Home device to check for flutter

The other day I had a successful cardioversion to treat my atrial flutter. My anxiety about the procedure was not necessary, as it was completely painless and over before I knew it. Thanks to all of you who told me so!
My Apple watch didn't detect the flutter, so I'm wondering if the Kardia Mobile 6L would be a better device to have for that? Sorry if this has been discussed here before, but I can't seem to find it.
Thanks, Linda

Some of the devices would be better than others, but in order to diagnose Flutter, you need to see the little P waves. A 10 or 12 lead EKG is the only thing I would trust to be definative.

I bought the 6L and didn't find it useful that purpose. You can switch between single or 6 lead modes. I mostly use mine in single lead mode. On the Kardia there is an enhance setting which applies a filter to the reading. It's used to help reduce noise but may be covering up possible flutter. I guess that's where a 10 or 12 lead come into play and then you're gonna need an expert to decipher the results.

I think you'll know flutter when you feel it. It's unusual in its presentation in my experience. Also Kardia 6L here but no help with flutter.

You're never going to find a handheld or wearable device that can accurately diagnose flutter. That's because the sensors are just too far from the heart to pick up the P waves. I spent several years dealing with flutter and I could never see it clearly with a Kardia, even when I tried the Lead II technique described on their web site, and Kardia is the most accurate of all the consumer ECG devices.

So lacking a 12-lead ECG and the ability to interpret it, the most accurate way to diagnose flutter is with two fingers. Feel your carotid or radial pulse for 15 seconds. Count the beats and pay close attention to the rhythm. Is the rhythm rock solid regular like a drumbeat? Is the heart rate elevated above normal? If the answer to both questions is yes and you've been diagnosed with flutter previously, it's probably flutter. If the heart rate happens to be near 150 bpm, it's virtually guaranteed to be flutter.

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Carey
So lacking a 12-lead ECG and the ability to interpret it, the most accurate way to diagnose flutter is with two fingers. Feel your carotid or radial pulse for 15 seconds. Count the beats and pay close attention to the rhythm. Is the rhythm rock solid regular like a drumbeat? Is the heart rate elevated above normal? If the answer to both questions is yes and you've been diagnosed with flutter previously, it's probably flutter. If the heart rate happens to be near 150 bpm, it's virtually guaranteed to be flutter.

If you happen to be subscribed (or grandfathered) to Kardia's enhanced interpretation service, if you create a PDF of the ECG, on one of the later pages they provide a heart rate vs time graph. Format is a little odd as the heart rate Y axis is on the right and increases down. Also, the left Y axis is RR time in decimal fractions of a second, increasing up. Hence the BPM axis is non-linear. For my single lead device, this graph is on page 3 of the PDF. You can still see what Carey is talking about.

When an afib episode of mine converts to flutter, there is a bit more variability than Carey describes, but tiny compared to afib variability. I used a beat to beat recording heart rate monitor and can get recordings that are hours long. In my case, I can see the pattern convert to flutter and then back to afib (flutter is a very stable rhythm and it typically takes me some doing to get it back to afib so I can convert the afib to NSR).

Thank you everyone for your helpful input. Carey, your description of physical diagnosis of flutter was exactly what I was experiencing, steady but high heart rate. I didn't realize what it was at the time, since I hadn't had flutter before.
George, I'm curious about your comment, converting from flutter to Afib and then to NSR. How does one do that?
Thanks, Linda

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LLA
George, I'm curious about your comment, converting from flutter to Afib and then to NSR. How does one do that?

Linda, not sure if anything I do applies to others.

I've had afib for over 18 years. It was brought on by chronic fitness at age 49. The first 4 months ended with a 2.5 month episode converted in 20 hours by a loading dose of flecainide as Tambocor. Subsequently I've generally controlled it extremely well by detraining the exercise, but maintaining fitness in a very specific way. I've also used daily electrolytes as magnesium to bowel tolerance, potassium citrate powder I put in about a liter of water and drink over the day, a couple grams of taurine and my calcium intake is low. A few times a year flecainide would convert me in an hour or two. In 2012 I got more episodes and figured out to restrict calcium.

What I've noticed over time is that flec has taken more time to convert me. 2021 was a bad year for afib for me in that I had 15 episodes, mostly associated with mRNA vaccines. I also had a J&J shot and the morning after had an episode that lasted 9 hours for me. One thing that was different is I used generic flec rather than branded Tambocor.

I commonly wear a beat to beat recording heart rate monitor during episodes. What I realized was happening is that the afib was converting to flutter and then I'd have to do something to convert back to afib to actually to convert to NSR. In retrospect, this had been happening during my conversions for some time, but I didn't really pick up on it. Now I will try many things and I don't recommend others do this as other than the afib, I am very healthy and it and am on no meds. This can include:

- long duration (3 minute) breath holds, having exhaled completely first.
- exercise with the breath held out: push ups, jumping rope, running, lifting weights and so on
- inversions by standing on my head or using gymnastic rings to invert
- cold water soaks. On Oct 27 2021, soaked 10 minutes in 57 deg F water (14 C) for a conversion
- on the less intense side I will lie down with my feet up and meditate. I will watch my heart rate on the app and will it to drop below 80. If I can get it there, I will usually convert.

None of this is guaranteed for me, though all have worked at one time or another, and there is risk. During one of the exhaled exercise sessions, I got my heart rate up to 220 and it stayed there for a moment till I decided it would be good to invert and settle it down, which it did. I also never take a rate control med with my flec. Again this is NOT standard of care advice and I don't suggest it to others.

After the Oct 27 2021 episode, decided to start taking 50 mg of flec in the evenings, did that for two months, then cut it to 25, then to 12.5. In June of 2022 cut it to zero and had an episode after 4 days. I took my normal loading dose of flec (300 mg for me - no more than 200 if you weigh less than 154 # (70 kg)), I chew it and this was flec that expired in 2014. I could taste it was less potent. Thought I'd really messed up, but it converted me in 1.5 hours with no flutter. I wondered if I'd been overdosing (for me) as I weighed my college football weight of 210# when I first got afib. I was very fit, but big. When I detrained, I started to gain, so changed my diet and dropped down to my current 168# (at 5' 11"). I started taking the 12.5 mg flec daily until Oct when I quit it again. Another episode after 4 days. This time I only took 200 mg of flec (that was unexpired, so more potent). This converted me in 2 hours, again without flutter. So I've had two episodes since Oct 27 2021, a huge improvement over 2021. I can also show you studies suggesting that 12.5 mg of flec should provide absolutely no benefit. Perhaps it is placebo for me???

My takeaways from all this: 1. doing something to change the status quo can sometimes make the flutter go back to afib.; 2. After losing weight, I hypothesize my 300 mg of flec was too much, even though it is within the dosing guidelines'; 3 the generic flec may have been more potent than the Tambocor, which is why that episode took so long (for me) to convert (compared to my history).

In 2018, in this post, I linked a paper from 1959 where they were lowering peoples temperature as a part of surgical procedures. As they lowered temperatures, the arrythmias would go away, then return as the temperature was increased after the surgery. Note that hypothermia is real. If you want to play with this, do gradual exposure to cold. Also have a spotter in case you pass out. I expose myself to cold nearly every day, so it is something my body is used to and I'm very familiar with. I shoveled snow yesterday wearing only shorts, no shoes, shirt, gloves & etc at 20 deg F. This morning I went for my morning sunrise exercise wearing shorts, sandals & a t-shirt at 18 deg F. I take cold showers daily. Again, I don't encourage people do do this. If you do, educate yourself to the dangers, have someone around and be careful.

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GeorgeN

In 2018, in this post, I linked a paper from 1959 where they were lowering peoples temperature as a part of surgical procedures. As they lowered temperatures, the arrythmias would go away, then return as the temperature was increased after the surgery. Note that hypothermia is real. If you want to play with this, do gradual exposure to cold. Also have a spotter in case you pass out. I expose myself to cold nearly every day, so it is something my body is used to and I'm very familiar with. I shoveled snow yesterday wearing only shorts, no shoes, shirt, gloves & etc at 20 deg F. This morning I went for my morning sunrise exercise wearing shorts, sandals & a t-shirt at 18 deg F. I take cold showers daily. Again, I don't encourage people do do this. If you do, educate yourself to the dangers, have someone around and be careful.

I had shy of a week of miserable flutter that refused to convert since Saturday. Last night I was so hot and sweaty from the tachycardia burden that I cooled off my face with cold water because I couldn’t take a cold shower in the hospital wearing telemetry leads and hooked up to an IV. I got an instant relief of 70hr for three minutes until my flutter returned. I then stuck my head out of a window. The temperature was 55 and I converted for the night from the cold windy blast of outdoor air.

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susan.d
Last night I was so hot and sweaty from the tachycardia burden that I cooled off my face with cold water because I couldn’t take a cold shower in the hospital wearing telemetry leads and hooked up to an IV. I got an instant relief of 70hr for three minutes until my flutter returned. I then stuck my head out of a window. The temperature was 55 and I converted for the night from the cold windy blast of outdoor air.

Glad that worked!

Using glabrous skin areas of the body: palms of the hands, soles of the feet, face, and ears to cool as you did Susan, may be a safer approach than my total body immersion.

"Heat loss through the glabrous skin surfaces of heavily insulated, heat-stressed individuals" [pubmed.ncbi.nlm.nih.gov].

"Insulation reduces heat exchange between a body and the environment. Glabrous (non-hairy) skin surfaces (palms of the hands, soles of the feet, face, and ears) constitute a small percentage of total body surface area but contain specialized vascular structures that facilitate heat loss. "

Stanford neuroscientist, Andrew Huberman, discusses heating and cooling through glabrous skin in this podcast: [hubermanlab.com]

"The temperature-regulation research of Stanford biologists H. Craig Heller and Dennis Grahn has led to a device that rapidly cools body temperature, greatly improves exercise recovery, and could help explain why muscles get tired. The researchers say the device provides better results than performance-enhancing drugs." [www.youtube.com]

George, thank you for describing your converting techniques. It's great that you have found what works that precisely! It makes me cold just reading about shoveling snow like that. I'm a wimp when it comes to cold weather, as I get cold just walking in 50 something degrees. But the next time I'm out in the cold, I'll try to think about it's beneficial effects!

I've been reading of the this cold therapy as well by Wim Hoff.

[www.wimhofmethod.com]

Huberman is great,

Here's the clip on feet/hands cooling (full body not recommended).

[youtu.be]