I have a 16 year history of afib and for the majority of that time it was controlled through flecainide and metoprolol. An ablation in 2018 controlled it for about 8 months. In March of this year I got COVID and my paroxysmal afib shifted to constant afib. On 9/6 I had OHS to replace my bicuspid aortic valve as well as a maze procedure for afib, left atrial appendage occlusion and CAB 1x. Anyway, here close to 3 months out I knew I was not back in rhythm and told doc. They ordered a Zio monitor. Here are results:
IRHYTHM FINDINGS: Atrial Flutter occurred continuously (100% burden), ranging from 62-161 bpm (avg of 100 bpm). Atrial Flutter may be possible Atrial Tachycardia with variable block. Isolated VEs were rare (<1.0%), VE Couplets were rare (<1.0%), and no VE Triplets were present. MD notification criteria for Rapid Atrial Flutter met.
Thoughts?
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Jafib
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I’m no expert but apparently the Ablation for Flutter is separate to the one for AF. I understand the success rate is good for flutter ablations so maybe have a chat to your doctor about that
that’s definitely a possibility… I had flutter as I tried to exercise my AF back to sinus and it turnover into Flutter… CV got me back into sinus in a few minutes, easy procedure. I’ve also had 2 CV’s for AF and my most recent AF last Monday corrected with some Flecainide and an effort on my indoor bike. Better than the fuss of a CV. Mind you I checked with cardiologist first and remember just because it worked for me it might not for others.
You have to be careful and seek permission from doctor to try. Some people that have a Vagal type AF have rebooted by vigorous exercise. In my case I had 6 or 7 episodes of AF between 1993-2022 and each was reverted via exercise. Since 2022 I have had 4 episodes and only tried exercise with the last one previous Monday and it worked. My previous attempt got my AF to turn into AFlutter so that’s why you have to be careful and don’t try without doctors approval
Just know when I eat to much or too rich a meal I can feel ectopics which sometimes can bring in AF this is thought to be Vagal stimuli. I know when I regularly exercise my AF seems to be more infrequent. I have reverted back to sinus by doing exercise in the past. I have been woken with AF which can suggest Vagal this is when your parasympathetic tone is highest. There is more research being done and from age 35 I only had 6 episodes till I got to 65. It just popped in and out without use of drugs. Now is a different story as we age things don’t work as well as before! I’ve had 4 episodes in 2 years
I was free of af for seven years after an ablation. But it started up again after a chest infection and possibly the jab. I had another ablation two years ago and had two blips this year but reverted spontaneously one in four days and another in several hours but 10 days ago I went into AF and that’s where I am at now. If I recall I did go to bed on full stomach ..I felt there was some connection and at 8 pm it started and don’t know how to get out of it. These meds make one so tired that you don’t feel like exercising. I was doing a lot of walking but slowed up recently. Maybe if I try again but heart rate high now! Also I think I didn’t drink enough water!
Sorry to hear that… you must stay hydrated it was my problem last week. Do not go to bed straight after eating I wait 3 hours though a small meal I might wait 2 hours if I’ve eaten later. You could be Vagal AF. I find it’s not so much the exercise but the change in tempo for example on my indoor bike I’m going steady for 15 mins then push fast for 15 seconds then slow for 15 then fast for 15. I did that 5 times. I’ve also tried cold shower in the past or jump into an unheated pool (depends where you are!) I would not try any of this unless you chat to your doctor first as they know your age and general health
What other types of AF are there if there is Vagal.? Can one stimulate it too much with vagal manoeuvres? I wonder how long this episode will last perhaps I will need a CV to get out of it. I am finding taking an extra nebivoloL bb unpleasant. I take very low dose for PVCs but now doubled it to control heart rate. Will see a cardiologist tomorrow and hope he can give me something else. I have tried so many of these drugs. I found flecanide effective years ago but when I had IV drip of it recently I went into atrial flutter. Then another doctor said you must not have any a heart strutural probs to take it. I have tried very cold water on my face when I thought things were turning into AF and that helped.
not sure about other types of AF but yes there is a balance with your parasympathetic and sympathetic system. I once went weeks without reverting as drugs did't work then we did CV and that worked. They might put you on a maintenance dose of flecanide maybe 25mg or 50mg mg twice a day to help stabilise your heart after CV for a month. I've done that too then stopped it. I hate the drugs too as they do make me tired. I've had the Cardiologist agree for me to lower daily flecanide to 20mg twice a day and metoprolol to 10.5mg twice. Both are very low doses and i must say no side affects. If i go into AF then i have PIP to fall back on. You must get some stability first then decide about stopping or reducing dosage
I think paroxysmal afib can be put at bay with cardio exercise...I've seen it with myself and there's a lot of research out there supporting exercise for afib..but if you stop exercising, then it comes back.
My AF and Flutter was kept at bay with daily exercises for 10 months then I did a charity event for a week as a driver 6am starts and 6pm finishes and got AF on the last day, mind you I let myself get dehydrated which is a sin with AF
I only know about afib since that is what I've got and I've seen in myself that it subsides when I'm actively going to the gym and doing cardio. I think what is happening is that as we get older, our heart muscle gets weaker and by strengthening it with exercise, it can function better and doesn't fibrillate as much or maybe not at all. I noticed in myself that the afib wasn't even bothering me for weeks when I was active going to the gym. Now that I slacked off, I am feeling the palpitations again, so I need to get back to working out again. I've also read lots of articles lately that say exercise can keep atrial fib at bay, one source is Harvard Health. Best wishes to you on this journey!
That could be one reason, but the autonomic system balance is a key arbitrator as to getting out of fib by exercise - increases the adrenergic drive. Resting, sleeping etc increases the vagal drive again, which can tip you back into fib, but it's a subtle and unpredictable balance.
That may be true for some if the parasympathetic is under active. Exercise, even very gentle exercise, always put my HR through the roof when I tried whilst in AF so for me it was rest which helped whilst putting feet higher than heart. Sometimes vasavagal manoeuvres helped but exercise - not for me. We all react very differently. As Cliff_G says, it’s a subtle and unpredictable balance.
Hi, my first AF ablation (PVI) ages ago failed with common right atrial flutter which was fixed (CTI ablation - see below) during a top-up. 15 years later I had a huge open heart surgery with a new aortic valve, aorta, and CABGx1, which brought my fib back. When I had to come off the Amiodarone they gave me for that, I went into flutter again and needed another ablation.
Common Flutter is a circuit in the right atrium which they ablate away at the cavo-tricuspid isthmus (CTI), and this is quite a simple ablation. However, flutter can occur in the left atrium too, depending on what has been done there, in your case possibly due to the Maze or even the left atrial appendage, if there is a circuit possible, left by the previous work. It can be difficult to determine from an ECG (even a 12-lead) where the flutter is originating. With me they had to go in and map, and of course the flutter wouldn't play ball so that they could identify the source, but they ablated a couple of small active areas and my flutter was stopped.
I suspect you may have a similar situation either with right atrial flutter or a left flutter arising due to the extensive Maze lesions. Your docs will discuss with you.
A key thing for interim management is the conduction ratio at the AV node. Atrial flutter can be at around 250 or even 300 beats per minute, but the ventricles won't normally keep up with that, as there is a sort of built-in delay at the AV node. But you could get different ratios there according to how the AV node behaves. If the flutter is, say, 300 bpm and you get "2:1 conduction", the ventricles will contract at 150 bpm, if 3:1 at 100 bpm, 4:1 at 75 bpm. The ratio can also vary so you can swing from 100 to 150 to 75, for example. Meds such as calcium channel blockers, or beta blockers, will slow conduction at the AV node and hence slow the ventricular rate, making it much more liveable-with, until you can get treatment such as ablation.
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