrhythmia nurses / consultant. Wishing your brother a successful recovery.
Is your brother taking any drugs for the flutter? I ask as I had an Afib PVI ablation , which was successful, but 9 days later developed atrial flutter. The symptoms of that were that I was extremely breathless, with a fast hr of 140bpm
I was taking flecainide rhythm control and diltiazem rate control for my AFib.
I contacted my EP who suggested I go to my local hospital so get checked (My ablation was not at my local hospital.) An ECG was done in A&E. Unfortunately Afib was diagnosed, and after contacting my EP my flecainide was increased to try to cadiovert me. A couple of hours later I was more breathless and my heart was VERY bumpy.
I was admitted to the medical assessment unit, where a second ECG was done and examined by cardiology. Rate controlled re-entrant atrial flutter at 140bpm .was diagnosed. The flecainide dose was reduced and the apparent "bumpiness" was eliminated (many hours later) .
Contrary to other answers I believe my EP knew, or was very certain it was typical atrial flutter from the ECG (Maybe because it was reentrant?) and an ablation was planned for that a few weeks later, which stopped the flutter. This was 5 years ago.
His ablation was for Flutter not Afib so my post was really about post ablation recovery after A flutter ablation. I know that after an ablation for AFib , Flutter can sometimes develope but was just wondering what to expect after an AFl ablation. Thank you for replying.
I had flutter and afib ablated at the same time. I had right sided flutter,identified by my EP long before I got my date in June 2022.To date I have had no flutter at all,not once.I expected to but none.
I have had only 2 episodes of fib ( that I am aware of)
I am wondering if the diagnosis of MND is significant in some way?
I feel I would be suggesting brother to contact the hospital or any back up he was given( arrthymia nurse etc)
Yes I had Afib and Aflutter done at the same time ( as a precaution- I didn't have Flutter before the ablation). I think his rhythm problems are being provoked by the effect of the MND on his muscles including his heart. How are you doing now? Are you still on meds?
Had my follow up eventually! I told him I had been fine ,except when provoked into that long episode of Afib by idiot GP suddenly stopping flec.He was aghast and said I was to stay on until next clinic to ensure nsr well established. If I had not followed Gp advice would be off now..grr.
The same for me but it was EP who stopped all drugs ( except anticoags) immediately after my ablation. It was very bumpy and I was put back on drugs again. All well now. I shall keep my fingers crossed for success for both of us.Happy New Year!
I was told that, unlike with AF ablation, there is no blanking (i.e. recovery) period for the AFl procedure, but that it can uncover other arrhythmias. In my second week I had a really bad attack of AF, for example, but it was easily controlled with a beta blocker. Since then I have had regular ectopic beats and some mild AF.
Thanks for your reply Steve. Did you have episodes of Afib before your AFL ablation or was it your ablation that provoked them?It seems there are different opinions on whether there is a blanking period after AFL ablation. That is why I asked as my experience is with RF ablation for Afib so was interested with members' AFL experience.
It was the cardiologist at Leicester who told me categorically that there can be no blanking period because of the way AFl starts and how the procedure works. That's why he stopped my beta blocker and digoxin within days but that proved a less than good move as the next thing was that attack of AF. I didn't knowingly have AF before the flutter began but I had had years of weird stuff put down as "panic" that the cardiologist suggested might well have been AF. I shall never know.
I see. So your Cardiologist said there is no blanking period after AFL ablation . Interesting. After an RF Afib ablation everone agrees there is a blanking period but it seems the opinion is mixed within the medical profession after an AFL ablation as to whether there is one. How is your Afib now ( or "weird stuff " 🙂 whatever the rhythm problems were)?
Apparently, the ablation procedure for AFl does not cause the mild inflammation of the myocardium and subsequent risk of further tachycardia or arrhythmias that the ablation for AF does (but which eventually resolves after the "blanking period"). From what I've read, there's is much that is unknown regarding this period and I seem to recall reading that any recurrence of AF during the blanking prior is a predictor of potential later recurrence.
After my single day of fast AF following my ablation in 2019, although I had no idea it was that until I got to hospital, I still found that I got a mildly fast heart rate during say, a long walk, accompanied by some chest discomfort and palpitations. The cardiologist gave me an MRI and pronounced everything was in good order and told me not to worry about my heart at all. But those symptoms never fully resolved and, in fact, worsened in January 2020 and continue today. Usually it's a racing heart (up to 130bpm) with lots of palpitations (i.e. runs of ectopic beats) and mild discomfort from below the left rib and into my back. Only on a few occasions has it registered on my Apple Watch as AF. My GP gave me bisoprolol (1.25mg) to take as I felt I needed it, and that's what I take. It does seem to calm things down after about an hour or two and I'm grateful for it. I've had to take it twice this week, for example, but sometimes weeks go by without my taking one.
Hi I had a flutter ablation last May and heart has been lumpy several times most especially after my 4th covid jab which sent me into a fib and tacky of 140 for 12 hours.Tried to get hold of arrhythmia nurse but no response for 2 days so I took a 40mg verapimil which calmed things done over an hour later.To answer you question ,it seems normal to me hang in there.
so sorry this is happening , the flutter is apparently easier to ablate - I’ve had ablation for AFib and AFlutter. I’ve had very little issue with the heart with the AFlutter ablation 6 weeks ago (the HR has speeded up and the occasional delayed beat but putting that down to continuous infections I’ve got.)
If you can, get back to the EP they’ll probably do ECG and probably US scan which is what they did with me Hope it is just a settleing down period
apparently I had AFlutter and after ablation I still had episodes for up to 2 months. Very occasionally I still have the odd short episode but otherwise much happier.
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