Atrial Flutter?

Well, I finally got a second opinion from another EP. He is suspecting that I have Atrial Flutter in addition to the Atrial Tachycardia. I have a two week monitor on and will be scheduled for an ablation. Is Atrial Flutter very common? S the ablation similar as for SVT? Are there more risks? Are the risk factors and triggers similar? Thanks!

Atrial Flutter (AFlutter) is very common and many people (including myself) have had AFIB and
AFLUTTER off and on, interchangeably. I've read that in some Cases AFLUTTER is better than
AFIB for a few reasons, but in the end they are both Arrhythmias. I don't believe the risk factors
change at all, an ablation is an ablation and some are more simple and others more complex.
From my understanding in most cases the quicker an ablation is done (assuming it's done) sooner
vs later from the time the arrhythmia occurred, the easier and less complex it is.



Edited 1 time(s). Last edit at 10/17/2023 07:14PM by cornerbax.

Yes, flutter is common. It goes hand-in-hand with afib, and it actually is a type of SVT, so those two go together as well. The types of SVT are AVNRT, AVRT, atrial tach, and atrial flutter. Flutter is usually distinguished separately because its causes are a bit different. It's caused by an electrical barrier with a gap in it in one of the atria. That barrier is usually scar tissue, which can form naturally or via a prior ablation. Flutter is a very common complication of afib ablations, and even more common with MAZE procedures.

Since it's more like afib than the other SVTs, an ablation for it is more like an afib ablation, though not usually as complex. If it's typical flutter, it will be in the right atria and is usually pretty easy to ablate. If it's atypical flutter it will be in the left atria, which makes the procedure more complex since that means a septal puncture to get catheters into the left atrium. Atypical flutter can be difficult to ablate (but still simpler than afib), but typical flutter is more common.

All the risks are the same as for afib and not much different from SVT. If your CHADS-Vasc score warrants it, you should be on an anticoagulant and will be following an ablation if you aren't already. Triggers? Again, like afib, so who knows. It's individual. I dealt with flutter for years, so a couple more things to know:

1. Unlike afib, it's a very regular rhythm, and therefore a stable rhythm that can continue almost indefinitely.
2. It's very difficult to terminate with drugs. It rarely responds to things like a flecainide PIP like afib can, and often has to be cardioverted to terminate. So a PIP solution is unlikely to work. Cardioversions will almost always stop it immediately with a single shock.
3. Fortunately, it's fairly easy to prevent with drugs. Flecainide usually works well.

Thank you for the reply!! I really liked the new EP. He was astute enough to recognize that during my first ablation for atrial tachycardia, they initiated an unexpected atrial fibrillation and atrial flutter. He recognized that there may be more than meets the eye this time around as well.They ablated the flutter at thst time as well. A year and a half later, the atrial tachycardia returned, but with a different pattern, sustained episodes of 3-6 hours. It is interesting. I never considered flutter. But the other night when I woke up from An episode, I could hear the atrium beating in a 3:1 pattern with my stethoscope. Ventricular rate was 150. I have woken up that way off and on for years, and just chocked it up to nocturnal anxiety attacks or something. Now I am wondering if it was flutter all along. Very curious.

The minute I hear someone say a heart rate of 150 I think flutter.

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Carey
It's individual. I dealt with flutter for years, so a couple more things to know:

1. Unlike afib, it's a very regular rhythm, and therefore a stable rhythm that can continue almost indefinitely.
2. It's very difficult to terminate with drugs. It rarely responds to things like a flecainide PIP like afib can, and often has to be cardioverted to terminate. So a PIP solution is unlikely to work. Cardioversions will almost always stop it immediately with a single shock.
3. Fortunately, it's fairly easy to prevent with drugs. Flecainide usually works well.

Can flutter resolve on its own (be paroxsysmal) if drugs do not convert a person? I had an event last June where it almost seems like Flecainide (used as PIP to end an AFib episode) caused the flutter. Don't ever remember having flutter before, but of course I can't be positive. I had to have my first DCCV after a few days and have been fine ever since. My kardia would read as NSR but was actually 3:1 flutter at 80bpm. I talked with George a couple months ago where a "reduced" Flec PIP has worked better for him in preventing flutter from cropping up while trying to end an AFib episode.

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BobsBeat
Can flutter resolve on its own (be paroxsysmal) if drugs do not convert a person?

Yes, it can convert spontaneously on its own but it tends to be stubborn. It can also sometimes be converted with vagal maneuvers, large doses of potassium, and even with exercise.

Thank you for the replies! I will update after I see the EP again. I have woken up in the middle of the night with 'attacks' of feeling like I can't breathe, heart racing at about 150, shortness of breath, chest pain, nausea, dizziness, etc. I have never had it caught on any monitor and thought it was some weird panic thing. This time, it happened three times while wearing the monitor and I never even thought about afib or flutter. When I listened to my heart, it was definitely NOT sinus. I am so thankful it happened on the monitor. Hopefully the doctor can tease out a-flutter vs SVT if the monitor isn't great at differentiating. Thanks!!

Well, I hope it does. But the treatment is pretty much the same for both until it's known for sure, so nothing to really worry about for now.

I read something that mentioned that only around 2 percent of atrial flutter occurs in 'normal' hearts with no disease or structural abnormality. I also read that flutter is extremely rare under age 50. Are there things I should ask my EP about just to make sure there is nothing else causing it?

Just want to add to what has been covered and correct a few things. I have been diagnosed with aflutter, SVT and afib and undergone treatment (medical and ablation) for both afib and typical flutter.

1. Ablating typical right-sided flutter has a very high success rate. It is also a much smaller and safer procedure than an afib PVI. Shorter recovery and no "blanking" as with afib PVI.

2. While flutter is technically SVT, in common ep usage, SVT is different and the ablation is different, although still on the right side.

3. Even by ekg, typical Flutter can not always be distinguished from SVT or Atach, especially on a single lead.
It also cannot be distinguished from atypical left-sided flutter. That call would be up to a good ep clinician analyzing your medical history, but they don't always call it right.

4. Because of this, a typical flutter ablation may have a lower success rate in patients with multiple arrythmia's. Don't ask me how I know

4. Daily Flecainide may prevent flutter, but you should never take Flecainide to try and come out of flutter episode. It could turn the flutter episode in 1:1 flutter which can be very dangerous. That is one reason that daily Flecainide is usually prescribed with a nodal blocker such as a beta blocker or Diltiazem for safety reasons.

5. My "flutter" episode were almost always under 10-20 minutes and self terminated, however I was told that if they didn't to take a rate control drug and then call the office. For those that don't convert naturally, Cardioversion is often necessary.

6. I believe your "2%" figure for "normal hearts" refers to atypical left-sided flutter. Besides occurring in compromised hearts, atypical flutter is often seen after multiple ablations. As far as I know, typical right-sided flutter can occur in normal hearts.

Jim



Edited 1 time(s). Last edit at 10/22/2023 01:09PM by mjamesone.

Jim,
Thank you for the very informative reply. I am waiting on the results of the 14 day monitor and follow up with EP. Will post when I have more information. Thanks to all of you for the wealth of knowledge!!

So I got my final holter report. It is significantly different than the last one in February. It is all still showing SVT, although I am still suspicious of flutter. Will see what the EP says, but probably another ablation coming up.

It all LOOKS like SVT although it seems that Atrial Flutter could be difficult to differentiate. Does it even matter, or is the ablation going to be the same regardless?

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MeganMN
It all LOOKS like SVT although it seems that Atrial Flutter could be difficult to differentiate.

I assume the Holter was a single lead device. Flutter is almost impossible to diagnose with a single lead.

{edit} rereading the report, would vote for SVT because I would expect flutter to not be single or couplet beats, but pretty continuous.



Edited 1 time(s). Last edit at 10/29/2023 01:00PM by GeorgeN.