A Flutter

I have posted in the past regarding movement of my pacemaker to near the underarm.  I was seen yesterday by my new Cardiologist plus the St. Jude rep.  A-flutter episodes seem to be increasing but not at an alarming rate.  I will soon be 79 years of age and apparently this increase is not that uncommon.  I am scheduled for a Nuclear Stress test in about 3 weeks.  I am paced for 100% heart block.  Is there treatment for this A-flutter in those of us with a pacemaker? Thanks.

3 Comments

AFL

by AgentX86 - 2022-04-20 23:12:51

There is treatment but I'm not sure about your age.  The simplest is an ablation.  If it's typical flutter (right side) the procedure isn't that difficult for a top-notch EP. It may or not be successful on the first try.  If it's atypical flutter, it can be more of a problem.

The other two options don't really fix the problem, rather they relieve flutter symptoms.

Since you have complete heart block, it may be possible to change your pacing mode to VVI, which would disconnect your atria from the ventricles.  The ventricles can go off and do whatever they want.  I've gone for this alternative (with an intentional heart block, rather than natural) because my flutter is permanent and the atria don't do anything anyway. It doesn't do anything for the flutter but I'm no longer symptomatic.  It required an A/V ablation for me but since you already have a complete heart block, that's been taken care of.

Since you evidently have paroxymal flutter, there may be a middle ground.  Your PM could detect the flutter and shift to VVI mode, then shift back to DDD, or some such, when you go back into normal sinus rhythm. This would retain A/V synchrony when you're in NSR.  When in flutter, you'd essentially give up the function of the atria for the relief of the flutter symptoms..

In any case, talk to your EP.  There are potential solutions.

Atrial flutter

by Selwyn - 2022-04-21 18:01:26

You are not too old for an ablation. This procedure is much less risky than having one done for atrial fibrillation. 

I trust you are anticoagulated. You should be if there is not a risk of bleeding.

I have had a flutter ablation. I don't take any meds. now for this. I have occasional paroxysmal flutter.

 There are no pacing set ups to get rid of flutter.  I recently posted about the  AMS function of your pacemaker that kicks in when there is flutter to ensure your ventricles don't respond to the rapid atrial activity. 

 

 

A Flutter

by benedeni - 2022-04-21 18:34:06

Thank you AgentX86 and Selwyn.  I have researched the ablation procedure online and will of course ask my cardiologist in three weeks when I see her after the stress test.  You have given me lots to consider and research.  Appreciate you both.  

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