Timing of AF or Flutter onset, Remodeling & ECV

After just shy of 14 years since a Natalie PVI ablation, I have just spent a day and a half in what seems to be A-Flutter... current EP suggested trying Flecainide for a bit & see if converts before considering ECV. My question is how rapidly does enough tissue remodeling take place that it could influence post ECV AFIB/AFL recurrence... on the Central CA coast we have had a couple of pretty stressful weeks & I'm hoping that is what precipitated this event... therefore, concerned that delaying the ECV would enhance whatever pathways are firing??? Thanks for any comment.
Joshua

I have a long history with flutter, and at least for me no drug could convert it, including flecainide. Flutter's like that. It's a stable rhythm that can continue on its own for a long time. But flecainide was good at preventing it. If I were in your shoes, I would ask to start flecainide and then do a cardioversion a couple of days later. That presents a much better chance of success in my experience.

Yes, you want to minimize the time you spend in an arrhythmia like flutter and afib because they do tend to remodel your heart to continue that arrhythmia. There's no emergency rush but definitely no reason to delay things.

You said , "what seems to be a flutter"

Have have you confirmed this by an EKG ?
If not, that might be a good first step, not only for an immediate intervention, but to document for future interventions.

Jim

Carey... my experience 15 years ago w/ Flecainide was that it didn't do anything but make me feel worse... this time around, nothing seems to have changed... was surprised, looking up meds online, that after this many years there are really no new names on the list of anti-arrhythmic me Tx... sorta curious...

mjamesone... the EKG is good thought, but being a 3 day holiday weekend as long I'm gonna have to go to the ER I might as well get ECV'ed... which I'm hoping to avoid...

14 plus years ago, there was quite the rush to get the ECV done before the heart infrastructure began its response... I was hoping to get a clearer sense of the timing... my EP assures me that days won't matter... any more thoughts?

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joshua
my EP assures me that days won't matter... any more thoughts?

I've had afib for nearly 20 years. In the first 4 months, I had a 2 1/2 month episode (and total AF burden for the four months of about 57%). I created a remission plan and the EP approved. Briefly, excessive endurance exercise was my path to afib. Plan was to train long duration activities at no more than a Zone 2 or nasal breathing exertion limit, supplement with taurine and electrolytes potassium & magnesium and use flecainide on demand to convert if I went out of rhythm. I've been generally following this plan since terminating the 2.5 month episode with a loading dose of flec. In the last 12 months, I've had 3 episodes (two "provoked - meaning I violated my exercise plan) for a total afib burden of about 4 hours. Point being the 2.5 month episode didn't prevent me from having a good outcome subsequently (about a 0.046% burden).

Days won't matter. Remodeling happens over the course of months, not days.

And like I said, don't expect flecainide to terminate flutter. It almost never does. But it's worth trying as a preventative, and you've got to get it onboard before the cardioversion. Without something to prevent the flutter from returning, cardioversion is almost a waste of time.

As for an ECG, you mean you haven't had flutter formally diagnosed? Describe your arrhythmia. How fast is it, and is it a very regular rhythm?

Alternatively,, since you're starting to get activity, you could get a kardia six lead. Not as good as a 12 lead for pinpointing flutter, but better than a single lead.

Just a thank you for the comments and an update:
Day 3 (Saturday) of presumed flutter... the forewarned potential pro-arrhythmic effect of the flecainide produced incredible dizziness & 3 separate periods of HIGHLY symptomatic afib... skipped the evening dose & by 9pm the dizziness ameliorated & the afib episodes stopped.
Went early this (Sunday 9/18) morning to local ER - arrived @ 7:30am & ECV'd back to NSR & home by 10:15am... things have sure changed in 15 years - used to be the conversions were performed in an OR with at least an attending anesthesiologist & cardiologist in addtition to the OR nursing crew... this was done in an ER exam room, with ER Doc, nurse & an RT....

Guess its back taurine, K & Mg for now... anything else preventative???

Thanks, Again

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joshua
things have sure changed in 15 years - used to be the conversions were performed in an OR with at least an attending anesthesiologist & cardiologist in addtition to the OR nursing crew... this was done in an ER exam room, with ER Doc, nurse & an RT....

It goes farther than that in the US. Paramedics can do them in your living room, a moving ambulance, anywhere. There won't be a doctor or nurse anywhere in sight.

But they won't convert your afib or flutter unless you're unstable. It's usually reserved for v-tach.

I wouldn’t be concerned about an ECV..it only takes a few minutes of prep and you will feel better. I had 54 of them