Ablation to cure Atrial Flutter

[Herman039]

I have been diagnosed with Atrial Flutter in 2009 which occurs mainly when I cycle.  I have had a number consultations and tests performed since 2009.   The results of wearing a Holter with which I also cycled for 2 hours during September of 2011 did not show any anomalies.  A procedure that was to be done in February 2011 to ablate my heart's right upper chamber was not performed as it was discovered that the problem is on my left upper chamber.
The cardiac professor of the Groote Schuur Academic hospital in Cape Town has advised that a electrophysiological study with 3D mapping is to be performed to with a possible RF ablation.
My question is will this procedure solve the Atrial Flutter I have been experiencing and what are the possible if any negative effects.
I have been on warfarin and different beta blockers since 2009.

[JohninTroy]

I've been put on Flecainide, Prodaxa, and Metoprolol for my A fib.  I'm not a competitive cyclist, but I would say I am - was - a very active cyclyst.  I would always be either first - or at least in the running for each stop light sprint.  I frequently used my Polar HR Monitor while cycling.  I used to be very comfortable staying at 150BPM for up to 3 hours.  Due to the weather, lack of daylight, and this afib (My wife is concerned my heart rate will go up to 200+, I'll pass out, fall off the bike, hit my head and die.  I've never passed out from A Fib in the Past - but the Dr's have her convinced I will) I've only ridden the trainer indoors.  On the Metoprolol, I can only get up to about 105 - and die at that level.

[Herman039]

Hi Richard.  Thanks for your reply.  As I mentioned in my previous mail I have been cycling competitively for many years and all my rides are recorded on my Polar cycling specific heart rate monitor.  These exercise rides are than downloaded on my computer so that I am able to analise this.
Regards
Herman

[RICHARD566]

Herman

I am on beta blockers for my atrial flutter also.  Prior to all this I could get 130bpm on my eliptical.  After taking the beta blockers,  I can only get up to 110 bpm with the same amount of work.  That is what beta blockers are supposed to do.  I had to adjust my dosage downward because my blood pressure was getting too low.  I take pradaxa not Warfarin.  I have also reduced that dosage somewhat. I question that 235 number.  How did you determine that?

Good luck
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[Herman039]

Here is the thing.  My heart used race up to 235 bpm for short periods when I cycled only.  I have had one episode when my heart beat increased to 120 bpm while I was relaxing in bed reading a book in the early part of the evening.  Normally my heart rate is between 52 to 58 when I am at rest.  This lasted for three hours.  Had an ECG at the hospital and my heart returned to normal rhythm.  The beta blockers I take have resulted that when I cycle now my heart does not reach the level it used to.  This has a negative effect in that I have lost the ability to perform at the level I used to attain.  Of course this is not the end of the world and I have accepted this.  It would be good to know if others that have the same problem as me and have had an ablation have regained normal heart rate again and the ability to stop the Warfarin and Beta blockers after a while.

[RICHARD566]

You said atial flutter not fib.  Atrial flutter is normally the RIGHT atria unlike atrial fib which is normally the left atria.

I have had two episodes of atrial flutter.  What does your heart rate do?

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[Herman039]

Thank you very much for your reply to my posted question regarding the ablation to my heart.  Much appreciated.  

[Jerry_NJ]

The only thing that surprised me in reading this thread was the "guess" that the AFib was caused by the right side atrium (upper).  From my patient-only experience I'd say AFib is usually (almost always?) associated with the left side, the more difficult (risky) side to get entry to via catheters.  This "knowledge" may be wrong, but I'd immediately want a "second opinion" if a doctor told me my AFib may be cured with a procedure on the right side of the heart.  The EP study is suppose to find the location, I understand, an I am not trying to second-guess a hands-on EP study by a doctor if that said right side.  Again, I am a patient, suffer from permanent AFib, I am not a medical doctor.

I think ablation is most likely to succeed in your case if they can find the location.  In my case, long term permanent AFib the chances of a successful ablation is low (I don't have a number, just say much less than 75%).  Even with permanent AFib, my cardiologist and EP say they do not support (I guess that means I have to go elsewhere if I want to discuss ablation any further) doing an ablation on me, the risk is too high for a marginal improvement in my quality of life.  I do not suffer, unless I want to climb steep hills (well, they look steep to me : ) )  or return to jogging or power biking.  

I think a younger person (I'm 72) may want to take the risk as they have a lot longer to live with the condition - then too they have more to lose if the ablation causes problems.  For me, I'd have gone with the ablation try if my doctors had been willing and gave me a better than 50% chance of success.  This may not be a good bet for me, thus my doctors' refusal, as when I had open heart surgery to repair my mitral valve (this may have been the cause of my heart enlargement/afib) the surgeon gave me a 60% chance of the mini-maze procedure performed at the same opening of curing my AFib.  I came out of surgery in normal sinus rhythm and stayed that way for about a month, the the old AFib came back.

I have been quoted studies that say my heart rate (ventricle) can be controlled and I take clot mitigation (warfarin) that my life expectancy would not be improved by somehow getting me back in normal sinus rhythm.  As is the case, I have heart problems and AFib is just one of the symptoms.   As already noted, I'm 72 and have thus already reached what was my projected life expectancy when I was a young person.  The fact I've made it this far gives me a good chance of years longer.... even with AFib.  I now simply walk and ride bike mostly on the level for exercise.  

[mlb16]

I had a ablation in Feb 2010 for a fib. It has been almost 2 years. I had short run of afib about a month and a half ago. I do still have flutters,or skipped heartbeats. Some days i don't notice that I have them and some days they are more noticeable. The only thing that I take is a asprin per day. I was on amiodarone, but have been off that med about 3 months now. I had by surgery in Nashville at Vanderbilt Hospital. If the afib comes back I will have another procedure done.

[itdood]

My own humble, possibly misinformed opinion is that ablation is a lot of guess work.  I read stories on the board of people with either poor results from ablation, worsening of the condition, or having a new issue crop up.  Then again people only come to the board to complain so we only read the negative.

I'd only make the decision to start burning away my heart muscle if I had no where to go but up.  No downside.  It sounds to me like you have a lot of possible downside since you only experience the flutter when cycling and even that isn't 100% of the time.  I hear about people in full time flutter or permanent afib and they still live a good life, albeit they aren't going to do well in marathons anymore.

You also have to consider whether you expect your condition to worsen on its own and if a preemptive intervention would be beneficial.

It's a tough decision.

One option is that you decide to do the surgery but ask that they be 100% sure of any site they decide to burn.    I hear of this sometimes, people go into ablation, have the mapping done but the surgeon decides against any burns due to risk-benefit.  

Another concern I have about ablation is its maturity.  The procedures and techniques used differ from institution to institution and from doctor to doctor.  There aren't any standards from what I can tell, that tells me its a very immature technology.  You need to educate yourself on which techniques are considered to be state of the art today.

For a professional opinion on your case I think a doc would need more data.  If you've got an EKG with the flutter you could post in the expert forum you will help yourself get a better opinion.  Keep the search going!

[MichelleP_3811]

This is just the members section.  You may want to ask your cardiologist these questions, they would have the best data and statistics for you.  There is also a lot online about it as well.  That said, no procedure is 100% guaranteed to work.  I believe there is around an 80% success rate but it could be higher.  Hopefully someone who has had an ablation for afib can jump on and give their input.  Good luck.  I hope it goes well.