post ablation - back in atrial flutter

Any tips on what I can do to get out of atrial flutter ? Last time - while still in hospital need an ECV.

Thank you for any help.

Do you have an Afib nurse from you electrophysiologist that you can call? I would start there or the EP that is on call that is associated with your EP who did your ablation.

Did they send you home on any meds? Definitely call the on call EP

There aren't many ways to get out of flutter. It's often not responsive to rate control and antiarrhythmic drugs, but cardioversion is almost always successful. It may stop on its own, but if it hasn't by morning definitely give the NP you've been assigned to a call.

How fast is the rate? If it's super high an ER will likely be willing to cardiovert you.

120-130 is rate

On multaq, met suc and eliquis BID.

Is there anything I can do to avoid getting into atrial flutter ? triggers?

I'm taking mag and potassium

I'll contact EP on call

I spent years battling flutter and the only trigger I ever found was dehydration and low potassium levels ("low" meaning the low end of the normal range, not abnormally low). It's a very different beast than AF. Flecainide was effective at preventing it for me, but useless at stopping it. Rate control drugs had absolutely no effect on it either. I didn't even bother with metoprolol (even 200 mg didn't lower the rate a single BPM).

One thing you can try that often worked for me to stop it is a combination of potassium and exercise. What I would do is guzzle a couple of large cans of LS V-8 on an empty stomach and then go do something that would raise my heart rate significantly (if I were in NSR). For example, if I was at home or work, I would jog up and down a flight of stairs repeatedly until I was thoroughly winded. If I was outdoors, I would find a hill and walk or jog up it at a good clip. Basically, anything that would raise my HR to 120 or better if I were in NSR.

And of course you can always try an ER, but with the rate only being 120-130 they'll probably insist on wasting hours of your time with a diltiazem drip first, which I virtually guarantee will do nothing. They may also want to try adenosine, which also won't do anything except make you feel like you're dying for about 5-10 seconds.

I might try that - some v8 and exercise.

not going to er anytime soon - waiting for shannon to call

Carey- you recommend exercise ( jog up and down stairs or hills) after a week post ablation? My post ablation HR is one teens so thus I ask if your method of exercise was after your ablation or just during the years you were in flutter?

Susan,

I strongly urge you to follow Dr. Natale’s specific instructions for you, via his Los Roblos NP Kelley, during the first few weeks post ablation.

Cheers!
Shannon

Quote
susan.d
Carey- you recommend exercise ( jog up and down stairs or hills) after a week post ablation?

If he feels up to it and hasn't been told to do otherwise, then yes. I did a 50-mile bike ride in very challenging terrain 3 days after an ablation, and I did it with the EP's full blessing. The only physical restriction I ever followed was the no-lifting for 5 days rule. None of the 3 EPs who did the procedures felt that additional restrictions were necessary. (And if I count the Watchman implant, make that 4 EPs.)

I know some people feel fatigued after ablations, but I never felt that way. I always went back to work and resumed my normal physical activities (minus lifting) the day after being discharged.

Quote
Carey

Carey- you recommend exercise ( jog up and down stairs or hills) after a week post ablation?

If he feels up to it and hasn't been told to do otherwise, then yes.

Exactly, one should only ask their EP first. Thank you Shannon for the same advice.



Edited 1 time(s). Last edit at 09/06/2020 05:57PM by susan.d.

Of course, that's just common sense. But I don't think I've ever heard of an EP imposing an exercise restriction post procedure unless there are comorbidities or complications. There's really no reason for it in an uncomplicated ablation on an otherwise healthy person. The days of convalescing for days or weeks following medical procedures are long gone because it was found to actually be harmful. The rule now is get up and moving ASAP unless there's a good reason not to.

[www.ouh.nhs.uk]
Page 8

[www.uhn.ca]

[www.webmd.com]

Seems each medical facility has their own advise. Thus it makes total sense to rely on only your EP advise regarding exercise.

[www.acc.org]
NLAMA-seems fortunate to RF ablation that you are an athlete. I wish you the best and to feel better!

Right now I am still waiting for the hollow weak feeling of met-suck to stop sucking all of the life and energy out of me.
If cape buffalo were charging me I wouldn't budge.

NLAMA-Did you get the same feeling after an ecv? How many times were you ecv during your ablation and the joules during the ablation, post ablation and in the past? I don’t know if it’s a common side effect but I always felt like you for up to 3 weeks after each of my ecv. Everyone is different but perhaps your current lack of energy is possibly related. Maybe that’s why I have energy this second ablation. I had no ecv during the ablation.

I had an ECV for Atrial Flutter in early August last year after being AFIB free for 10 years thanks to Bordeaux. The Flutter kicked in whilst at the gym and lasted two months none stop before the hospital would carry out the successful ECV. I believe I am lucky to have kept out AF/AFL and any other arrythmias since then. The main concern is whether its Right sided AFL or Left sided AFL. Prof Jais in Bordeuax could probably sort out Right sided AFL using a candle however Left AFL is a totally different animal and indeed Prof Jais did give up on me after about 2.5 hours saying he couldn't 'get it all' but it should still be successful which indeed it was for 10 years. I would presume that during your ablation the EP will have easily eliminated any Right sided AFL as this is considered a simple and effective procedure, I believe LAFL mostly kicks in after an ablation for AFIB. Unfortunately the EP has to 'go in' to definitely find out whether its RAFL of LAFL, at least that's what the EP told me last year as I was seriously considering a further ablation for the Flutter which the EP was willing to do quickly if I give him the green light. All a bit scary, but I guess you need to know the issues.

I’ve been in flutter I speculate since 3pm yesterday at 125+. My ablation isn’t even a week new.

Barry - the hospital made you wait 2 months? Is there some reasoning behind that?


Does the propensity to go into atrial flutter indicate anything about the success of the ablation?

Probably because they had to put him on an anticoagulant and wait for any clots that might have formed to dissolve. That's pretty standard procedure for ECV when the patient hasn't been on an anticoagulant. The alternative is to do a TEE prior to the ECV.

What about the 252-electrode mapping vest ? Does it allow better tracking of the ectopics points ?

Quote
NotLyingAboutMyAfib
Barry - the hospital made you wait 2 months? Is there some reasoning behind that?

If you go back and read Barry's posts from the time (about a year ago) [www.afibbers.org] Barry would likely say it had to do with being in China, where he lives, the language barrier, timing to get in to see a cardio as well as anticoagulant timing, as Carey says.

NotLyingAboutMyAfib,
Yes correct to both Cary and George's posts. Living in Hong Kong China I get most general hospital treatments almost free so there is always some kind of waiting list. I was not on any anticoagulant so no doubt that was a major reason to put me farther back on the list for the cardio-version as EPs here are few and far between and a TEE was not even mentioned. As the Flutter kept my heart rate at bang on 80BPM when relaxed I presume I was not considered a serious case compared to others. As mentioned in my previous post my main concern was whether the Flutter was the Left sided or Right sided version should the cardio-version fail. The EP could not tell off my ECG printout which version of Flutter I had so he said he would have to 'go in' to find out however going in and finding out worst case I was in LAFL would mean he would have to come out right away as I was not confident he would have the experience to successfully carry out a LAFL procedure. I did discuss this with the EP and he did agree that should I have LAFL and with my history of 5 previous ablations that my best chances was to return to Bordeaux should the need arise. P.S. I have no idea what going into Flutter after an ablation means in regards to whether an ablation will be successfull however after my last ablation in 2010 which was for LAFL I started having many ectopics??? after about 10 days and which lasted more than a week. I struggled through this without checking whether PACs, Flutter or AFIB, I had almost given up, but luckily all went calm and not a noticed missed beat for the next ten years.
Cheers,
Barry G.

This is an older 2014 article so take that into consideration considering your ablation was performed by a skilled elite. If you read it, perhaps it will give you solitude that you didn’t get the complications mentioned.

[www.ncbi.nlm.nih.gov]

Post-procedural atrial tachycardias are relatively common and have been considered to be largely associated with circumferential ablation using wide-area circular lesions around the PV, or when additional ablation lines are incorporated in the procedure, creating an electrophysiologic milieu for both small and macroreentry circuits.[9,10] From a clinical point of view, these arrhythmias are characterized by: early onset of significant symptoms (frequent palpitations and fatigue) after ablation, refractory to management with rate-controlling drugs, limited amenability with antiarrhythmic drugs, and high recurrence rate after cardioversion.

Very good paper Susan.

It's never easy is it?

You just have to have faith that all will work out in the end. Otherwise it’s not productive to rehash or doubt your original decision why you went through the ablation in the first place or be a Monday morning quarterback with other doubts. As my np says”we don’t have a crystal ball.”

As you read in that article, everyone is different. During my index I was couch bound for 6 weeks. I didn’t have flutter like you but 5.5 months of pure hell PVCs that in the end became full time. I was just lucky I postponed my pvc ablation and tried 2.5 weeks of Tenormin which stopped my PVCs in its tracks. I joked with dr N how bizarre because I was lucky my PVCs stopped four days after my postponed ablation. While in PVCs I bought (I kid you not) 6000 pounds of river rocks 6 weeks after my index when I started to feel better—and bucket by bucket laid out 175 feet of a dry creek for my spectacular (if I may boast) Japanese garden. I stopped in May —28 feet shy of finishing when my AF returned 8 months after my index ablation.

Just rest until tomorrow.
Yuck...I just started 145-155 afib. Going to end this post and rest.
Feel better and good luck with your Ecv tomorrow and I wish you a speedy road to full nsr recovery. You deserve it. Your lucky son is patiently waiting for his hop on pop.