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Atypical atrial flutter
I was recently diagnosed with “atypical” atrial flutter. This is my second bout with atrial flutter. Four years ago I developed “typical” atrial flutter which was ablated. I have been advised that “atypical” atrial flutter is much more difficult to ablate.

I am a 59 year old male with a 20 year history of heart issues mostly relating to the heart’s electrical system.  First developed AV nodal re-entry tachycardia about 20 years ago which was ablated. Three years later developed 3rd degree AV heart block. A dual chamber demand pacemaker implanted in August of ‘97.  In June of ‘09, was diagnosed with “typical” atrial flutter which was ablated.  Before the ablation, EF was 25% and 40% after the ablation. EF is now 30% where it remains today. Take 50 mg/day of Coreg, an ACE inhibitor, and a blood thinner. I am non ischemic with no pulmonary or peripheral edema. Put in 15-20 miles a week running and walking. I do have exercise intolerance and occasionally have occasional problems climbing stairs but can still manage to run about a 13:00 minute mile. Because of the possibility of having to live with atrial flutter the rest of my life, I am getting feedback from different sources.

1. What is the long term damage to the heart from atrial flutter with a LVEF of 30%, rate responsive pacing, and complete AV heart block at age 59?  In DDIR mode now.  VVIR mode better.
2. Life expectancy?  5 years, 10 years, more? Less?
3. What triggers atrial flutter? Can the pulse from a pacemaker trigger it?
4. Would a sinus node ablation stop atrial flutter now and prevent future bouts of atrial flutter or possibly atrial fib?  I do have a ventricular escape rhythm of 34 beats/min.
5. Are some forms of “atypical” atrial flutter impossible to ablate?
6. Does Cleveland Clinic perform ablations for “atypical” atrial flutter? If so, how successful are the ablations?

You have answered my questions before and I appreciate your input. Thank you.

Richard

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1884349 tn?1353818598
Hi Richard,

Welcome back to the forum.  You ask a lot of good questions. I hope you have a good enough relationship with your cardiologists to ask them these questions too.

1. I am not from Cleveland Clinic.  I am at Northwestern Memorial Hospital in Chicago and yes, we perform atypical flutter ablations and they have variable success rates (though many are successful).
2. Some flutters are more difficult to ablate than others.
3. No to the sinus node ablation question...dont go down this road.
4. Flutter that is rate controlled (and you have completed AV block with a pacer) unlikely to result in any "heart damage".  However, consideration should be given to BIV pacing in your case since you are pacer dependent with LV dysfunction (ie addition of an LV lead).
5. Cant answer the life expectancy question.  But you are on great meds, and your functional ability is also excellent.  I think barring something unexpected you have an excellent chance to enjoy many more years of good quality life.

Wishing you all the best,

Dr. Rich
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