Flutter

My first episode of flutter was 6 yrs ago. Second, 2 yrs after. Now every other month. Sometimes alternating with afib or mixed in. PVCs everyday for years, regularly all night and often during the day.

Any thoughts/experience/wisdom on distinctions of flutter vs. afib respecting ablation? My EP doesn't seem to want to talk about it.

I am on metoprolol and holding Flec as PIP, but the 1:1 conduction risk with flutter has me spooked to use Flec. Thoughts/knowledge on that?
(I have low resting HR so I can tolerate only 12gm/day of Metoprolol)

It seems, to me, ill-advised to wait to do ablation when it seems obvious that is where I am going....eh?

Thanks for anything.

If you're taking metoprolol you're at little to no risk for 1:1 conduction. That's why most EPs prescribe it along with flecainide (but some don't because the risk of 1:1 conduction is very, very low).

That said, I have low hopes for flecainide working as a PIP against flutter. Never did for me, and I have a LOT of experience with flutter. Flecainide is usually pretty effective at preventing it, but it's almost useless at stopping it. Unlike afib, flutter is actually a pretty stable rhythm that isn't easy to stop once it gets going.

Flutter ablations are usually easier than afib ablations, but "usually" is the key phrase here. Any relatively new EP should be able to ablate typical right-sided flutter with ease, but left-sided atypical flutter is another matter. That demands a highly experienced EP, perhaps even one experienced to the level of isolating the LAA, which few are.

I agree with your thinking about waiting. The disease is clearly progressing and it's not going to get better. I would seek out a highly experienced EP and ablate that crap out of your life.

Beware, some ill informed EPs will say, "lets ablate the flutter & see if the afib goes away." Run away from that EP & find one who will take care of both afib & a flutter in at the same time.

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Carey
If you're taking metoprolol you're at little to no risk for 1:1 conduction. That's why most EPs prescribe it along with flecainide (but some don't because the risk of 1:1 conduction is very, very low).
.

I had 1:1 conduction all the time this past year while in flutter and SVTs. I guess Cardizem doesn’t address it as well as metoprolol does.

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susan.d
I had 1:1 conduction all the time this past year while in flutter and SVTs. I guess Cardizem doesn’t address it as well as metoprolol does.

Also worth noting -- 1:1 conduction didn't kill you.

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Carey

I had 1:1 conduction all the time this past year while in flutter and SVTs. I guess Cardizem doesn’t address it as well as metoprolol does.

Also worth noting -- 1:1 conduction didn't kill you.

No it didn’t kill me (I woke up above ground today) but I lived in the hospital the month of November with uncontrollable high tachycardia flutter. Flutter is an inconvenience.

Side note: a pacemaker can be programmed to treat (burst therapy) and convert Af to nsr at 1:2 but not 1:1. 1:1 is not pleasant and after 54 ECVs and Cardizem bolus and drips they became ineffective to convert.