Do cigars seem to trigger A flutter?

[fgrizzly]

70 year old male, with an occasional flutter and AVNRT, and having intermittent episodes of supra ventricular tachycardia and considering ablation rather than flecainide and metoprolol. My heart is structurally sound, no blockages and no other meds. I enjoy an un-inhaled cigar on the golf course. Has anyone had experience with this? Please, don't automatically group a cigar with cigarette risk, just wondering if there are other occasional cigar smokers who have experience with this as a trigger for their events?

[mjames1]

You didn't mention if your Cigar smoking a trigger for you or not? We all have different triggers.

As you probably know, the good news is that ablations for typical flutter and AVNRT have a 95% success rate.

On the other hand, if you have any history of afib, sometimes ablating atrial flutter, only, will increase your Afib burden. That's why in many cases they will do an a fib ablation at the same time as an a flutter ablation.

Jim

[fgrizzly in reply to mjames1]

Thank you for the reply. I can't seem to find any pattern to a trigger. Can hit in bed, or sitting totally relaxed, driving or has happened after the occasional cigar and accompanying small amount of whiskey, but definitely not always. And yes, I believe they are considering a 'double' ablation, so am guessing that is what you are referring to. I am waiting on a consult with the cardiologist to discuss it. I have heard after certain types of ablation, if it does return in the future, you cannot go back to meds like flecainide, and the only option is pacing, do you know if that's true?

[mjames1 in reply to fgrizzly]

That could be the case, or the double ablation could simply be an aflutter ablation and an SVT ablation. both of these are on the right side of the heart and are less invasive than than an atrial fibrillation ablation, on the left side, with a success rate of around 95% versus 60-80% for an afib ablation

I think requiring a pacemaker is a worst case scenario with a very low statistical chance. That said it's very important to find a highly experienced electrophysiologist who has done thousands of ablations, not hundreds. The AVRT ablation in particular is very close to the AV node and there is a very small chance that if they get too close to the node, you might end up with the pacemaker. Again statistically, rare but more common with less experience operators. Here if you can find someone to use Cryo near the AV node, it may be safer.

Meanwhile you say your burden is not very great, so you could just ride it out and sometimes AVNRT burns out by itself, but usually not atrial flutter. You can also try different medication's under the supervision of an electrophysiologist.

More so with AVNRT snd less so with atrial flutter, I have found the "modified Valsalva maneuver" very helpful to self terminate an episode. You can look it up on YouTube.

Best to be done with a partner, but I've done it myself many times just lying on my back and elevating my legs and something like a share or couch. And in your case it could be a golf cart and I guarantee you will be the talk of the golf course. 😄

Jim

[Karendeena in reply to mjames1]

I had both afib and flutter ablated together 🤞 so far so good apart from other blips during recovery

[Blearyeyed]

There isn't as much specific study of cigar inhalation into the mouth or lungs in contrast to cigarette smoking but what has been discussed points to cigar consumption causing the same potential risks of triggering aFib and increasing aFib events.The reason for this is partly because of the Nicotine and other antigens which still enters the cellular wall of oral tissues and therefore can have a similar impact on platelet aggregation and atrial fibrosis because it still enters the blood stream.

Oral walls and the moisture in the mouth makes the boundary between tissues and the blood stream semi permeable and that's why things like GTN spray or sublingual drugs ( pill that dissolves under the tongue) that are taken in via the mouth pass into the bloodstream so quickly and are so effective.

Holding smoke in your mouth can mean you ingest chemicals in it just as a person does with any inhalant or sublingual medication.

Any smoke is classed as being inhaled if it's taken into the mouth as some of it inevitably makes it's way down the airway and into the lungs. Reduced oxygen volume , even for a short time can affect a sensitive vagus nerve which is part of aFib and Arrhythmias occurring , not just the heart itself, and this can also trigger an episode.

aFib , itself, may not happen every time that you smoke but the process of smoking, even cigars, increases the risk of aFib over time.

You are more likely to have an aFib event if your cigar appreciation is done at the same time as drinking alcohol.

Alcohol has a significant impact on the vagal nerve too. The vagas nerve is actually very sensitive to alcohol intake and even the odd glass can cause vagus stimulation which can trigger aFib attacks.

Each individual alcoholic drink you have in one drinking session increases the risk of an aFib episode by 8% according to studies.

Which is why, in some cases, people can have an almost instantaneous aFib reaction to a glass of vino or a once much loved night cap.

These are some of the main reasons that quitting any type of tobacco consumption and reducing , or preferably stopping alcohol completely, is a great way to reduce your risk of developing aFib or the number of aFib events you have , as well as helping to reduce other cardiac and stroke risks.

[fgrizzly in reply to Blearyeyed]

Thank you for the well thought out reply!

[Abbyroza]

I don’t smoke, so I have no experience with cigars, but one of my best friends smokes cigarillos and he’s a retired cardiologist. He gets paroxysmal Afib from time to time and takes Flecainide and Bisoprolol to end the episodes. So do I, I take 200 mg of slow-acting Flecainide and when Afib breaks through, I take another 200 mg of fast-acting Flecainide. This combination will get me back in sinus rhythm within 2 to 4 hours.

I do not consider ablation as an option, and neither does my friend cardiologists, because of the invasive nature of the procedure, in combination with a less than stellar succes rate and quite high risk of complications.

All the best!