I had an ablation in January 2024. Since then I've had 4 cardioversions, the most recent on January 2, 2025. I'm now back in Flutter with a high heart rate, 120-128 range. Beta Blockers didn't work for me. I take a calcium channel blocker now, dofetilide, and Eliquis.
But for the flutter and heart rate, I'm in good health. My blood pressure is under control and at 76, I"m a writer, very active, eat well, and exercise daily. I maintain a good weight and I've not had alcohol or caffine since my ablation.
The roller coaster is frustrating. As I've exhausted just about everything, the next step for me is a pacemaker. It's not my first choice but if I can't last one year without Flutter and a high rate, I think it's ultimately my only option.
Has anyone gone this route and had success with a pacemaker?
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Ablation for AFL is much more straightforward than for AF and usually has a higher success rate. If you convert to NSR via cardioversion then unless there is another good reason why an ablation is ruled out, you would be a good candidate I would have thought.
SO Why straight to PM and if so what sort and are you talking Pace and Ablate?
I had mixed AF/AFl - had 2 ablations which gave me 3 years free of AF but unfortunately AF returned and I can’t take any meds so my only option really was PM. I had CRT Pacemaker in planted in 2018 in preparation for Ablation of Sinus Node but because the PM worked so well for me I have never had the SN ablated. I still have very occasional episodes but AF burden of less than 2%, usually occur when I have infection however I always self convert within a few hours.
I had an ablation for AFib before I had the 4 cardioversions. Within a week of the procedure, I was in flutter with a very high heart rate. My doc waited three months to see if it would straighten out. I was put on beta blockers. It didn't work and the my cardioversion journey began. A second was ruled out because the doc wasn't sure where the flutter was coming from. I take calcium channel blockers now. I also have an enlarged left atrium which complicates things. Additionally I have ADHD. I was diagnosed in my 60ties and had to wean off my ADHD meds two years ago when I was first diagnosed with AFIb. It's been a wild ride. I'm writing a memoir now, Aging with ADHD, One Older Woman's Lifelong Journey about ADHD, the meds used to treat it, it's co-occurring conditions and the comorbidities of aging itself. The pacemaker will be the last resort. We'll see. Fingers crossed.
I have atypical atrial flutter so it's the left not the right atrium which is affected. this means an ablation is more complicated. I had a pacemaker fitter because I needed a higher dose of a beta blocker to control the flutter but because I had LBBB and a grade 1 heart block anything more than a very small dose dropped my HR too low. I've had a pacemaker fitted and I can now take a very high dose of a beta blocker but I am on the waiting list for an AV node ablation which hopefully will mean I will be able to come off them completely. Without knowing more about your situation it's difficult to comment except to say in my case, the PM has made a huge difference, it took a while to get comfortable and my resting HR seems to tick along nicely around the 60bpm which is what the PM is set at.
Thanks for your reply. I can't take beta blockers so I take a calcium channel blocker which doesn't make me feel like I pushing a semi up a hill. I tried beta blockers in my early 50ties with the same result. I also have ADHD and mild sleep apnea, which further complicates things. I will explore the pacemaker options with my doc. My aunts had pacemakers installed in their 80ties years ago and lived well into their 90ties. My guess is there's also some genetics going on in my case. I'm glad to hear that your pacemaker is working well.
Unfortunately my first ablation didn’t work. I had it for AFib, I came out of it with Flutter. My doc and I haven’t ruled out another try though. It’s an option still on the table. Thanks for your reply
I'd get a second opinion. Flutter ablation is normally very successful. And without a electrical study the EP can't say he doesn't or does know where it's coming from.
Bad luck. I was told a left-sided ablation for AFl was near 100% successful, as it was for me back in 2019. My flutter rate was higher than yours at 155bpm. So dar as I understand the mechanism of AFl, a rate of 120bpm is unusual as the rate is fixed by the allowed conduction ratio provided by the AV node, most often causing a ratio of 2:1 (as in my case, equating to a very uncomfortable 155bpm). Bisoprolol 5mg brought that down to 3:1 (105bpm), but digoxin then made it 4:1 / 5:1 (60-75bpm) and I was more comfortable. Finally, my ablation solved it (only to allow AF to surface later).
My AF is often at 90-135bpm these days, as it is now while I type, but I don't find that too uncomfortable, thankfully, and it causes only a little sense of "breathiness" with an occasional slight light-head.
It’s the middle of the night and I woke up with palpitations. Of course I panicked which probably made things worse. And of course I checked my Apple Watch. Yikes. 135bpm. Then I read your reply. I usually don’t feel much but reading your reply helped me to understand that I’m not alone. I was all over the place last night between 90 and 135…no Afib though. Deep breaths Heidi, deep breaths. Thanks
It sounds like we had very similar nights. Add into mine three visits to the small room thanks to "men's troubles" and, well... What a life! Mine has been on and off all morning, too, with lots of palpitations when not AF.
Thanks Steve. I hope you have a better day too. Funny I visit the little room a lot at night too . Apparently that’s related to the flutter business as well. It’s nice to know that I’m not alone. I’m off to Zumba at 9 and that always helps!!!
My doc mentioned that as a possible next step I believe. But I have to wean off the dofetilide first I think. I’ll find out tomorrow when I get in touch with him. Thanks
I had an ablation for flutter but it wasn’t a success. After pills etc flecainide worked for a long while I then developed afib then both hubby and I had pacemakers as he had heart failure snd low ejection fraction. He has a 3 lead and mine is 2. He is so well with his and I am ok too. I do still have afib snd flutter but with the pacemaker I don’t notice it.
Noticing it is a problem I’ve found. Until recently I was asymptomatic but now I can often feel the flutter. If I feel it, I get panicky. It’s usually in the middle of the night when I wake up suddenly. I have apnea and we’re still struggling with that. CPAP is a problem for me. Looking back into my 50ties I felt palpatations too. I described it like a chimney swift hanging out in my chest. I was diagnosed with mitral valve prolapse then. The bottom line is I’ve been having issues for a long time I guess. Genetics anyone? I may have mentioned that my two aunts had pacemakers installed in their 80ties. They both lived into their late 90ties and that was many years ago. A pacemaker may be in my future too. Thanks for replying to me.
I call mine flutter and afib clowns doing acrobats in my chest. I have to say since the pacemaker not the awful thumping where it felt the bed or settee moving and how panicky I used to get
For as long as I can remember I would get episodes of Paradoxical AF . Then when into A flutter about 15 years ago . Initially the flutter was controlled by cardioversions . But left me with sick sinus tachycardia-Brady . A 2 lead pacemaker was implanted
The period of time between cardio versions was getting shorter and more frequent. So I had an ablation for the A flutter. Sadly it only took the rate down from 300 to 250 and pericarditis that lasted for 3 months. One of the leads had been damaged during the ablation , so after a few months on Amioderone I had a 3 lead pacemaker CRPT for heart failure. That made all the difference., at last I could talk in sentences, my friends as the electrophysiologist if there was an off button . Followed by an AV node ablation
I still have high doses of CCBs , I am still aware when I gave episodes of A fib as I decompensate and pulmonary oedema. But thankfully that only once or twice a year .
Oh my. What an ordeal. I’m glad you’re doing better. I need to get a grip. My heart rate went up to 195 a week after my ablation but with drugs and 4 cardioversions, it’s never gotten out of the 130 range except when I’m exercising. When the cardioversion and drugs are working it hovers between the 50ties and 90ties. I had no idea until I read your reply that a heart rate could get over 200. I’m happy that you’ve got it down now. Thanks for sharing.
I had a pacemaker implanted in 2022 followed by one failed ablation and then implant of watchman. Other than fatigue I seldom have any symptoms. Going off blood thinner now in March. It seems that the pacemaker and meds have it under control although I am also told I have persistent afib. One day at a time!
I have been living with what started as intermittent AF for around 15 years. Despite trying various treatments — beta blockers, anticoagulants, and rate control medications — and undergoing multiple interventions, including the implantation of a pacemaker five years ago and the destruction of my thyroid through a radio-iodine pill (suggested as a possible contributing factor to my AF), my condition has only worsened.
Let's not forget the amiodarone, which caused damage to my lungs, leaving me more fatigued and breathless. After all of this, I now live with permanent fast AF and severe breathlessness. And now they want me to have an AV Node Ablation — because, apparently, that’s all that’s left. But if it goes wrong, and I suffer known complications or side effects… then what?
I fully understand that some people with AF can live relatively normal lives without significant issues. I also know that many others have successful ablations and continue on without setbacks. However, there are those like me, where the treatments and medications cause more harm than good, leaving them in a worse state than before — spending their remaining years in misery.
I’ve shared a bit of my story as a precautionary note: don’t take everything you’re told as gospel. Always research any proposed drug or treatment beforehand. And if you have doubts, it’s okay to say no.
An unqualified YES. I’ve gone that route and had success.
After 2ablations and my 9th cardioversion, I decided I needed a solution, an actual resolution to the afib roller coaster I’d been on. I wanted to be DONE!
I got a pacemaker and AV node ablation 4 months ago. Now afib is a thing of the past, no longer intruding on my life. My atria are still fibbing and fluttering away—we were not able to correct the miscreant cells sending bad electrical signals to my ventricles— but now my ventricles could care less and just keep beating with absolutely consistent regularity.
And I feel a whole lot better. I have my normal energy back just to be able to live my normal life, just my normal, everyday life. That’s all I wanted. I don’t feel like Superwoman, but I do feel like myself again and that’s more than good enough.
My only wish is that I’d done the pacemaker sooner. CV’s in the last year could keep me in NSR at most 2 weeks, more usually 5 days. That was no solution. Beta blockers made no difference that I could ever tell, except to sap me of energy and contribute to lightheadedness. Ditto calcium channel blockers. Amiodarone left me in bradycardia and feeling like a zombie. And was not a solution. After a CV, I constantly reverted to tachycardia, 120-150bpm. One does not feel well in tachycardia, but I don’t need to tell you that.
Ultimately, a pacemaker was the only solution I could see. Importantly, I also have an LAAC, a Watchman, so I don’t even need anticoagulants because the place in my atria where 90+% of clots form is closed off. My atria can be in afib, and are, and it makes no difference in my heart rate or risk of stroke. That’s a double win.
I’m not sure why LAAC and a pacemaker are not a first-line treatment of choice for afib. Neither procedure is riskier than an ablation, and ablations are done all the time.
Thanks I appreciate your comments. Im also happy that you found a solution. It sounds like I’m on a similar path. You may have just saved me another year of agony. Every thing you’ve described I’ve felt. I want this over-with. It occupies too much of my mental energy. Enough! thanks again.
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