Atrial Flutter?

[MeganMN]

Well, I finally got a second opinion from a different EP and am almost done with a two week monitor. He is suspecting that I am also having Atrial Flutter in addition to the Atrial Tachycardia. I have never had this rhythm before,.although they randomly initiated it during the first ablation in 2021. Does anyone have any good info on flutter? Is ablation usually successful?

[mjames1]

Yes, if it's typical (right-sided) flutter, ablation is successful over 90 per cent of the time. Not sure the stats on atypical (left-sided) flutter.

Jim

[Cookie24 in reply to mjames1]

I have atypical flutter and it is harder to control. It looks like I need #4 ablation.

[BeeBee79]

I developed flutter after 2 unsuccessful ablations but my third ablation got rid of the flutter. A year on, and it’s back

[Cookie24 in reply to BeeBee79]

Do you have typical or atypical flutter?

[BeeBee79 in reply to Cookie24]

I have atypical flutter. Do you?

[Cookie24 in reply to BeeBee79]

Atypical

[Speed]

Had Flutter as first arrhythmia. Took 2 RF ablations under sedation to finally sort, last one Nov ‘21. Slightly easier procedure that for AF if typical (right side) (corrected as previously said left side) as they don’t have to go through septum from Right atrium to Left ( corrected as previously said Left Atrium to RIght A)

If you have A Tachy, they may try to do both in single procedure?

[Mugsy15 in reply to Speed]

Speed, I've read your post several times and I'm sure you have your right and left mixed up!

[Speed in reply to Mugsy15]

Yes you’re right - I will amend to avoid future confusion. Apologies.

[Mugsy15 in reply to Speed]

Ah, no apology needed; so easy to do and I only commented for clarity.

Thank you.

[jondeanp]

I was first diagnosed with AFib and had 2 cardioversions to put me back into rhythm.

While waiting for an ablation I was diagnosed with AFlutter and offered to treat both at the ablation.

I elected to go one step at a time and had the Flutter treated only.

That was in 2018 and 🤞I’ve been in NSR bar a handful of 12-24 hour blips

[wilsond]

I had atypical flutter,stopped 100% by ablation for both AF and Flutter. Tge stats for ablation success for flutter are far higher than AF ,in the High 90s.Flutter is resistant to medication treatment.

[Halfheart]

It can be difficult to see atrial flutter on a holter monitor, as it sometimes does a very good impersonation of Afib or SVT. Even cardiologists get it wrong. I thought I had Afib for years (so did my cardiologist), until a recent very obvious long run of highly regular atrial flutter finally caused the penny to drop.

The best way to be sure is to look for flutter waves on leads II or III, and to do that at home I would recommend a Kardia 6L. A holter monitor, Apple Watch, etc only captures lead I and you can't see the flutter waves on that. Another indicator is a rate close to 150 bpm, indicating flutter with 2:1 conduction (around 300bpm in the atrium, around 150bpm in the ventricle). But this can be disguised if you have a variable block, where it changes between 2:1 and 3:1 or 4:1 (giving 150bpm, 100bpm, or 75bpm) perhaps rapidly, like just a beat or two at each rate. Then it looks a lot like Afib.

If it is flutter, and especially if you don't also have Afib, there is a decent chance that it is in the right atrium and can be easily fixed with an ablation, but even if it is in the left atrium you still have a good chance (about the same as for Afib).

[Cookie24 in reply to Halfheart]

That is correct , good post

[Ppiman]

I had an ablation for it in 2019 which was, as the EP expected, a complete success. I have since developed occasional AF, which he also warned was likely!

Atrial flutter is quite hard to see on an ECG, I was told, and, in my case, required an injection to briefly halt my heart or something (!) to show it up properly as a "saw tooth" ECG.

It's a condition in which the right atrium is beating at about 300bpm, rather than randomly quivering as in AF (in the left atrium). The effect on the ventricular pacemaker is to stop a 1:1 conduction and, instead, to allow, often, 2:1 (i.e. 150bpm) conduction and so on. The rate moves step-wise between the ratios, so there's no "in-between" heart rates with flutter, generally. Mine was stuck at 155, then 105 with bisoprolol, finally down to 75 / 50 with digoxin.

The ablation is safer by far than an AF ablation, I was told, and also easier, quicker and much more certain since the errant conduction pathways are clearer and not close to any important other structures such as the pulmonary vein or oesophagus.

Steve

[Desanthony]

I have been told by some one who has had ablation for both Afib and A flutter that it works better for A flutter than Afib - although he was lucky and only had one ablation for both and is fine now.

[MeganMN]

Wow, I have so many questions for the EP now. Wonderful responses, so helpful! I really liked the new EP. He was astute enough to recognize that during my first ablation for atrial tachycardia, they initiated an unexpected atrial fibrillation and atrial flutter. He recognized that there may be more than meets the eye this time around as well. They ablated the flutter at that time, during the first SVT ablation. A year and a half later, the atrial tachycardia returned, but with a different pattern, sustained episodes of 3-6 hours. It is interesting. I never considered flutter. But the other night when I woke up from An episode, I could hear the atrium beating in a 3:1 pattern with my stethoscope. Ventricular rate was 150. I have woken up that way off and on for years, and just chocked it up to nocturnal anxiety attacks or something. Now I am wondering if it was flutter all along. Very curious.

I also did not know that the monitor had a tough time picking up the flutter and isolating it from SVT. That is very interesting. I looked into getting a Kardia, but it doesn't work with my phone. I will consider it if I can get access to a different phone! Thank you all so much for the replies! Two more days with the monitor and then I will see the EP again for review...

[MeganMN]

I read something that mentioned that only around 2 percent of atrial flutter occurs in 'normal' hearts with no disease or structural abnormality. I also read that flutter is extremely rare under age 50. Are there things I should ask my EP about just to make sure there is nothing else causing it?