Anyone have a failed Aflutter Ablation?

[mjames1]

I had a typical (right-sided) aflutter ablation in January. Success rate is greater than 90%, but apparently I fell into the unlucky 10% (:

Two weeks after the ablation, had a flutter episode. Since there is no "blanking" for flutter ablations, my ep and myself agreed it either didn't work, or my flutter was coming from somewhere else (left side), although unlikely.

Had an afib PVI Cryo ablation almost 9 weeks ago. They did "check" the flutter line and said it was "intact". However, they did not re-do it. I should have insisted pre-op, but try telling an ep how to do their business

I had been hoping the PVI alone would take care of the flutter, but it did not. This morning had a 15 minute flutter episode. I know I'm still in "blanking" from my afib ablation, but this felt too much like my old "friend" going back four years. My gut tells me it's the same flutter, not new, not blanking. And my Kardia 6L told me the same thing.

So if the flutter keeps coming back, I will have to make a decision. Live with it, or re-do the flutter line on the right side, hoping that's where it is. Have no desire for hunt around the left side for it now, as here in the US, the left side is always done under General Anesthesia, of which I'm not a big fan.

So anyone have an unsuccessful typical right-sided flutter ablation? And if so, what were the next steps?

Oh, the good news The flutter didn't convert into afib, which it has a tendency to do. So still hopeful that at least the PVI part of my Cryo worked. As Roseanne Roseannadanna, of Saturday Night Live fame, used to say, "If it's not one thing, It's another"

Jim

[mav7]

Not familiar with aflutter at all. But in researching afib, I have read (true or not) that like afib, there is no absolute cure for aflutter. But again, this is just reading articles on the same publication as afib.

Like BobD often says, the key may be the effect on your quality of life. And of course and most important the effect on your health.

You previously stated you carefully researched your doctors. So their advice for the path forward should be the best.

Best to You in managing the condition.

[CDreamer]

Sorry you are still getting the Flutter, I had mixed flutter/Afib but occasional bouts of only Ffl and have to say that it made me feel much worse than AF.

Mine seems mostly under control now but I have a friend who’s Afl is still around after 2 ablations and is still a problem which they live with and take drugs. My own view (not expressed to them) was that was somewhat predictable as the person did not adjust their lifestyle and more than often the bouts happened after a heavy night drinking and then stressing themselves with either over exercise or work.

I’m sure you know the drill regards lifestyle and Sorry cannot be more helpful.

[mjames1 in reply to CDreamer]

Glad your flutter got under control. My episodes so far are fairly short -- under 15 minutes -- but put me out of commission fo the rest of the day If they persist, at some point I will have to decide whether to live with them or go back under the "knife". Oh yeah, I know the lifestyle "drill" well and may dig deeper. When western medicine lets us down, which happens, going more holistic makes sense, including lifestyle and beyond.

Jim

[petmice]

I understand your frustration with a medical procedure that doesn't do what you expected it to do. I had an ablation for my flutter in April 2022. By June, I felt very unwell and my heart monitor was still showing some fluttering (plus some afib!). My EP said my heart might still be healing and had me undergo a stress test (which I failed spectacularly). I stopped worrying about my flutter two days later when I (lucky me) thought I was having a heart attack, which the ER doctor said was afib (perhaps triggered by that stress test). My heart has been quiet since an ablation for the afib in February.

Before we were interrupted by afib, my EP said those unlucky enough to be in the 10% failure group are in it because the first ablation missed part of the faulty flutter pathway. My choices were: 1) increase my diltiazem dosage (which we did, but it didn't help), 2) try a more dangerous medication that required a hospital stay to start, or 3) repeat the ablation. Had afib not gotten in the way, I would have chosen #3 and repeated the flutter ablation. (I prefer to avoid medication, especially if I have to be on it long term because I wonder what my options are if it loses its effectiveness over time. By choosing the ablation, I have the option of adding medication again if it's needed in the future.)

[mjames1 in reply to petmice]

Best news is that you're doing better Yes, it might require a re-do, but without going inside, can't say for certainty that the issue was "missed part of the faulty flutter pathway" or that the flutter is coming from elsewhere on the left side. Let's hope you don't have to find out. As to meds, Diltiazem never did anything to prevent my flutter episodes, really only useful to bring rate down. Flecainide, on the other hand, does prevent them for me.

Jim

[SeanJax]

I don't know if you are based in UK or US. IMHO, your flutter might come from the left side, most likely LAA or the coronary sinus and you would need another ep who is well versed in ablating left side aflutter. As you already knew Aflutter does not respond well with medication. If I were you I would not stick with the same ep. A good mapping by a good ep will let them know it if left side or right side. Best wishes.

[mjames1]

I'm from the US. Yes, the two possibilities are that even though the CTI line was checked --twice-- it still may need re-doing. The other like you said-- and maybe more likely -- is that it's coming from the left atrial wall and/or LAA.

Unfortunately, here in the US, everything on the left side is done under General Anesthesia, which I am reluctant to do -- so unless I find an outlier ep, probably would take another crack at the right side if necessary -- or maybe visit your side of the Pond! I've only had one or two short flutter episodes while on daily Flecainde, but my goal is to be drug free

Jim

[lovetogarden in reply to mjames1]

Interesting, I’m also in the US and have had 3 PVI (and assorted flutter) ablations, all under conscious sedation. No GA.

[bobbyp28 in reply to lovetogarden]

Loveto. What is a PVI? Thx

[mjames1 in reply to bobbyp28]

Pulmonary Vein Isolation with is the basic ablation for afib.

[Mogirl]

I have had 3 failed Atrial Flutter ablations. I finally had to have a total AV Node ablation to prevent my ventricular rate from staying above 120. My Aflutter came about when I had my mitral valve repaired (an annuloplasty done) apparently the impulse hit the scar tissue from the surgery and then would go into a loop and beat very fast.

I pray that you will get relief!

[bobbyp28 in reply to Mogirl]

Mogirl. So did the av node ablation work???? Thx