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How to deal with paroxysmal Atrial flutter

Posted by NoTrigger 
How to deal with paroxysmal Atrial flutter
February 16, 2024 12:08PM
Hello all,
I have a long history of afib going back 30 years or so and flutter which came on after my first ablation in 2017. Tried a whole bunch of anti-rhythmics - some of which worked for a while. Finally had 4 ablations, last of which was about 4 years ago. All good until about 2 weeks ago when my heart rate would go up from 50s typically to 90s in the evening and persist off and on until I woke up. Then the dreaded afib episode lasting after 3 hours about a week ago. Since then I have been going in and out of flutter (guessing here due to HR in the 90s) No one seems that concerned at my EP clinic based on the messages going back and forth between me and them. The clinic is booked for 6 months and trying to deal with this through MyChart and phone is somewhat frustrating. I am not getting any clear direction on my options as I don't see this as sustainable even though I am not symptomatic. I am on a low dose of metoprolol which obviously is not working too well now. Increased it slightly yesterday but it didnt help. Also, BP a little low.
I did all ablations at UCSF but given that appts are 6 months out I am sure it might be a long wait for an ablation as well. since I am going in and out Cardioversion is not really an option either.
Does this sound familiar to anyone? Any thoughts on what might be causing this flurry of activity? Is another ablation in the works? I am at my wit's end.
Mary
Re: How to deal with paroxysmal Atrial flutter
February 16, 2024 02:10PM
Sorry to see this happen to you, although it is rather common. Almost expected. It's a progressive disorder, so for many of us, an ablation just buys us some months/years of respite.

Have you had a 12 lead EKG to prove that it is flutter, and not PACs or AF?
Re: How to deal with paroxysmal Atrial flutter
February 16, 2024 06:17PM
Hi Gloaming - yes I did. Not exactly confirmed as opinions were all over the place. Am sending the strip. Also my EP finally got in touch and has decided that I should try propafenone again even though it did not work last time. He thought it might after the ablation. Problem is no one seem to have it. I've tried both Safeway and Walgreens. Trying a few others. Also super expensive at $600 or so for 3 months supply. I plan on getting just 2 weeks supply for a start if I can find it. A lot cheaper at Cost Plus but takes about a week to ship. Provided they have it.
Thanks.
Mary
Attachments:
open | download - ECG .jpg (175.5 KB)
Re: How to deal with paroxysmal Atrial flutter
February 16, 2024 07:31PM
You can toss my opinion into the ring with all the others....

I don't think that's flutter. I don't see multiple P waves between the QRS complexes. They should be apparent in leads II, III, and aVF. With a rate of 100 there would probably be 3 P waves between each QRS complex, so should be easy to see.
Re: How to deal with paroxysmal Atrial flutter
February 16, 2024 08:14PM
Quote
No Trigger
. Problem is no one seem to have it. I've tried both Safeway and Walgreens. Trying a few others. Also super expensive at $600 or so for 3 months supply. I plan on getting just 2 weeks supply for a start if I can find it. A lot cheaper at Cost Plus but takes about a week to ship. Provided they have it.
Thanks.
Mary

If you try it and it does work for you and you want to find it more reasonably priced, try a Canadian pharmacy. Some of us do order our medications from Canada and it is perfectly legal.
Re: How to deal with paroxysmal Atrial flutter
February 17, 2024 09:46AM
Thanks for all the suggestions. I did find it eventually at a mail order that I use for a fraction of the price. It is Mark Cuban's cost Plus. About $30 vs $592 for a 3 month supply at local Safeway. So outrageous. I have Medicare Part D which has the drug at Tier 4. No insurance required for Cost Plus. It didnt work 4 years ago, in fact, made it worse. So I am not very hopeful.:-(
I do have to wait about a week for it to arrive but since no one locally has it....
Re: How to deal with paroxysmal Atrial flutter
February 17, 2024 09:49AM
My EP said it was sinus with a few atrial tachycardia runs...He does believe that I am probably going in and out and the ECG just did not capture it.
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