Flutter ablation also cure atrial fib?

[Laurel75]

I am a 75 yr. old woman who has had paroyxmal afib and flutter for about ten years.
Since my episodes are now becoming both too protracted and too often (about once a week)..I am finally considering the possibility of a right flutter ablation if I thought there was any reasonable chance of my fibrillation disappearing.   I have felt for quite some time that my flutter always precedes the fib during my episodes....and if a heart event monitor can confirm this, perhaps I would have a more successful outcome. (I havent found any studies that address flutter ablations in which  fib is also present and may be triggered by flutter.)

I also wonder if a leading EP center would consider a fairly straightforward ablation
on a person whose only risk factor is her age.  My current status has definitely
become a quality of life issue and although I have only used rate control meds
I have many difficult side affects even with low doses.  Any comments would be
greatly appreciated.  

Laurel

[scouser costa rica]

Laurel,
        Thanks  It is inversionesboricu at gmail.com
                                                            Regards Ian

[Laurel75]

Hi,

I can't figure it out.   I answered your note of 10/17 only to lose it when I went to copy the Afib site I intended to send you.  Then I wrote you again and I guess that post also didnt make it.    Anyway, here is the site and hope you get connected or at least get this note:    http://www.afibbers.net/forum/list.php?f=6

If you want to give me your email address, I can suggest ways to browse the
forum before you jump into a discussion.    Good luck.   Laurel

[scouser costa rica]

Laurel,
         Your last post was blank.
                                          Rgs Ian

[scouser costa rica]

Hi,
   The coumadin is only to reduce the coagulation risk during A-Fib/Flutter events.Yes I do have GERDS and have to take NEXIUM every night and have raised the bedhead by 4-5 inches. I have no structural heart problems so the Lone A-Fib site sounds interesting and may help me find the trigger.
   Can you send me the Web site?                                    Thanks Ian

[Laurel75]

Hi Ian.

I know very little about the  particular  heart problems you have struggled with but might make a few comments anyway.  

I have read about at least one serious problem with the use of Amiadorone involving pulmonary fibrosis but perhaps you are no longer on that medication.

I assume you have a pacemaker because of your bradycardia but are you on
Coumadin because of your episodic arrythmia or your other heart issues?

Pretty much all of my education about my problem comes from a  remarkable forum I have belonged to for many years.   It is essentially a forum for people with
Lone Atrial Fibrillation, i.e. individuals with no structural heart problems but may
be in paroxymal, chronic or permanent afib.

From what you indicate,  you certainly sound Vagal even tho' most Vagal fibbers
have episodes in the evening and/or through the night, they also have a clear
digestive component  as you seem to.   When my own fib worsened it seemed
very much linked to meals, mostly mid day to evening, even tho I do not have
Gerd.   I have been taking digestive enzymes lately which I believe help with
digestion as well  as chewing slowly and not having large meals.

Have you had tests to see if you have Gerd because trying to correct
any digestive problem would be paramount in dealing with your arrythmia.  Also
many individuals on my forum have been able to slow or keep their fib at bay
with diet and/or supplements (e, g. , magnesium, taurine and potassium).

It is not surprising that a workout might interrupt an event since that is the hallmark
of a Vagal fibber.  Since I am what is called "mixed" and my flutter and fib are
always very fast, I hesitate doing exercise when I am in fib but it does not
usually keep me from taking a planned walk, etc.  (Years ago I would simply
try to meditate, sit still and the like.   Now I think nothing makes a real difference
in that this little clock inside my head/heart  seems to dictate when my heart begins
to do its thing.

I have read that there is little likelihood that Vagal fibrillation would become
permanent but perhaps you already know that and even though you say you
are learning to live with it, I am sure, like me, you'd be gratified if it didnt show
up quite so often.  I know I am trying very hard to send it on its way but dont
have the courage yet to consider an ablation that could attempt to correct
both fib and flutter.  I am still researching, as you see, the ablation for flutter.

Take care.

Laurel

[scouser costa rica]

Hi Laurel,
             When I was 18-20 I first realized that once in awhile my pulse skipped a beat,but in those days of the late fifties,I didnt take much notice. I was a road racing bike rider for the Liverpool team,and in my best year was sixth in North West England (boasting sorry).
When I had my first complete check up in 1985,the doctor told me that I was born with a slight Left Branch Bundle Block,which could sometimes cause an irregular EKG.I continued to work out mainly running plus Nordic Track and  finally started using a pulse monitor.One morning after stopping my work out on the treadmill my pulse rate did not come back to its normal 45 and stayed about 130. I went to see the company doctor who drove me to the ER,where they got it down to a NSR.
After a major check up they confirmed the LBBB and the Sick Sinus Syndrome,and I was started on 200mg of Amiodarone to get the rate down,which at night dropped to the low twenties.Dont know what it was before the medication,but I had a pacemaker installed as an insurance policy.I also take Coumadin to keep my INR between 2-3.During the event my HR does not normally go above 115.
We have never been able to find the trigger,coffee,alchol etc,and often before an event starts I feel a bloated stomach,so it may be vagal. One last thing,if it starts after breakfast and I start a slow workout it many times goes away.Strange but I have learned to live with it,and still workout at a lower level (71)
                                                                     Regards Ian

[Laurel75]

Hello Ian,

I used Propanolol for awhile until I realized that beta blockers were not a good choice for a mostly "Vagal" afibber.   I also used Verapamil (calcium channel blocker) in the past but when I was prescribed it recently in a 180 mg. extended release, I began to have many problems with fatigue and generally symptoms of  blood pressure reduction ( its other purpose).  I am now taking it only when I am in
flutter/fib, i,e, "on demand".

The length of my episodes are much longer than yours, unfortunately....with a
mean of about 12 hours plus and therefore more difficult to tolerate .  

Is your fibrillation and flutter like mine in that the latter seems to trigger the former?
And may I ask what you mean by saying you were "born" with it?  Do you mean
you have had arrythmia since childhood?  I never had it before 10 years ago
but I know there is a familial connection in that my father had the very slow
variety and my brother's is infrequent but sends him straight to the hospital
because it is dangerously fast.   After my first visit to the ER, I have managed the
problem on my own, i.e. learned enough not to panic at, say, 12 hours or so.

How have you been handling your own?

Laurel

[scouser costa rica]

Hi,
   I have the same problem,which I was born with and it has become more frequent with age.I am now 71 and my events are weekly and last anywhere from 2-6 hours. What rate reduction drugs have you been using ?
                      Regards Ian

[Laurel75]

Hi again,

Thank you for your response.   I'm disappointed to hear that a flutter ablation (if my own  situation involved my  flutter triggering fibrillation) would be no more help than rate control being easier.   If I thought my fib would be as long and as often evenwith a flutter ablation....well, that would hardly be any improvement at all since Ihave never had one without the other (although the flutter didnt start until a couple my of years into my afib. episodes.)

I frankly would have liked to take this leap with an "easier" ablation and in either
case would only want to go to a center that offered  one of the best chances of success, but within a reasonable wait time, which I guess cannot  then be the Cleveland Clinic but perhaps Univ. of Pa. or NYU (Chinitz).  I live in upstate New York and my impression is these are the closest major ablation centers and actually intended to check out the feasibility of going to one of them.

As I said, I have only used rate control drugs and my strong reaction I think
indicates I may not be a great candidate for more potent antiarrythmic drugs.  
I suppose I hoped that candidates might be considered on an individual basis...and  my age and many years struggling with this condition might make a difference.

And, finally, I have done so much research on my conditiion, I am quite nervous
about the prospect of a full ablation.....since repeat ablations are  common even
at the most prestigious centers.

Thank you again for any comments.  

Laurel

[Michael J. McWilliams, M.D.]

Hi Laurel,
Atrial fibrillation ablations can improve atrial flutter but not vice versa.  The reason to do an atrial flutter ablation in the setting of atrial fibrillation is because atrial fibrillation alone is easier to rate control without the flutter component.

When I was at the Cleveland Clinic we did lots of  people your age and with no other risk factors. If you are otherwise healthy and you have failed attempts with one or more anti arrhythmic medications, an atrial fibrillation ablation is an option.

If you tell me roughly where  you live, I might be able to make recommend a center or a person in your area.

I hope this helps.  Thanks for posting.