Flutter while waiting for Dr. Natale fix

Hello all again,

Had ablation #2 in Feb 2021 and flutter started a month later. Handful of cardioversions later (last one two weeks ago) and on Sotalol 2x daily, drinking plenty of water and keeping magnesium and potassium levels up BUT back into flutter today. Flutter is 2x and Kardia says HR 101. Not scheduled to see Dr. Natale till end of year unless there is a cancellation, probably doubtful.

Question is do I keep getting CVs until Natale visit, or ask EP to try Amiodarone?
Tikosyn and flecainide didn't convert me while in AFIB and sotalol isn't converting while in flutter. I am asymptomatic while in AFIB or flutter.

Thanks,
Tony

If you start amiodarone, you'll have to come right back off it very soon for an ablation at the end of the year, so I don't think that's a viable option.

Were you on the sotalol before your last cardioversion? If not, then it's worth doing another one. All the drugs you mentioned are better at keeping you out of flutter than they are converting it. I dealt with intractable flutter for two years and I found no drugs that would convert it (but didn't try amio). However, almost all those drugs did a decent job of preventing it once it got stopped by a cardioversion.

There was a period of several months in 2015 when I was in the ER getting cardioverted multiple times per week. So yeah, you can actually do cardioversions until the end of the year, especially if they're a couple of weeks apart. But hopefully with the sotalol on board a cardioversion now might hold until Dec.

Carey,

I did the sotalol load in the hospital cardioversion the day after the load and it lasted 4 weeks then another CV two weeks ago and back in flutter yesterday. Been on sotalol right along, 120mg 2x.
How long should you be in flutter before it becomes a problem?? My HR is 103-108 in flutter.

Thanks,
Tony

You're rate's not super high, so you can put up with it for quite a while, but I wouldn't let it go more than a week or two. But that should be plenty of time for you to arrange it with your EP. I doubt an ER would cardiovert a rate that low.

Well the Dr. Natale fix is Wednesday 10/20
Still in flutter 105 bpm most of the time with some runs in the 50's
Was scheduled for a cardioversion this past Wednesday but Dr. Natale's office said to hold off as it would be better for me to be in flutter during the procedure.
It will be 10 days in low rate flutter by the time I am on the table so I think that will be OK.