Flutter Ablation Versus Conservative Treatment First

Speaking only for myself, a person with highly symptomatic atrial fibrillation, and where index ablations have about a 75% success rate, and where I would otherwise have to take metoprolol in increasing doses, a direct-acting oral anticoagulant for life, and whose left atrium was already showing moderate enlargement, I chose the 75% success rate. And, it failed...unfortunately. I was in that unlucky 1/4 of all ablatees whose first attempts fail. I elected to try again, and have been in NSR since Feb of 2023.

Flutter is more easily corrected and the success rate for ablations runs about 90-95%, depending on the skill of the EP doing the procedure. If you remain in NSR for six months afterwards, your EP is probably going to agree to take you off the DOAC, although it depends also on other risks you may have for stroke.

Personally, I'd rather be off medications and know that my heart isn't developing fibrosis or enlarged vessels due to the arrhythmia. Also, as the link below suggests, about half of all AFL sufferers go on to develop AF where enlargement, valvular problems, and heart failure can follow:
https://www.mayoclinic.org/diseases-conditions/atrial-flutter/symptoms-causes/syc-20352586

Thanks for quick response.
As far as you/others know is it common that flutter ablation is offered and then it could turn out to be AFib to lead to more troubles down the road?

Go ahead with the ablation as current thinking is the sooner the better. Flutter continues to get worse with time absent an ablation.

@gregkogan AFAIK, Atrial flutter is typically results in tachycardia with rates in the 130-150 range; that's not a healthy for a heart if sustained. When I experienced it, the doctors who treated me stressed the importance of getting that rate down to normal without delay. They also said that flutter often progressed to A-fib, and gave me two options: cardioversion or ablation. I chose the ablation since it has a greater chance of correcting the condition long term than cardioversion does. Five years later I haven't regretted the decision. Good luck with yours..

If you have typcal atrial flutter ablation has shown 97% success. Even after though you can get fib. The diiference is typical flutter is organized whereas fib is unorganized. Both represent aberran electrical pathways and remain untill their roads are blocked and with ablation the road block is a scar. However electricity is like water and takes the path of least resistance so the ectopic foci are looking for a way around the scar.

The good news wqith typical flutter is it involves the cavotricuspid isthmus usually and only involves the right side of the heart so there is no septal puncture and you go home the same day. You should feel better getting it fixed. Cardioversion is usually a failure and the drugs aren't very healthy or effective

@labexperiment Agree with your perspective on this. AFL tends to want to stay in AFL, whereas the earliest stages of AF, they being 'paroxysmal (comes and goes, but mostly absent) and 'persistent' (begins to assert itself more often, and goes on more than a week at a time), mean you are in normal sinus rhythm much/most of the time. Flutter is often more asymptomatic for the patient than AF is; both can be complete surprises to their hosts when a physician tells them they are in AFL or AF. I know a very active retired professor who found out about his own AFL in a doctor's office. They rushed him through the lineup for an ablation, which he got in ten days instead of ten weeks because they weren't sure how long he'd been in flutter, and it can really put a load on the heart. He had to have two ablations if I recall correctly, but he has been in NSR for over five years now.

Typical AFL is a re-entrant circut and remains until the circut is destroyed.

Every cardiac muscle cell can generate it's own electrical current, skeletal and smooth muscle can't so rougue cardiac muscle cells are more the cuprit in fib and finding them is the biggest trick. From what I have read mapping leaves a lot to be desired. New systems such as Aferra are hyped up but when you read the company's sales pitch the product like others aren't advertised t obe better for the patient in terms of mapping but more oriented to allow the provider to do more procedures. It's all about the $$$$

@gloaming
What kind of min. diagnostics are required to be done by doctor before he is confident that the patient are facing flutter ablation? As it stated above by everyone during procedure it could be overwritten by seeing more data so I am just talking about stage one -diagnostic

Around 10 yrs ago I had my first Pacemaker inserted. They attempted to do an ablation prior but my heart wouldn't demonstrate the irregularities, even with medications to stimulate them.
So, no ablation.
Since then (10 yes ago) I've had no serious irregularities (ie atrial fib) so my occasional SVT has been controlled by medication (and Pacemaker, I presume).
Just my experience....

@gregkogan The definitive assessment is done with a 12-lead ECG which, if you do have flutter, will be revealed on the graphic display as literally a sawtooth pattern between the other waves. As for whether the patient is a good candidate for an ablation, the electrophysiologist would probably (I'm not one, nor do I have any medical training) want to be assured that you have no obvious ischemia from heart disease that needs correction first, or that you have one or more valves that need repair or rehab....that kind of thing. You would have to demonstrate a soundness and all-round health that would make his/her efforts reasonable to perform, especially since all procedures that require entry to the body offer some risk. He doesn't want to make you worse off!