Is Advice for A-Fib the same as for Atrial Flutter

I have had atrial flutter 3 times in the 3 years since my A-Fib ablation. The first episode was so close to the end of the blanking period, just 27 days past it, that I did not know if we had to count it. The next episode was 8 months after ablation & I would have gone then for the "Touchup ablation" by Natale, but COVID stopped me. The last episode was May 15, 2022, 3 months short of being 3 years post afib ablation.

I am looking through old notes I have copied and saved & I have some information here from Anti-Fib & Wolfpak re A-Fib:

My question at the time was: Re how long is it safe to be in A-Fib:

Wolfpak says: Rate control to < 100 bpm and anticoagulate. Then you have nothing to worry about for days or weeks until you either convert or get shocked.

Anti-Fib says: As far as your question of how long it is OK to be in AFIB, there is no exact answer, but there is a rough 48-hour window that it usually takes for a clot to form while the Atria is Fibrillating during AFIB. Anti-Coagulation reduces but does not eliminate Clot/Stroke Risk. The fact that you’re back in NSR at 24 hours is good news. In my case, since I only convert out on my own about 30% of the time, I go to the ER room for a Cardioversion at about the 40 hour mark, to stay within the 48-hour window. The Hospital will not Convert me if it has been over 48 hours, unless they also perform what is called a TEE, in which they stick an Ultrasound device down the Esophagus, and look into the Atria to verify that there is no Clot prior to completing the Cardioversion. A TEE has to be scheduled as an Out-Patient procedure, which has been usually taking an extra 5-10 days to schedule.

Is this the same advice I should follow for flutter, possibly left atypical flutter? I am waiting to be put on the schedule with Natale for ablation of this.

Thank you. I am trying to get prepared as I was in a dumb state May 15th, when I had this flutter episode after being free & normal over 2 years. I completely forgot to take the blood thinner I had on hand, etc. Was told to go to the ER & I would have preferred not to rush it so & to have followed some of the precautions like taking the blood thinner, maybe some of the sotalol or flecainide I had on hand, etc., before getting stuck in ER for 8 hr without a single person asking me if I was currently taking a blood thinner, etc.

Thank you. I have quoted Wolfpak & the Anti-Fib above in particular.

I am putting some emergency notes at the top of my file for the next time I get into trouble before I can see Natale to get this fixed.

There is no recognized safe period of time to be in afib or flutter without anticoagulation. Doctors for many years followed a 48-hour rule, and some still do, but there is no evidence supporting that "rule" and there is evidence indicating it's wrong. If you're going to try to use anticoagulants on a PIP basis (and I've done that), the rule you should follow is to take it immediately when an episode begins and continue it for 30 days after that. That may be overly cautious, but there simply isn't enough known on the question to follow any other advice.

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Carey
If you're going to try to use anticoagulants on a PIP basis (and I've done that), the rule you should follow is to take it immediately when an episode begins and continue it for 30 days after that. That may be overly cautious, but there simply isn't enough known on the question to follow any other advice.

Following that rule, I should take an OAC everyday. My CHADS score is 0, but I've afib 4-5 times/month, usually self reverting without meds in less than 3h (less than 2hrs for most).
If still in afib at the 2hrs mark, I usually take an OAC. Nevertheless, when this happens, I always self-revert in the following hour.

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Pompon
Following that rule, I should take an OAC everyday. My CHADS score is 0, but I've afib 4-5 times/month, usually self reverting without meds in less than 3h (less than 2hrs for most).

Being a CHADS 0 kind of changes things.

How can you Pompon be a chads 0? Doesn’t an afib history alone justify a point? Atrial myopathy?

I may be wrong, but I think the kind of afib I have does not add a point.

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susan.d
How can you Pompon be a chads 0? Doesn’t an afib history alone justify a point? Atrial myopathy?

Nope. The score is only intended to be applied to people with atrial arrhythmias in the first place, so it doesn't include that as a point. But it's generally agreed that if you're actively in afib/flutter, you need to be on an anticoagulant. Poppino is asking about using Eliquis as a PIP, which is reasonable if you're a CHADS 0. When I was a CHADS 0 in 2015, I used Eliquis as a PIP and my EP approved of it, but he insisted that I should start it the minute the arrhythmia started. I think his advice was correct.

I thought you posted not that long ago (the post about this website isn’t “lone afib”) and somewhere in that post you mentioned in fact afib is a form of Atrial myopathy. If that is the case then isn’t Atrial Myopathy a mild form of heart disease which is either one or two points on the CHADS score?

Im asking because I question the accuracy in me adding up my points because I’m curious. 5 or 6 doesn’t make a difference-both are still high. Dr N wrote chads 5 in one report and chads 6 in another so I’m trying to do the math in determining which check box was added to obtain 5 or 6. I haven’t had my 6 month TEE yet to see if my watchman is sealed and leak free…thus I’m curious about the level of compliance in temporarily stopping my 2.5 dosing (dental surgery/colonoscopy etc) since I’m not on a baby aspirin.

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susan.d
I thought you posted not that long ago (the post about this website isn’t “lone afib”) and somewhere in that post you mentioned in fact afib is a form of Atrial myopathy. If that is the case then isn’t Atrial Myopathy a mild form of heart disease which is either one or two points on the CHADS score?

Having atrial myopathy (afib, flutter, etc) is what makes the CHADS score apply to you at all, so it's sort of a super point. Giving you another point for having it wouldn't make sense because it's what got you on the scale to begin with. I can envision a CHADS-Vasc-3 someday that addresses things like this (and the female point), but it isn't here yet. Right now you just apply the CHADS-Vasc-2 to anyone who has a history of atrial arrhythmias.

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Carey

How can you Pompon be a chads 0? Doesn’t an afib history alone justify a point? Atrial myopathy?

When I was a CHADS 0 in 2015, I used Eliquis as a PIP and my EP approved of it, but he insisted that I should start it the minute the arrhythmia started. I think his advice was correct.

Back then, how long were your afib episodes when they happened ?
Mine are usually so short that I take Pradaxa only when the 2hrs length is reached. And a second one 12hrs later. And it's all, since I always self revert shorty after my first dose.
If your episodes were usually longer and required an ECV, taking your PIP at once and for so long after the ECV looks right.
We're all different, and I assume it wouldn't be a good choice for myself. Right?

Waiting a couple of hours is what I used to do, but my EP persuaded me not to do that. Even if you don't continue it for the full 30 days, I would recommend just taking it right away.

Thanks. Next year I'm 65 and retired, which may change some things. I must talk about that with my cardiologist, in september. There's a balance to find between the risks: bleeding or stroke... Maybe a low dose of OAC would suit my case