I (60m) noticed and then was diagnosed for typical right atrial flutter which I can often (not always) trigger with exercise if my HR approaches 140. If it triggers my rate jumps almost instantly to 150 and that becomes a floor - but it can go higher - with continued exertion to 165. during this, I feel distinctly less energetic.
If I stop the exercise the flutter continues for up to 5 minutes, then normality returns
I believe this is an adrenaline trigger, it has not happened in other daily scenarios like sleep work, walking, stress or whatever.
I have been scheduled for an ablation but have cold feet. I read that flutter is sort of an organized afib. It starts as a short afib then organizes to circular signal. Ablation will fix flutter, but can uncover the afib. Also I read that afib in general may be triggered by chronic body inflammation. For example, inflammation from excessive training. (muscle damage and so on).
Am worrying if ablation is a blunt instrument and I may regret doing it. I can still jog under flutter. But with reduced performance. I can run less often, or run slower, or less duration, and maybe not trigger it. For example I have raced a 5k without entering flutter but jogged “easy” for an hour, and have entered flutter.. No coffee, rested, morning? seems to help stave it off. Tired, afternoons, maybe overtraining, appears more reliably.
Should I defer the “solution”, maybe try life changes, before jumping at an ablation? Ablation for flutter has a high success rate but it is unclear to me what happens after 3 5 or more years. I do not want to be in for a second ablation or uncover afib which would definitely end a run immediately!
The electro cardiac specialist was basically like well you can try a drug but you probably wont like it, so we can do this procedure, it has a 99% success rate. He didn't really want to discuss possible triggers, trying lifestyle changes first, the relationship to afib, etc.
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Ablation will fix flutter, but can uncover the afib.
That's a good point, but in general there would have to be afib coexisting with the flutter, which is not always the case. That's why thorough monitoring -- not just a 24 hour holter -- is important to see if you have both afib and flutter, or flutter alone. If flutter alone, a typical right sided flutter ablation should solve your problem. If you have elements of both, then the flutter might be solved but now afib can become dominant. For that reason, people with both flutter and afib usually have an afib PVI ablation (left side) done at the same time as the right-sided flutter ablation.
If your only trigger is when your HR goes above 140, have you considered altering your workouts so that it doesn't? At 60 years old, you can get your heart in excellent shape working out in the 120-130 range, or even lower following other exercise protocols, including the Maffetone Method.
As to medications, you could try beta blockers, either daily, or on your run days, but if they don't work, then you're stuck with daily anti-arrythmics like Flecainide which have to be taken with a daily nodal blocker (beta blocker or diltiazem), so now you have two extra drugs in your system every day.
thanks, I am unclear whether any afib was spotted, the totality of evidence was a single treadmill stress ekg (ectopic beats then flutter noted at end of test) and 24 hour monitor (pressed the button on a run when hr went to 150). Plus they asked if I had experienced any other symptoms (no).
absolutely I can run slow, discard my hopes to push in a half marathon, slow down training from 6 days a week now, to 3. Cross train more. Maybe confine myself to 5k where the exertion is over before it really gets going. That would be sad for my dreams of new PBs (did not even start running until last year so PBs are still easy) however the bonus is avoiding a procedure with risks, albeit low, of complications. My spider senses are tingling because the doc is being a little too breezy about the ablation vs avoiding triggering it. Maybe the majority of people he sees are in the position of desperation for a fix, though, so I am in their funnel.
Also I read something else about ablation diminishing the nerve signals that give one a low resting heart rate. I am proud of my resting hr of 40 and if post ablation it is 60 or 70, will feel like I lost something. This is probably stupid though!
I understand your reluctance to stop/modify your training and forgo some PBs, but I would do some soul searching about what you really want to accomplish with the fitness program you are on.
There is a big misconception that good fitness equals good health. In reality, you can be fit but unhealthy, as too much exercise can impact the heart and other organs as much as too little exercise. That's one reason why so many marathon runners end up as afib patients.
Too good reads on this subject are Dr. John Mandrola's "Haywire Heart" and "The Maffetone Method" by Paul Maffetone.
On the other hand, if the joy of running and training hard are what gives you joy in life, by all means do it, but then accept the consequences, especially given your current arryhmia's.
Meanwhile, you might think about getting a Kardia 6L, which would allow you to capture some of these episodes for identification purposes.
I read the kardia 6L doesn't do flutter alerts though it does capture enough to spot it? have certainly pondered it however at the moment I am 99% sure that I know when it starts and the garmin shows my hr at 151 then.
Just finished a pleasant jog for 7 kms and deliberately moderated exertion to average 120 bpm, slowing when it wandered into 130s. Success. No flutter. But its really difficult to resist the temptation to go faster. And long hills are gonna be a problem.
But its really difficult to resist the temptation to go faster. And long hills are gonna be a problem.
Problem? It's called WALKING up the hill. 😀 Done it myself, no shame. Who is keeping tabs?
You are going to eventually have to make a decision whether you want to chase PB's or get control of your flutter, or whatever else is going on. Because if you don't moderate your activity, then ablation might be less of an option and more of a necessity. So read those books I recommended as they explain the reasons for a more moderate approach to excersise better than I can!
Kardia doesn't tag "flutter" but the ekg itself will show it. You can email it to your doctor or easily learn to interpret it yourself. Flutter is pretty easy to differentiate from afib on an ekg. And that's why I recommended the 6L version, because the extra leads will help with non-afib type tachycardia's like flutter.
I'll put a copy and paste below - which may or may not help!
Good luck with whatever you decide.
Paul
It sounds like you're facing a challenging decision regarding your atrial flutter and the potential ablation procedure. Here are some considerations to help you weigh your options:
Understanding the Condition: It's commendable that you've taken the initiative to learn about your condition. Atrial flutter is indeed a structured form of abnormal heart rhythm, and ablation is a common treatment option.
Risks and Benefits of Ablation: While ablation can be highly effective in treating atrial flutter, it's essential to acknowledge the potential risks and long-term outcomes. Ablation can sometimes trigger atrial fibrillation (AFib), and there may be other unforeseen complications.
Lifestyle Changes: Exploring lifestyle modifications, such as adjusting your exercise routine, managing stress levels, and monitoring inflammation, can be beneficial. These changes might help reduce the frequency or severity of your symptoms. However, it's essential to discuss these options with your doc to ensure they align with your overall treatment plan.
Medication as an Alternative: While you mentioned that medication wasn't initially favoured by your specialist, it might be worth reconsidering in conjunction with lifestyle changes. Medications can help control heart rhythm and rate, potentially reducing the need for invasive procedures.
Long-Term Outlook: It's understandable to be concerned about the future and the possibility of needing additional interventions. While ablation may offer immediate relief, it's essential to discuss with your doc the likelihood of recurrence and the need for further treatment down the line.
Second Opinions: Seeking a second opinion from another cardiac specialist might provide additional insights and perspectives on your condition and potential treatment options. Another specialist may have a different approach or be more open to discussing alternative treatments and lifestyle modifications.
Ultimately, the decision to undergo ablation or pursue alternative treatments should be based on a thorough understanding of your condition, careful consideration of the risks and benefits, and discussions with your doctor. It's essential to advocate for yourself and ensure that you're comfortable with the chosen course of action.
I’m with secondtry - consider adjusting your exercise regime and although it may be sad to ‘abandon’ your dreams - least you will be able to still exercise. Wearing a HR monitor and keeping HR down to 120-130 really does help.
What makes you think it is adrenaline stimulated rather than vagal? Exercise or rest induced AF tends to be vagal however that applies to AF and I don’t know about AFl. I had a mix of both. 2 ablations - first made things a lot worse, second gave me 3 years free of AF although the AFl could not be ablated but interestingly I’ve hardly had it since.
Ablation for many of us takes time to recover from, is often not a forever solution and sometimes makes things worse. Having said that for some younger people who are very fit it is their solution enabling them to return to competitive exercise. My old EP team felt that anyone over 45 had a lower risk of ablation being completely successful with a higher risk of complications - but that’s just one opinion based on experience.
Several eminent athletes who are also EP cardiologists have written about this dilemma and from memory, all recommend adjusting exercise regimes - whether or not you go for ablation.
I did some digging on types of afib - vagal etc - - and figured the closest match was adrenaline as its what happens in fight or flight : interestingly sometimes the flutter starts when I stop for a quick drink at a bubbler! maybe some primitive chemical reflex after running for a while. Just figured the afib types map to flutter types and it was the one that best fit. But yeah I dont know and doc has not classified it.
And that is the problem, really difficult to define types. I worked out I had a mix of both. All I know from experience that I used to have nocturnal AF and episodes were also triggered by exercise when HR exceeded 120, now even 100 as I have aged plus any infection = inflammation = episode plus stress. Exercise was vagal so working on improving vagal tone helped and stopping all HR medications, especially Beta Blockers which messed with my ANS response. Nocturnal AF turned out to be sleep apnea - disappeared as soon as treated and the fact. I really had to be my own detective and sounds as though you are similar. Good luck.
If you have underlying AFib it will raise its head eventually. Flutter is resistant to medication and the very high success rate of ablating is tge best solution. I had it done in 2022 and nothing since.
AFib can only be 'uncovered' if it is already there, but in any case,ablation or rythym medication can be used
I have considered ablation myself, as my first cardiologist who treated me after my heart attack mentioned it immediately.
After that massive attack, I did every possible thing in my power to limit the damage to and remodeling of my heart muscle, by cardio-training and medication. The damage therefore is surprisingly limited and I’m still exercising vigorously every day to keep it hat way. That is one of the reasons I have decided not to go the ablation route: I would feel very uncomfortable having my heart damaged on purpose, to treat a non-mortal condition. Moreover, one of my best friends is a retired cardiologist, who also has Afib, and he agrees with me wholeheartedly. I know that ablation can be succesful, but the succes rate of 60 to 70 % for the first one is not very appealing to me, and the risk of approx. 1 chance in 500 to suffer serious side effects and unforseen damage to heart and oesophagus is too high for my standards, not to mention the high dose of radiation involved.
So I’ll stick with Flecainide and Bisoprolol for the time being. It keeps me out of Afib and I do power lifting daily, combined with sauna and ice cold baths.
I call deliberately burning spots in heart tissue (be it by heat or extreme cold) damaging. So does every cardiologist that I have met. Irreparable damage moreover.
I had much the same as you in the spring of 2019. I was walking happily up some stairs when my heart rate shot up and I ended up with what seemed like a panic attack lying on bed panting and in great fear that I was having a heart attack. And yet it eventually calmed and went away. My GP said it was likely my anxious nature and gastric issues (hiatus hernia and reflux). That made sense.
Then, about a month later while walking up some stairs in the Bodleian Library in Oxford to view an art exhibition, and thus ruining a wonderful day out with my son, the same happened but with less force. I was packed off to see an emergency GP, who found I had tachycardia of 155bpm, but despite which, I managed to drive home but did follow his orders to go straight on arrival to A&E, where I was lucky to find a cardiology registrar was on duty who fascinated by my case. It was atrial flutter.
How yours goes from 150bpm to 165bpm interests me as in my case my heart rate followed the typical flutter pattern of being allowed only step-wise rate changes between ratios of the atrial pulse of 300bpm. I guess yours is a mix of AF and AFl for that to happen? I wouldn't have dared (or even been able to) push mine harder for fear of 1:1 conduction. I was more debilitated than you are by far, perhaps owing to stress reaction? I don't know. Bisoprolol, even up to 10mg wouldn't lower the rate below 3:1 (100bpm), but then digoxin was recommended by someone here and that took me to 5:1 and a manageable rate of 60bpm.
To cut a long story short, I saw a heart specialist who said that I couldn't take flecainide or sotalol because of what the flutter was doing, so it was stick with what I was on, move to low-dose amiodarone, or have an ablation. This latter became a possibility quicker than I thought and did all that was hoped for it, and the AFl stopped.
Sadly, AF then came my way once the beta-blocker was stopped following the ablation and has eventually encroached more and more over the following five years but not with excessive symptoms, so far, thankfully.
If I were you, I would, and given the way you seem able to cope well with it all, as well as in the knowledge that your ventricles are safe from all this upstairs' chaos, likely manage the condition without drugs or ablation for another year or so. I would then weigh things up at and, after another echo or whatever scan you can get (a stress cardiac MRI being the gold standard), reconsider the possibility of an ablation. The treatments don't cure the root of the problem and might reasonably be viewed as quite a crude hammer to crack a nut.
I play loads of sport and suffered with episodes regularly then my knee went so haven’t done anything for approx a month and have had no episodes since 19th March. Proves to me exercise triggers my AF 😫
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but yes, thanks ! it makes sense.
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