A-flutter and pacemaker?

I have had my PM since January 2019.  At last checkup heart was in flutter a lot.  Am going to wear a Holter monitor tomorrow for 24 hrs and then learn next step.  I had had Cardio verson and ablation before the PM.  I am now wondering why I have the PM when it isn't used for flutter?  I will ask Dr. these questions next visit but it's hard to cover everything in the 15 minuter allowed for the appt.  Thanks for any info.


4 Comments

faster

by Tracey_E - 2019-09-23 22:09:23

Simple answer, we get a pacemaker when our hearts need to go faster. Did you have another diagnosis other than flutter?

Flutter

by AgentX86 - 2019-09-23 22:42:36

Tracey is rignt.  Flutter, alone, isn't a reason to get a pacemaker (alone).  A pacemaker can only make the heart go faster, which certainly isn't what's needed when you're in flutter. There has to be another reason for the pacemaker.  Perhaps they've given you antiarrhythmic drugs (ameoderone, sotalol, or a number of others) that tend to surpress the heart rate and are using the pacemaker to boost it back to a reasonable rate? 

In any case, you really need to buttonhole your EP and have him explain exactly what they're doing to you.  Bring your significant other along.  A second set of ears is quite useful.  The "only has 15 minutes" thing isn't a valid excuse.  They have an obligation to educate you on your condition, treatments, and treatment alternatives.  Flutter is a major PITA, I know, but you really need to be involved in your treatment.  There are lots of options, none without potential problems. Only you can make the decisions but you need information.

atrial flutter, ablations, pacemakers

by Selwyn - 2019-09-24 13:10:56

 Atrial flutter can be very uncomfortable with your heart thumping away at 150 beats per minute. Been there, and had an electrical cardioversion ( some people can have a chemical cardioversioin)  and  a cardiac  catheter flutter ablation. 

Ablations may be for atrial flutter, fibrillations, or sino-atrial junction. The ablation operation involves an electrical burn.

The flutter ablation is much more simple than the fibrillation ablation. The flutter ablation cuts the circular conduction resonsible for the atrial flutter,  above the tricuspid valve ( the left side of the heart between the atrium and the ventricle) . All the ablation catheter does is to produce a small burn/scar  and this cannot conduct the impulse. The ring is forever broken.  If the scar is too small some healing may occur and you may not get success in the long run.  No pacemaker will stop this circular current as the pacemaker wires are connected to usually both the upper and lower chambers of the heart ( the atrium and ventricle) and the pacemaker delivers a little  electrical shock to those chambers for stimulating the heart muscle. The circular current causes the atria to 'flutter' ( beat very fast), this current  is in turn transmitted, to the maximum possible by the conducting system of the heart, to the lower chambers, and hence the 150 beats per minute. 

I hope this answers your question to why a pacemaker cannot help in atrial flutter. 

Sometimes going in and out of abnormal rhythms the heart does not like the change and may decide to give up and stop ( asystole). Such pauses, if prolonged, leads to a danger of the heart not starting again, and hence he need for a pacemaker ( and monitoring to see if this is happening). 

You may want to see https://www.mayoclinic.org/diseases-conditions/atrial-flutter/symptoms-causes/syc-20352586

which explains some of the above. 

Atrial flutter, ablations...

by AgentX86 - 2019-09-24 14:39:21

Not all flutter is created equal. Though my atria beat at 240bpm in flutter, my heart rate never exceeded 100bpm, though was very irregular. I could tell when I was about to go into flutter because my heart rate would increase from 50 to 80bpm.  An EKG wouldn't show flutter at this point (but give it a day or two)  None of these conditions are typical of a flutter but there it was. Three ablations didn't help but an AV ablation at least got rid of the worst of the symptoms. My atria still beat at 240bpm but my heart rate is controlled by my PM so it's not felt.

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