Reading about a lot of LAA ablation patients getting flutter after ablation

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Poppino
John my 2 cents: i developed atypical flutter 9 yrs after an afib pvi. The flutter was ablated here in Charlotte. Lasted 6 weeks. More flutter. It actually got worse. Off to Austin i went. 8-6-21 Natale did 2-3 areas that were never touched including LAA. I asked why? Dumb question btw. Dr Natale said because that was the flutter source. 4 months later i had omicron covid. Rough. Zero flutter. 2-16-22 back to Austin. Natale put in the Watchman. Im now off eliquis and have had zero flutter episodes. Ive had 2-4 short bumps - something of low rate 97-105 for 2-20 mins but ive never taken another anti Arrythmia med nor been to er nor hospitol. Best decesion i ever made. Thanks to Shannon Carey Jackie & this site. I drink a little beer drink coffee eat drk chocolate and lift weights & scream at college bb games. Miami is good btw

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Carey
I'm not sure what results you're referring to but there's nothing about isolating the LAA that makes flutter more likely, nor is it a more dangerous procedure. It's pretty simple, really. If the LAA is a source of afib, you can either ablate it or have a failed ablation. All the PVIs in the world won't stop afib that is coming from somewhere other than the pulmonary veins.

There's no way to know in advance where your afib is coming from. The only way to know is for an EP to get mapping catheters inside your atria and discover the actual source(s). And, in fact, the average EP doesn't know how to find afib originating in the LAA nor how to ablate it, so unless your EP is one of a small handful of top EPs, there's no chance they will touch your LAA.

Also, there's nothing more ominous about atrial flutter. It's a possible complication of any ablation whether it involves the LAA or not. If it happens, the good news is it's generally easier to deal with than afib.

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Johnnyk80
Thanks Carey. I'm think I'm just starting my 30 days of fear regarding this upcoming ablation. I am curious however what causes the incidences of flutter post ablation? Are there any signs that an EP Can look for to discern if the patient may run into flutter? If so, would they tell the patient?

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Any EP worth her salt will challenge the heart before they wheel you out of the surgery. They use either adenosine, or isoproterenol, or both, and make the heart slow and speed up, hoping to reveal some lingering pathways where the unwanted signals will get through the 'dams' of new lesions caused during the ablation process. So, that's the answer to your 'are there any signs...' question. Yes, and a good EP will take the time to look, and then deal with them while you're still under anesthesia.

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Carey

Thanks Carey. I'm think I'm just starting my 30 days of fear regarding this upcoming ablation. I am curious however what causes the incidences of flutter post ablation? Are there any signs that an EP Can look for to discern if the patient may run into flutter? If so, would they tell the patient?


Flutter is usually caused by a barrier to electrical conduction in the atria that has a single hole in it somewhere. The barrier I'm talking about in this case is an ablation scar, and by hole I mean a point where the scar isn't continuous, there's a hole in it somewhere that allows an electrical signal to pass through. When that exists, what can happen is a single cell on one side of the scar fires and that signal propagates through the hole, continues around the atria in a circle, and comes back to stimulate that one cell again. So flutter is just a self-sustaining signal going around and around in a circle in your atria. That's why you'll sometimes hear flutter described as clockwise or counter-clockwise.

Can an EP detect that hole in the lab? Yes, and if they do they don't just do nothing and conceal it from you; they fix it. When a good EP thinks the ablation is complete, they will do a challenge with Isuprel (isoproterenol) or adenosine (Natale uses Isuprel), which are strong cardiac stimulants. They will also deliver a pulsing electrical stimulus to the atria. The goal is to provoke any hidden sources of afib or flutter into revealing themselves. The problem is that sometimes the hole isn't there at the end of the procedure, but over the coming days and weeks healing of the scar occurs and a hole can appear where perhaps one burn wasn't quite deep enough or two burns were just a little too far apart. That's why a repeat procedure is often called a touch-up. It's almost never an actual redo of the ablation. It's going in and making perhaps just or or two burns to close the hole.

I understand the pre-procedure anxiety, but relax. You're in the most capable ablation hands in the world.

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Pompon
Any EP worth her salt will challenge the heart before they wheel you out of the surgery. They use either adenosine, or isoproterenol, or both, and make the heart slow and speed up, hoping to reveal some lingering pathways where the unwanted signals will get through the 'dams' of new lesions caused during the ablation process. So, that's the answer to your 'are there any signs...' question. Yes, and a good EP will take the time to look, and then deal with them while you're still under anesthesia.

Even that may not be enough...
I've told about my fourth ablation here, some years ago.
Isoproterenol and adenosine (scaring !) were used. Fourty minutes waiting, after the burns had been made, and the EP trying to stress my heart... Everything was fine.
But next day, paroxysmal AFib was back. Since then, it comes for an hour and goes away spontaneously about 5x/month. Weird thing !