Will A-flutter ablation cure a-fib?

[Cherianne]

I have battled Afib (initially dx as SVT)for 2.5 yrs. I had been treating with a cardiologist who had me on Sotalol 180mg 2x per day & 10 mg coumadin along w/ 80 mg Diovan for HBP but I had break-through about 3-4x per month.  Finally went to a good EP in Buffalo (the only good EP) who recommended an EP test. The test was performed on 3/16 and my EP found and ablated a "flutter".  Since the ablation, knock on wood, I have not had as much as a skipped beat & pulse is regular (no extra beats) - but not that strong - for the first time in 2 yrs.  Question is, he kept me on the same med regime - no changes whatsoever.  Was hopeful to get rid of or at least change/decrease the meds, so I can resume a normal life and lose some weight! No matter how hard I work at excercise, I can't get my heart rate above 85 while on Sotalol. I have a follow up appt in 4 weeks.  Is there a chance he may wean me or change the meds at that time?  Just wondering if ablating the flutter will stop the fib. Thank you.

[Cleveland Clinic]

cherianne,

thanks for the post.

There is always the option to wean medicines after the ablation.

With regard to your heart rate.  If you are able to exercise and diet, I wouldnt worry about your heart rate at all.  Unless you are trying to train for elite competition, or have ischemic issues, I generally tell patients not to focus on their heart rate when exercising.  I would discuss a program with your physician that involves diet and vigorous aerobic exercise 5-7 days a week.

good luck

[tickertock]

Hi, I am no doctor but i understand a-flutter is a more regular version of a-fib, sometimes a-flutter converts to a-fib and vice versa. Even after an ablation patients are kept on the medications for a while even though the ablation appears to be a success, your doctor probably want to gradually taper you off the sotalol, it will probably help keep your heart less irritable after the ablation.Being you have HBP , you will probably be kept on Diovan indefinitey as you know HBP is usually a lifelong battle that needs control, the sotalol will probably be tappered off gradually after success has been established with your ablation.Hope you continue to feel better. Good luck.

[DottyCece]

I had atrial fib that changed into flutter after a mze procedure.  Then after a second open heart surgery and another maze procedure, it went back to atrial fib which persisted despite ablations etc.  I was told to stay on my drug, amiodarone, after the ablations to prevent the reoccurence of the arrhythmia which was so persistent. Early on in my illness, I was atrial fib and they used sotolol at a very low dose after a cardioversion.  That kept me in a sinus rhythm but my rate was very slow.  My EP physician wanted me to be on amiodarone.  It was his opinion that amiodarone was the drug of choice in my situation.  I now have had a AV nodal ablation and am paced AV sequentially very successfully.  However, I still need to take the amiodarone which I was hoping to discontinue because of all the arrhythmias.

[john30]

sorry i had to to open new issue in here coz the server didnt allow me to post new question
i am 29 years old. with goodhealth. one month ago  i felt tired and like chest heaviness then i developed with tachycardia. that lasted for few mints. and the episodes attacked me many times. . i went to the cardiologist. he did ECG and echocardiography. i was told that echo was all normal. and EKG  showed what my doctor called " sinus tachycardia" , my heart rate reaches up to 110 when the episode attacks me .. then my doctor  advised me to do thyroid function test. which was normal , i did ESR and blood picture. no evidence of anemia. my ESR was 4 . everything was normal as u see! now he prescripted Propranolol 40 mgs daily.
now my complaint is. i havnt felt any imporvment.  concern  the feelings. the tachycardia attacks me  whenever i go out walking. at rest. my heart rate becomes normal but the feeling of chest tightness and the tiredness is wrapping me,.i always feel sleepy and lazy and heaviness in my head  without or without the tachycardia. it always presists.
also i have a strange phenomenon . that my heart beating is palpalbe, whether there is tachycardia or not! i mean whenever i put my hands over my heart. i can feel the heart beating. sometimes loudly. it occurs with me all the time. i m, wondering. is the heart beat usually palpable? or not. i heard in thin people its a normal manifistation. but i aint that thin. i am 187 cm  and 81 kgs weight.i am scared like hell. whenever i lay in my bed i keep putting my hand over my heart to feel the beating " which worsens the situation" plz can u explain me the causes of the tiredness feeling. and chest tightness. that happen to me whether during the tachycardia or normal heart rate?? thank u again. i know i posted a newspaper in here . its long. but really i am worried

[Jeff67]

Wow ... my HR goes to 140-150 just mowing the lawn, and I am fairly fit! Even when I was on a Beta Blocker I could still get my heart rate to over 150.  It is amazing how the drugs affect people so differently.  Of course, the amount you are taking has a lot to do with that.

[tickertock]

i can reach 93% of my maximum predicted heartrate on the the maxmium dosage of atenolol daily on an exercise stress test.my max predicted heartrate would 180 , so that  168 bpm within 12 minutes on the the Bruce exercise stress test.

[john30]

ok guyz but no1 answered my yet.. am i having dangerous symptoms? or what.

[tickertock]

Only your doc could answer that, but sinus tachycardia at 110 bpm is barely a tachycardia and is practically the norm for some, sound as though your heart awareness is causing you a great anxiety and contributing to most of your symptoms, if in doubt seek a second opinion but i personally think you have nothing to worry about, in the maintime try and relax and don't concentrate on your heartbeat , it will drive you nuts, been there, so i know the feeling only too well.My opinion only, not to be taken as in information by a medical professional or doctor.

[Jeff67]

I echo what Tickertock said.

If you want a doctor to answer your question you will have to post it.  It is not that easy to post, but just keep trying.

[Jeff67]

Last stress test I did I reached 110% of maximum prdicted (205 at age 37).  I was on the treadmill for a bit over 12 minutes (13 METS).  I was not taking a beta blocker at the time. My HR has always been on the high side whenever I am active, although at rest it is typically 55.

[tickertock]

Hi,

Without being on a beta blocker , i would assume that is nothing to worry about, at 37 your max predicted heartrate would be around 183bpm. As I understand 12 bpm as an increase or decrease over or under the max predicted heartrate during an exercise is normal. I myself if I hadn't been on a beta blocker during the stress test , my maximum would have probably been around 200 or over myself.

Some just naturally have a higher heartrate in response to exercise or excitement, the fact that it is 55 at rest i would assume is excellent and that you are fit and well conditioned.

13METs is excellent, I achieved 12mets and was told that was excellent, unless you doc or cardio same concerned i wouldn't be alarmed about slightly excessive increase in your heartrate during the exercise test once it was sinus rhythm and not some other ectopic atrial response which i am certain you would have been informed of.

My understanding is that you have to reach at least 85% and over of your maximum predicted heartrate for the test to be considered accurate in the majority of cases.

[dquenzer]

I don't think the doctor answered your question if an ablation for Atrial flutter would cure atrial fibrillation.

I'm not a doctor so I surely wouldn't know.  However there are three possibilites that I can think of in your case:
1.  The atrial flutter was a trigger for atrial fib.  Thus getting rid of the atrial flutter probably had an impact on the fib.  
2.  Getting rid of the atrial flutter may have caused your medication for atrial fib. to finally work.
3.  In doing the atrial flutter ablation they unwittingly did enough of an ablation to get rid of the afib.

I guess you might want to ask your doctor what kind of an ablation was done.  Was it a PVI (pulmonary vein ablation)?  If so then that's the ablation procedure for AFIB.

Whatever, it's a wonderful thing not to have afib.

[Stelladallas]

Ihad an ablation for several episodes of afib/aflut. only to have a relapse two months later.  I continued to deal with this until my heart decided to slow way down and I ended up with a pacemaker.  Now I feel super!  I'm still on meds.  And John, you feel like you feel, please go back to a different cardiologist.  You are way too young to feel like you do.

[Cherianne]

John - May I suggest you get on line VERY early in the morning to post your own question to the board rather than using someone elses thread? I was excited to see numerous responses to my question only to find out that your intrusional post solicited 8 of the responses on my thread ~ needless to say I am a little disappointed.  I would never think of posting a question under someone elses thread.

[jennann]

Cheriann,
How was your expereince of the ablation?  It's been recommended to me for extremely rapid SVT (200bpm even while ON a beta-blocker - tho only for 7 seconds) and a possible brief afib episode, but I'm completely scared of the procedure. I'd really appreciate your feedback, as well as anyone else's who's had an ablation.  Thanks!
Jennifer

[Neener44]

Hi Cheriann,
Just wanted to let you know my experience. I've had two ablations for svt/vt. I have been on sotalol since fall 2000. My EP has always advised me to continue exercising. I walk/jog 5-6 days per week and lift weights 2 to 3 times per week. I have been able to lose weight and get in better shape while taking sotalol. During the first year or so I experienced fatigue, dizziness, etc., but exercising helped lessen side effects and now I don't notice that sotalol really affects me much at all other than keeping my heart rate lower than it would be normally. Take care.
Neener

[dquenzer]

I had an ablation 2/20/2004 for AFIB.  It worked wonderfully.  But I was very symptomatic.  Drugs did not keep me in rythmn. And AFIB was negatively affecting my quality of life.

I went to Mayo, and saw one of the best EP's in the country.  The procedure took about 7 hours.  I had three days of tests before the procedure.  So it was a very thorough exam.

My cardiologist who was fairly aggressive in treating the AFIB said that it should only be done if:
1)  Two meds fail to keep in rythmn.
2)  Symptomatic (I just felt drained when in AFIB).
3)  Persistant.  It was occuring on a frequent basis.

I spent three years messing with meds.  But finally had the ablation.

The procedure itself needs to be done by someone who really knows what they are doing.  I wouldn't have just any one do it.  It is not without risk.

Therefore I would only do it if it's the only treatment that promises help.

On the otherhand if in the hands of a good doctor it can deliver a wonderful result.  I have been AFIB free for over one year.  I still take a beta blocker (small dose), and that's it.

Expect to be out of commission for about 3 days following the procedure.  And you will feel tired for about a month.  Also you can expect some arrythmias after the procedure because it does irritate the heart.  Typically one doesn't know if it worked for about 3 months afterwards.

[jennann]

Thanks for your response.  How was your actual experience of the ablation?  I'm so anxious about what it could be like...I'm fairly surgery phobic!

[dquenzer]

The ablation procedure was not without discomfort.  

Most of the discomfort came early on when they were putting the catheters in.  At Mayo they put in three, one in each groin, and one down the throat area.  However at that point I told the anesthestiologist to put me to sleep. I wasn't under anesthesia, but I was sleeping the entire 7 hours.

The biggest pain came in my lower back area from lying flat for 7 hours.  But they gave me pain meds and that was fine after awhile.

Put it this way I have had far worse experiences of pain.

I would ask your doctor what their procedures are.  I would certainly not want to be awake during the entire time.  But my procedure took 7 hours.  Lots of places to ablate.  I've heard some where they don't use as many catheters and then you are out for a shorter time.  

[Cherianne]

I can surely relate to your anxiety over the procedure. I even cryed uncontrollably on the way to the hospital! Don't waste your energy on worrying, it's not worth it! I would not hesitate to do it again if I have to.  The most uncomfortable part of the procedure was the ablation itself, like a burning in the right side of my chest near the shoulder, not in the area of the heart.  They give you a good amount of valium (or something similar)so you are really awake (in la-la land) but in no discomfort.  I felt nothing when the catheters were inserted.Mmy main complaint the following days was stiffness on my right side from being tense, laying so still and and looking to my left during the procedure!  I didn't work for 2 days but that was my choice - I am looking forward to excercising beginning tomorrow as it will be one week.
I did have a 12 hour bout of afib yesterday and felt slightly discouraged but I called my MD & feel much more optomistic about the success of the procedure. He stated that the heart is irritated from the procedure and bouts of afib may be more frequent/severe for a few weeks following the procedure but they should become less frequent and less in duration as time passes. Hopefully the end result will be known in 3 months. Let me know if you have any more questions.