Atrial flutter episode

[DSB1958]

Hi,

Before I go any further, some background and the timeline of events.

I'm a 66-yr-old male who has played tennis regularly since the age of 13.

2017 I went to A&E with what were later diagnosed as benign ectopic beats. Bloods and ECGs were fine, and I was discharged after 6 hours. The only "flag" was dehydration. Unfortunately, I feel my ectopic beats, and they have always come and gone in phases but have not stopped me from playing tennis. I've never received treatment for them.

August 2022 - I'd come back from playing in a tournament, and after having a shower noticed my pulse was racing (but regular). It didn't settle after 15-20 minutes so my wife called 111. I had no other symptoms. They advised an ice pack to cool down, rest and rehydration suggesting I was experiencing an episode of dehydration-induced tachycardia. Things did settle in 2 hours and normal rhythm was restored.

November 2024 - tennis again and after an hour noticed my pulse was racing. No other symptoms. Ambulance called when things didn't settle and was advised to go to A&E. Diagnosed after 3 hours as having an episode of atrial flutter (think ventricular bpm were 140). Given 4 x bisoprolol and normal rhythm was restored after about 20 minutes. Bizarrely, during the episode I felt like I could run a marathon. Bloods were OK and ECGs taken. The only "flag" was (again) dehydration (they said everything else was "in the blue" (I've never heard that phrase used before). I was discharged and told I was OK to play tennis but that my GP (who would receive notes on what had happened) may decide to refer me to a cardiology Dep for further tests. No medication was given. After another ECG at my surgery and subsequent discussion with him, he decided to refer me to the cardiology Dep at the hospital I visited when I went to A&E. He also said that there was no block but there may be an electrical issue, and "possible ablation" was mentioned in his notes to them.

I'm now in the NHS system but there have been "communication problems" (my interpretation) between the cardiology Dep and my GP, such that it's now 6 months since the initial referral was made. I've been in contact with the cardiology Dep who say that they are waiting for more info. from my GP, but he has said there's nothing more he can add - I suspect the cardiology Dep (or the person who is dealing with my case) is trying to prioritise me in the system and determine which department I should go to (arrythmia?).

As it's been nearly 6 months since the initial referral, I'm considering going private for a consultation as I feel very much in limbo and was told by the cardiology Dep dealing with me that it could be another 9-10 months before I'm seen once they decide where I'm going. I've been prescribed PiP (bisoprolol) by my GP who also said it was OK to play tennis and likely safe (but to be aware of symptoms), but since the episode last November I've had no cause to take one. I still suffer ectopic beats, but the burden is very low. I keep hydrated as best as possible. I'm of the opinion that there may be a link between dehydration and ectopic beats/flutter, but obviously further tests are likely required.

I've read information on this site about flutter and fibrillation, and read the experiences of some, but from a tennis-playing point of view I've effectively stopped (although I still do gentle exercise). The last thing I want id to experience another episode despite having PiPs. I am not on any other medication and my stroke risk was assessed in November as 1% (because of my age I think).

Should I wait for the NHS to come back to me or go private for an assessment then feed back into the NHS if treatment is required?

Has anyone experienced something similar to this? Infrequent (atm) flutter (2 episodes I'm aware of in 2 years) - paroxysmal flutter? What has been the outcome? I appreciate everyone's situation and circumstances are different, but I'm not entirely sure what I'm dealing with here, and whether (all things considered based on test results) if I become dehydrated, I'm more likely to suffer an episode of flutter when exercising. My GP would not have referred me unless he thought it necessary and has said he suspects an electrical issue of some sort.

Grateful for any feedback or advice.

Stephen

[Borderterriorist]

TBH I'd just enjoy your tennis, keep yourself hydrated and if you are really worrying, book a private appointment with a cardiologist who is an EP. It's really helpful to have time to talk through your concerns and I thought it was worth every penny it cost me. It didn't change any of my treatment but it was reassuring and by chance I was referred to the same EP when my NHS appointment came through. Annoyingly my atrial flutter has progressed but you may well be lucky and find yours is managed with a PIP and not letting yourself get dehydrated. Many of us with electrical issues find either avoiding or a very careful intake of alcohol is really helpful, I also avoid caffeine. Looking back I think I had short episodes of AFL for several years before it really became an issue and like you I was and still am an active relatively fit person although a seriously damaged achilles tendon put pay to my tennis days sadly! Good luck

[DSB1958 in reply to Borderterriorist]

Thank you Borderterriorist for your quick response.

I've effectively not played tennis for 6 months because nothing has been sorted and I'm just a bit wary, and of course that has a knock-on effect, so overall fitness has declined somewhat.

Whilst at A&E last November, and having been given the bisoprolol, it was like a switch had been pressed and my whole body just seemed relaxed. ECG should normal rhythm with a few ectopics. I did mention this to the duty Dr but he said they weren't bothered about them.

I hear exactly what you're saying, and my frustration is things having taken so long to date (which is no surprise really). I will enquire about a private consultation. I'd be happy with a PiP as treatment, but my own GP does suspect an electrical issue, so we'll see what happens, and he did discuss ablation as a possible treatment pending results. However, and since last November, I've not experienced anything similar. I was told that if my case was deemed routine by the cardiology Dep (hopefully it is) it would be 9-10 months before I saw anyone via the NHS!

Greatly appreciate your time responding to my query. Thank you again.

Best,

Stephen

[Borderterriorist in reply to DSB1958]

I was forced to give up tennis but I continued riding fit dressage horses (and no the horse doesn't do all the work!). Life is for living and although Atrial flutter is unpleasant and worrying, it's not actually life threatening unless it continues for a long time. Both of the episodes that put me in hospital arrived in the middle of the night but I definitely had short episodes at other times. TBH I think keeping our fitness levels going is better for our heart than trying to protect ourselves from an episode by avoiding exercise and I bet you really miss the buzz of a good game of tennis and the social aspect too.

I'm now on 10mg of bisoprolol and also digoxin which is keeping my heart rate low but I still walk the dog for an hour each day and do reformer pilates twice weekly despite the pacemaker. I got bucked off the horse in 2024 (naughty boy) and the blood loss due to being on a blood thinner nearly polished me off so I have reluctantly hung up my riding boots but at 76 I am determined to enjoy my life as much as I can. The weather is lovely, get that racquet out and have a gently knock up with a friend and see how you go. Best wishes Jane

[Asteroids]

I was diagnosed with atrial flutter a few days after mitral valve repair. The first symptom was dizziness, but also some tiredness.

I was immediately put on amiodarone to try to snuff it out. That didn’t help, so after six weeks after the surgery I had a catheter ablation which worked and I’ve had no arrhythmias since.

There was no debate about whether I needed the ablation, which suggests to me that it was necessary. People live with arrhythmias, but generally I don’t think it’s pleasant and cardiologists prefer to sort it out.

If you do go private (as I did for my surgery and ablation), go with the team you’ll be with for ongoing care. While I’m living in one London NHS trust, I’m looked after by the same cardiologist I saw privately and want it to stay that way.

[30912]

Personally, as I did, after being told that the NHS waiting list is 6 months to see a cardiologist (the referal was back in July and still no appointment), I did some research and found a cardiologist that specialises as an EP and who also works for the NHS in our region. I booked a private appointment.

If you are self-funding like me, they may well be able to put you on the pathway for NHS treatment if necessary with corresponding waiting times but the initial consultation and follow ups were worth every penny.

Good luck.

[DSB1958 in reply to 30912]

Thank you everyone for your replies.

The more I think about it the more the private consultation appeals, pending a decision from the cardiology Dep which I (hopefully) will get next week, according to their secretary when I started following things up after a lengthy period of no contact following referral.

A fellow tennis player and GP has said that my condition sounds like it’s paroxysmal at the moment. Further evaluation required, of course, but what he said further (based on my own GPs notes) makes sense.

I’m also picking up that ablation is the usual treatment if it’s an electrical cause(?), irrespective of the type of flutter: perhaps I’ve misunderstood some of what I’ve read.

Thanks again.

[Qualipop]

Well best of luck waiting for the NHS. It's now 2 1/2 years s ince I was admitted with a very bad arrhythmia that lasted 10 days. On discharge I was referred to cardiology. I've since had another 10 day attack and still waiting for cardiology.