Atrial Lead & AFL

On August 21, 2015 I had open heart surgery to repair my mitral valve, close patent foramen ovale (PFO), and a septal resection to correct LVOT Obstruction. During the surgery the atrial lead from my pacemaker became dislodged and 3 days later I had more surgery to insert a new lead. Due to the septal resection, which probably removed my AV Node, I am now 100% pacemaker dependent.

I found out today I have Atrial Flutter (AFL). It was caught by the pacemaker technician while doing an interrogation. I knew something was amiss. For the past 2 weeks I've been having flutters, palpitations, etc., though not as bad as before surgery. Can anyone share anything about AFL and whether it's related to the pacemaker issue?

5 Comments

It's the other way around

by Theknotguy - 2015-11-09 02:11:12

It's the other way around. Your heart problems have progressed to where you're getting atrial flutter (and probably will lead into afib) and the PM is reporting it. Pacemakers don't cause atrial flutter or afib, it's the underlying heart problem that causes it.

Best situation is your heart is reacting to the surgery and the aflutter will clear up on its own. However, if it doesn't....

For afib there are at least three ways to address. One is rhythm control, the other is rate control. The third is ablation. Ablation is the most aggressive and can cause damage to the heart. However for people who can't get relief any other way, it's the only way to go.

I can't address rhythm control. Was unconscious when they tried it. So don't know.

Rate control is where they allow you to go into afib / a flutter but control the speed of the heart. I'm on that now. They've found out if they slow the heart, you are less likely to go into afib and the like.

Cardizem, Metoprolol, Sotalol, and Flecanide are some of the drugs used. Your cardiologist may have to try several before there is a good fit. No one can tell which will work for you. I've seen posts where people can't stand Metoprolol. I get along great with it. I can't tolerate Flecanide, it works great for my spouse.

From your bio, you have a Medtronic. Medtronic has pioneered a software program that can be loaded onto your PM called APP (Atrial Preference Pacing). APP can sense when you go into afib. The program kicks in, elevates the speed of your heart which, in turn, can mitigate your afib. APP has done very well for me over the last two years. I had it turned on at the five month period after I had my PM implanted. Felt really strange the first time it kicked in. But, I've had good results with it.

So, for you, you've got some research and then need to have a discussion with your cardiologist / EP. Which will work best for you? Rhythm control? Rate control? Does ablation loom in the future? Can your afib / aflutter be controlled by drugs? If so, which ones. Can APP be loaded onto your PM. Is it suggested for your treatment? Does your cardiologist / EP even know about APP? Have they had any experience with it? And, of course, since you've had surgery, how does that affect everything I've said? What course of treatment do they suggest?

Hope everything clears up quickly or they have a course of treatment for you.

Atrial flutter is not the same as Afib

by IAN MC - 2015-11-09 06:11:58

I think Theknotguy is wrong to bracket together atrial flutter and a fib as though they are the same condition . They are similar but different !

The most important difference is in the management of the two conditions.

Although a fib is managed first with drugs, then cardio-version then an ablation as last resort this does not apply to atrial flutter.

It is now increasingly accepted that the first line treatment for atrial flutter is a cardiac ablation , the chances of a complete cure with one ablation is over 95 %.

I had atrial flutter and my cardiologist was absolutely unequivocal when he told me that " It is a no-brainer, you need an ablation " . This is not the advice he would have given if I had been suffering from atrial fibrillation.

Following his advice was the best decision I ever made as I now have normal sinus rhythm and don't take any drugs.

It is totally wrong to assume that all arrythmias need to follow the same treatment protocols !

Ian

Great Feedback - Thanks!

by gstripling - 2015-11-10 06:11:32

Thanks so much for the feedback and comments. Had an x-ray today and it revealed abnormal positioning of the atrial lead ("projecting over the IVC with a redundant coil"), coming as a direct result of the atrial replacement surgery I had in August. The cardiologist told me today I have AFL but it comes and goes. He increased my Coreg to 6mg 2X daily to control rhythm while I wait for procedures to correct everything. My only symptoms are chest tightness, minor chest pain (which could be residual from the open heart surgery). and the fluttering or palpitations.

He referred to his practice's electrophysiologist for a consult prior to (1) ablation for the AFL and (2) atrial lead replacement surgery. I'm expecting to schedule both in the next 30 days. I don't know if it's typical or atypical AFL, but I will certainly ask that when I meet with him.

Any other questions I should ask?

I should have said that

by IAN MC - 2015-11-10 09:11:42

mine was typical atrial flutter , In fact the cardiologist was so impressed by my ECG trace as being that of a classic AFL that he made a slide of it to include in his lectures on the subject !

I would certainly ask the electrophysiologist to estimate the likelihood of a first time ablation success after discussing what type of AFL you have.

Also EPs have varying skills at doing ablations so do your researches as much as you can to ascertain whether he or she is the very best EP in your area. I did and it certainly brought me the results I was after.

Best of luck

Ian

A Flutter

by parmeterr - 2015-11-10 12:11:34

I have had a flutter twice in the past 6 years. Was advised it was due to low heart function. I have 30% ejection fraction. I also go into a flutter about 3% of the time and the cardiologist did use the APP pacing to try to help. Don't feel anything because of complete heart block.

You did not indicate if you have typical a flutter or atypical a flutter. I have had both. Typical a flutter is easy to ablate. They know where it is located. A no -brainer as mentioned above. However atypical a flutter is hard to locate and much harder to ablate. Usually cardio version to stop it. The typical a flutter can be ablated and has a success rate in the upper 90's. Atypical a flutter is much lower, usually 60% to 80% successful. I have lived in a flutter for months and it has minimal effect on me.

Richard

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