Aflutter Ablation -- Blanking Period or No Blanking Period?

[mjames1]

A week ago I started a thread about my recent typical, right-sided, aflutter (AFL) ablation.

healthunlocked.com/afassoci...

Here's an update -- I finally heard back from my doctor, a senior ep at a leading teaching hospital in the U.S.

Short recap -- a few days after my ablation, I had a short episode of aflutter. The question is does this mean the ablation failed, or is it a normal part of the healing process, ie the blanking period?

My ep's view, based on his training and experience, is that unlike with an afib ablation, there is no blanking period with an AFL ablation. So, unfortunately, if my flutter episode was typical flutter, then the ablation was a unsuccessful. On the other hand, the flutter could have from the left side (atypical) but that kind of flutter cannot be helped by a typical AFL ablation.

Of course, he could be wrong (wish he is lol) but this opinion is also consistent with what one or two of our members have also heard from their ep's and I have seen nothing in the literature to contradict it.

Jim

[Teresa156]

Oh Jim,

I am just keeping my fingers and everything else crossed for you. I hope he’s wrong as well.

If he’s right, do you think you will be offered an Afib ablation and would you have it?

Teresa

[mjames1 in reply to Teresa156]

Thanks Teresa,

Be nice if he's wrong, yes, as I was hoping this would hold things for awhile, but I'm sure a PVI will be recommended. The rest is a little above my pay grade, but in addition to a PVI, I assume they will either re-do the typical flutter ablation, and/or hunt down the source of the arrhythmia I experienced, be it on the right or the left. From what I understand, they cannot even be 100% certain it's actually flutter without going back to the cath lab and even then they would need to be able to trigger and map it. Could be atach, SVT or even afib. I will see ep in a few weeks and discuss options and then come to some sort of decision.

Jim

[Teresa156 in reply to mjames1]

Hi Jim

I suppose a positive to come out of this, is they should now hopefully be able to act on it and investigate further based on what’s happening to you now and do all they can to find the root of the problem and sort it. These things are sent to try us 😊 I will keep everything crossed for you Jim.

Take care,

Teresa

[Afibflipper]

Hello mjames1 - I can only offer based on personal experience - 3 ablations between 2007 & 2022. First 2 for AFib and always had breakthrough fib that just got worse over time. This year was still continuous AFib until commenced Flecainide in April - it eventually seemed to control the AFib but changed the rhythm to an ATypical flutter which was thought to be a combination of previous ablation scars and the Flec. Was taken in for Flutter ablation as easier to target - bingo - EP having filled in gaps from previous surgeons rounds and getting the flutter sights just had a few feelings of “it’s trying to do it but didn’t succeed” in the beginning and 2 consecutive days of delayed/missed beats last week . My heart remains in NSR 6weeks later (this is great as still ill with repeated chest infections and asthma - normally the heart would be cartwheeling all over especially with the amount of Salbutamol inhaler I’m needing - but still pretty perfect heart currently 🤞

Really hope this gets sorted successfully for you soon 😊

[mjames1 in reply to Afibflipper]

Thanks for sharing your experience and glad things working out. I'm assuming your flutter ablation was on the right side for typical flutter like mine. Delayed/missed beats are pretty normal post typical aflutter ablation (even afib), but actual typical flutter is not, according to my ep and others. Then again, sorting out these arrhythmia's often seem more of a mystery than a science.

Jim

[Afibflipper in reply to mjames1]

Hi Jim, do you know they never mentioned the right side at all - I am under the impression it’s all been LA with me - they talked “filling in gaps” then ablated some of Atrial roof and back wall - all previous AFib work was done in LA! I’m thinking the AFib in the LA is the same stuff that changed to the atypical AFlutter (it wasn’t a new stand alone arrhythmia). EP as yet undecided as to whether the Flecainide needs to stay on board as feels it was that controlling the AFib which may in turn come back if it’s stopped! To be quite honest I’m actually afraid to come off it for that reason. Just need to get rid of the residual lung issues and feel well for first time in 10 months (if it’s possible) xx

[mjames1 in reply to Afibflipper]

Thanks for clarifying as I misread your previous post. Makes more sense now in "filling in the gaps" which would be on the left side for atypical flutter, which may be my issue as well. Do you know if they were able to trigger the aflutter during the procedure before ablating, or did they just ablate the usual suspects. Atypical aflutter is not unusual because of the scar tissue left after several PVI's. Glad things are looking better and hope you can get off the flecainide at some point.

Jim

[Afibflipper in reply to mjames1]

I was in a constant’s atypical flutter so I believe they did the gaps and then the rhythm did something a little strange so they went into a different area which I believe was a little convoluted/winding and as they zapped that area it all disappeared

During the after my HR went down to 40 and then up to 60 - it apparently behaved on a bisoprolol dose of 1.25 (I was on 12.5. I was upped to 2.5 which should have been fine at but left hospital HR 70 and over the next week or so it crept up to 90/100 which isn’t bad but to me with NSR now it felt uncomfortable (my GP increased it to 3.75 and we a few times went to 5 but I’m now back at 3.75 (I’ve previously tolerated 15 so wasn’t surprised had to tinker) Keep us updated how you get on hope all settles for you x

[MummyLuv]

I have no knowledge of aflutter I am afraid but wanted to wish you all the best and hope things settle down for you. X

[saulger]

Good luck, Jim.

[Ppiman]

I was told that there is no blanking period following a right-side Afl ablation but that it can unmask other arrhythmias, which mine seems to have done.

I remain feeling unsure whether the ablation did "unmask" these things or that some other cause isn't at work.

Steve

[ETHEL103]

Hi I had a flutter ablation last May

Did you ask why there is no blanking period.I wasn't told anything at St Thomas's in London..I have had several bouts of fast heart rate and even a fib after a covid jab as shown on my Kardia which I sent to arrhythmia nurse.Surely we receive the burns and that needs to heal .

[mjames1 in reply to ETHEL103]

Hi Ethel, What you describe with yourself is to be expected after a typical aflutter ablation. In fact, many have more afib after the ablation than they had before. What is not to be expected is typical atrial flutter after a flutter ablation, at least according to my ep, and some others here. Yes, we receive burns that need to heal, but that does not mean that part of the healing will be more flutter. Sounds logical, but you can't always apply lay logic to medical conditions, because we don't have the medical training.

I started this thread not to make a declarative statement but to reach out to members to see if any of their experiences are different from what I have been told. I was actually hoping to find out that their experiences contradicted what my ep said.

So I truly appreciate everyone's opinion -- such as "it makes sense since you're healing ", "if that happens with afib, it should be the same with flutter", etc. -- however so far, no one here has contradicted this point with either their own personal experience or by pointing to literature that does.

Jim

[Maggimunro]

hi there James

My first ablation for right sided SVT (supra ventricular tachycardia) was an immediate succes but they discovered during the procedure that I also had left sided Afib.

Right sided ablations are usually relatively simple, with few rogue cells to ablate.

However, one they delve into the left side of the heart it is an entirely different story since there can be literally dozens of rogue sites around the pulmonary veins. For me that meant two further ablations, but on the left side, and I’ve not had a blip since the last op in June 2017 , touch wood.

Apart from the obligatory anticoagulant, I am drug free and my quality of life is much better.

[mjames1]

Heard from a second ep who held out a little hope, using the word "possible", however his opinion is that if my recent episode was flutter, than the likely scenario is that it was typical flutter meaning the ablation was unsuccessful. Time will tell, or if not, hopefully things will get sorted out during a second ablation, where I would probably do a PVI at the same time.

Jim