atrial flutter, stopping & starting AARs

Hi,

I want to ask some things about flutter. I had atrial fibrillation. Ablated by Natale Aug 2019. Got atrial flutter about 4 months later (but I had stopped my antiarrhythmic before that). Got flutter again this April, also not on an AAR at that time either.

I am trying to understand something my cardiologist said, but he is a rapid speaker whose native language is Spanish & I am not sure but I think he said he was more worried about me having flutter than when I had afib. I saw him bec I was wanting to stop my antiarrhythmic (AAR) for a while to see the effects on my mouth ulcers. I think the import was that the afib had been successfully ablated & even when I got it in the past, the episodes were further apart or maybe that they could be stopped more easily with meds (maybe the latter was what he said). But now that I have flutter, if I were to temporarily stop my AAR & went into flutter again it could only be stopped with ECV? We stopped it the first time in Dec 2019 with AAR only. He went straight to ECV this last time, but I was never sure why other than he might have thought I was still on sotalol, but under Natale;s ppl, I stopped sotalol January (3 mo before the flutter) even tho my cardio here wanted me to stay on sotalol - so perhaps he was confused about that. He also said (I think) the flutter would happen more frequently than the afib. I am not really sure about what he said or was meaning - I think maybe to summarize he was probably telling me flutter would come back & it would be harder to stop & I would have to have ECV again. And of course with COVID-19 high again, I probably still would not be able to get it through him at the hospital without an overnight stay (& that is awful - all the unnecessary poking & prodding & measuring & constant bothers over that 24-hr period).

I ended up stopping my flecainide 13 days ago without his knowledge bec my ulcers were never-ending & painful. I had 2 ulcers at the time & they take about 14 days to heal if they are not stopped in the first few days. So, good news is that they are almost completely healed now & I do not have any new ones tagging on back to back as has been the case for a couple months. I feel I have to stay off flec at least another week to see if I get any new ulcers & then maybe that is enough time to connect flec as having a true effect in accelerating my problem with m. ulcers.

So after another week, I think I should restart flec so I can #1 protect myself from further A.Flutter & #2 see if the ulcers come back again fairly soon after restarting flec. One thing I will add - it is really hard to do these non-scientific experiments bec of course it takes more time to really make correlations. I do know every time I stop or start an AAR, my body reacts for a while by chin breakout, mouth ulcers .... So if I get an ulcer again in the first week, it may just be due to my body adjusting to the changes. Though I do feel if they progress to be as aggressive & constant as they have been, I can safely say AARs are the culprit, maybe flecainide moreso than when I was on sotalol.

But before the AARs, I could usually stop an ulcer from progressing by using my Ayurvedic toothpaste with Neem and Peelu about 3x a day, but that was no longer working while on AARs.

I am sorry I write such long notes:
1. Can I safely restart flec again at home after being off 3 weeks? I stopped it a day and a half before & got back on it on my own. I was able to get on sotalol on my own after stopping it without going the hospital/ekg route again. So, can I do this when I restart flec this time?
2. Do you think if I had to get ECV for flutter again, I should accept going through the ER if allowed - in order to avoid overnight hospital stay? I feel safer not being in an ER & also being with my dr who knows me. But I don't want to have to stay overnight again. Covid is keeping me from getting my ablation in Austin now & it is complicating things if I need ECV also.

Thanks for your input & help & your time!

"1. Can I safely restart flec again at home after being off 3 weeks? I stopped it a day and a half before & got back on it on my own. I was able to get on sotalol on my own after stopping it without going the hospital/ekg route"

I'm no doc, but if PIP is OK with flec, starting it with your old dose should be OK, in my opinion.

There was a point in 2012 when I was unknowingly over consuming calcium. My afib control decreased and at one point I used PIP flec four early mornings in a row, till a cardio suggested I take it prophylactically. I had not been using flec daily until that point. I started taking the flec before bed and then titrated it to 0 over a month, adding in powdered ginger which kept me in rhythm (and I've written about elsewhere here).

I also took flec PIP to convert a 2.5 month episode in 2004. I'd never taken flec before. I've subsequently used it PIP for the next nearly 16 years, albeit very infrequently at times (and thankful about that, too).

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Madeline
1. Can I safely restart flec again at home after being off 3 weeks? I stopped it a day and a half before & got back on it on my own. I was able to get on sotalol on my own after stopping it without going the hospital/ekg route again. So, can I do this when I restart flec this time?
2. Do you think if I had to get ECV for flutter again, I should accept going through the ER if allowed - in order to avoid overnight hospital stay? I feel safer not being in an ER & also being with my dr who knows me. But I don't want to have to stay overnight again. Covid is keeping me from getting my ablation in Austin now & it is complicating things if I need ECV also.

1. Yes. People start and stop flecainide all the time. I've done so multiple times. (Did the same thing with sotalol too.)

2. Hospitals are very safe places now -- safer than grocery stores -- so don't worry about that aspect. Nevertheless, sure, you can do a cardioversion in an ER. If they'll do it, that is. Some ERs docs can be finicky and want to spend hours trying diltiazem first. Just refuse the diltiazem. I've been cardioverted in an ER some 15-20 times. I used to tell them right up front that I refused all meds except propofol. It's really a nothing procedure and any ER doc will be qualified to do it (hell, paramedics are qualified to do them). I've never heard of a hospital holding someone overnight for a cardioversion. That's kind of the whole point of cardioverting you: to get you in rhythm and back home ASAP. I typically found it takes about 2 hours, and most of that time is spent just waiting for the meds to wear off after the procedure.

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Carey


2. Do you think if I had to get ECV for flutter again, I should accept going through the ER if allowed - in order to avoid overnight hospital stay? I feel safer not being in an ER & also being with my dr who knows me. But I don't want to have to stay overnight again. Covid is keeping me from getting my ablation in Austin now & it is complicating things if I need ECV also.


2. Hospitals are very safe places now -- safer than grocery stores -- so don't worry about that aspect. Nevertheless, sure, you can do a cardioversion in an ER. If they'll do it, that is. Some ERs docs can be finicky and want to spend hours trying diltiazem first. Just refuse the diltiazem. I've been cardioverted in an ER some 15-20 times. I used to tell them right up front that I refused all meds except propofol. It's really a nothing procedure and any ER doc will be qualified to do it (hell, paramedics are qualified to do them). I've never heard of a hospital holding someone overnight for a cardioversion. That's kind of the whole point of cardioverting you: to get you in rhythm and back home ASAP. I typically found it takes about 2 hours, and most of that time is spent just waiting for the meds to wear off after the procedure.

Hey Carey,

I guess I meant in light of Covid, re going to an ER. Not sure of how many sick ppl lying about exposing me to their germs while I have to wait & wait???

The only reason my ECV was thru an overnight stay in hospital in April was bec that was right after Covid-19 had started & no elective procedures were allowed, including an ECV - something like that is what my cardiologist said, so he said the only way he could get me cardioverted that time was to put me in hospital for an overnight stay. And, oh boy, did I hate it. All that fuss, tubes, IV lines, needle sticks with blood draws, monitoring, all that mess of ppl fooling with you like they know what you need, when I knew they were stressing me to death & all I needed was a quick procedure. They had tubes & machines hooked up on both sides of me, so I could not move easily to get up & rearrange my bedcovers much less go to the bathroom. And then the minute I finally fell asleep in the morning, they came in to get a blood draw for the 2nd time - all so much hoopla. BUT, if that was the only way I could get out of flutter at the time, I had no other choice. No telling what that cost the insurance too.

So, that is what I am wondering - is it still that way - that my cardiologist can't do the ECV outpatient in the hospital on the day of instead of overnight or are the restrictions the same?

Well, that's a matter of hospital policy that only your cardiologist can answer, but I really doubt it. The policy in most hospitals right now is to get everyone who doesn't need to be there out of there ASAP.

Hospitals have for the most part got this COVID crap figured out. They're assessing patients the minute they walk in the door and segregating the ones with potential COVID symptoms into separate areas. I really wouldn't be afraid to go to an ER today. But wear a mask, obviously.