Intermittent runs of fast heart rate (about 165 bpm). What kind of arrhythmia is this?

Hey all. So, I’ve been having these runs of fast heart rate for the past couple of days and wondering what might be going on.

First, a little background. I had my ablation in Bordeaux about 1.5 years ago and have been doing pretty well all around. I had rounds of palpitations off and on several months back that subsided.

But, something I noticed sometimes over the last year though is that I can get these runs of fast heart rate. It’s usually always right at 165 BPM. I noticed this a year ago when we went to a fun center and I played one of those basketball arcade style games where you just keep taking shots and the balls keep rolling back. I got into it enough that I was lightly winded. But, then noticed that my heart rate just sort of “clicked” over to 165 bpm and wouldn’t come down even after resting for 5 min. After about 15 min, I was good. But, that’s way to long for this light exertion.

I don’t exercise the way I used to….I don’t really push my cardio at all. I’ll do a couple of exercises and rest and be sure to let me heart rate come down before doing another set. I’ve done pretty well like this as far as with my afib. But, it’s still yet pretty limiting. I’m 41 and have a fairly athletic background. I’ve pretty much done 0 running since my ablation….but rather just some light elliptical. I just tested some light jogging the other day.

Today as I write this, I’ve been having these runs of fast heart rate on and off all day. I think it’s because I did the light jogging and tried to bump my exercise up a little more this week. It seems like there is some kind of vagal connection too….because I can make it go away for a while by tightening my stomach or being very deliberate with a deep breath to create a sensation in my stomach. My heart rate just clicks back instantly to 70 - 80 bmp. But, 20 seconds later, back to the 165 bmp.

I’m pretty sure its the increased exercise this week. Thankfully, I haven’t been having the erratic afib beats like I used to pre surgery (that was a nightmare).

But, I’d love to not have to dance around this and avoid cardiovascular exercise. That’s not good long term. Could there be one more area in my heart that needs to be ablated to get rid of this last pesky arrhythmia?

Are you able to determine it's NSR or not when the rate is this high? You're familiar with this ? - [journals.lww.com]

Is it a regular rhythm? If so, it's probably atrial flutter (AFL). Always hitting the same rate every time, and that rate being in the neighborhood of 150, has flutter written all over it.

There are four things you can do about AFL: 1) ablation, 2) meds to control it, 3) meds to slow it down, 4) nothing.

AFL ablations are much simpler than AF ablations, and if you're lucky the flutter is originating in the right atrium so they wouldn't even need to do a septal puncture and go to the left atrium.

Meds to control it are the usual suspects also used for AF such as flecainide.

Meds to slow it down are generally beta blockers or diltiazem.

And finally, doing nothing is a viable option for you since it stops on its own so quickly.

Just be aware that flutter carries the same stroke risk as AF, so if this is happening a lot you really should consult Bordeaux or a local doc about starting an anticoagulant.

Carey- you mentioned 3) meds to slow it down,

Is my case out of the ordinary but if one gets regular 70s hr and then high hr flutter which quickly resolved and converts back to the baseline slower 70-80s hr—isn’t there a risk of a BB in crashing one’s hr once flutter converts to a then lower than 70 hr because of the effects of a BB is kicking in??

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susan.d
Carey- you mentioned 3) meds to slow it down,

No, I didn't. Flecainide is a rhythm control drug, not rate control. Beta blockers and diltiazem are the rate control drugs, so I mentioned two.

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Is my case out of the ordinary but if one gets regular 70s hr and then high hr flutter which quickly resolved and converts back to the baseline slower 70-80s hr—isn’t there a risk of a BB in crashing one’s hr once flutter converts to a then lower than 70 hr because of the effects of a BB is kicking in??

Never heard of it happening, but it would seem to me it's a good idea to take a drug before you need it to find out how it affects you. Better to find out it will crash your BP in the doctor's office than on that vacation you planned for two years.

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Carey

Carey- you mentioned 3) meds to slow it down,

No, I didn't. Flecainide is a rhythm control drug, not rate control. Beta blockers and diltiazem are the rate control drugs, so I mentioned two.

Is my case out of the ordinary but if one gets regular 70s hr and then high hr flutter which quickly resolved and converts back to the baseline slower 70-80s hr—isn’t there a risk of a BB in crashing one’s hr once flutter converts to a then lower than 70 hr because of the effects of a BB is kicking in??

Never heard of it happening, but it would seem to me it's a good idea to take a drug before you need it to find out how it affects you. Better to find out it will crash your BP in the doctor's office than on that vacation you planned for two years.

Mine crashed to 24 in the ER once they ecv my tachy after giving me multiple doses of BB. I guess if it is going to crash, the ER is the best place for it to happen. Not to make light of the dangerous situation I was in and a few ICU nurses telling me how lucky I was to be alive. As I mentioned, my case was out of the ordinary.

Thanks Carey! Yes, it’s a normal sinus rhythm. It’s almost always about 165 bpm without fail. I didn’t sleep well last night because I kept having runs of it.

Maybe I had this arrhythmia all along but didn’t notice it because of afib? My ablation was successful at getting rid of my afib. I’ve been in normal sinus rhythm since the ablation thank goodness (with the exception of some runs of palpitations I had for a few months)

Exercise is definitely an aggravator for me. Pre ablation I tried to increase my exercise and it caused increased afib episodes for about two weeks.

My recent attempt at increasing my exercise rate has given me bouts of this (apparent) a flutter for the last several days.

If it would be an easy ablation and I could knock out this last nagging problem, I’d be all for it.

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HBK
Thanks Carey! Yes, it’s a normal sinus rhythm. It’s almost always about 165 bpm without fail.

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If it would be an easy ablation and I could knock out this last nagging problem, I’d be all for it.

Yeah, almost certainly flutter. Not uncommon following an AF ablation (also Maze procedures). Flutter ablations can be super simple and quick if the source is the right atrium, or a bit longer and more complex if the left, but either way they're much easier and shorter than the original AF ablation.

If you know how to make it happen, why not get an appointment with your cardiologist or EP? A stress test might allow recording the phenomenon.
Just my two euro cents...

Thanks Carey. I glad to hear that it is more simple that the original ablation. The recovery for me was a tough few months on my ablation.

Pompon, that’s a good idea and I will probably do at some point. Up until now though I’ve just been managing by not pushing myself physically to much.