Is ablation necessary for atrial flutter?

Question

Hello doctor,

I have been diagnosed with atrial flutter. I have experienced this condition three times in the last two years. It is atrial flutter, not fibrillation. Two years ago, I was in atrial flutter for three weeks. After being on an anticoagulant for those three weeks, I underwent a successful electrical cardioversion and remained free from the condition for two years. I am 73 years old, thin-built, and have been a vegetarian for several years. I walk four miles a day. I have no other heart or health issues, except for some PVCs (premature ventricular contractions), which I have had since my youth. Six weeks ago, I had a flutter episode that lasted about five minutes.

I wore a 24-hour monitor and everything was completely clear. I can tell when I enter a flutter episode—it is distinct and uncomfortable, but tolerable. Then, about a month ago, it returned, this time lasting about eight hours. During that episode, I had an EKG (electrocardiogram) to confirm the diagnosis, and my doctor referred me to a cardiologist who could perform an ablation on the right atrium. However, I felt the new doctor was not too interested in the details and I was scheduled for the procedure within a few days.

I am very data-oriented. I understand that the flutter may return at any moment, or it may not return for years, or ever. What is the subjective probability of the flutter returning each year in my condition? Do you have any recommendations? Should I go through with this procedure? I am currently taking 5 mg of an ACE inhibitor, and my blood pressure is well-controlled with this.

Please help.

Answer 1

Hello,

Welcome to icliniq.com.

Thank you for your detailed query.

I have reviewed every aspect carefully to arrive at a decision that may be better for you in the long run. The probability of experiencing unpredictable and unplanned episodes of atrial flutter seems high enough to warrant a procedural ablation without delay. The concern is not just the pain or discomfort you feel during these episodes, but the potential damage they can cause, or even the risk of cardiac arrest. I understand how unsettling this is, which is why I always pay close attention to details to ensure patient satisfaction. Therefore, my final recommendation is to proceed with the ablation, as advised by your doctor.

I hope this helps.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

Every patient has a different scenario. You cannot apply the same pre-operative and post-operative situations to every patient with atrial flutter. However, your concerns are valid, and I understand the sensitivity surrounding heart issues, especially regarding the rhythm of beats. There are always accompanying complications with every procedure, but experiencing a higher heart rate is not common enough for us to directly relate it to ablation.

We ablate an extra point of trigger in the heart tissue that may be generating additional pulsations and interfering with the original heartbeats, preventing the heart from pumping in a synchronous manner, which can lead to flutter and, in some cases, fibrillation. I cannot comment on your friend's case, as I know nothing about his clinical situation.

In your case, I hope for the best results, as there seem to be minimal factors that could lead to issues post-procedure. Additionally, cardioversion worked exceptionally well in your case, meaning that if we ablate the point of the trigger, you may achieve a flutter-free heart for life. Your surgeon can provide you with better information regarding the risks and complications before you undergo the actual procedure.

I hope this helps.

Thank you.