AFIB or AFlutter?

Posted by lmt1 @lmt1, Dec 31, 2025

Hi, I was diagnosed with AFIB a year and one half ago and offered ablation by 2 local health care systems. I declined since other than palpitations, I'm asymptomatic. However, in order to confirm I'm making the right choice, I visited Mayo-Rochester a couple of weeks ago. There, I wore 24 hr. Holter, Echo and other tests and confirmed 11% PAC, but no AFIB. I had the cardiologist review a Holter report I wore for 8 days in 2024, and she confirmed plenty of PAC's but did not see AFIB. She said I do not need an ablation now and the plan going forward is to wear a 14 day moniter a year from now. She also said we do not want to subject you to a procedure for a condition you don't even have, explaining AFIB is generally left atrium and Aflutter is right side, and if we can confirm both we can treat with one procedure. Has anyone else had this experience?? 71, M.

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gloaming | @gloaming | 6 days ago

First, welcome. Second, I'm far from being anything that could be called an expert, even charitably. I have no medical training.

I am an AF patient who has had two ablations (even the very best electrophysiologists have about a 20-25% failure rate for a patient's first, or index, ablation). Between ablations, I was told my Holter showed a lot of PACs.

PACs are closely related to atrial fibrillation (AF) and usually signal that AF is close by, maybe even imminent.

PACs are problematic, and the prognosis or morbidity is poorer, when their number approaches only 3%. As their number rises, they can become more and more problematic, and will often result in AF. https://biologyinsights.com/what-pac-burden-percentage-means-for-your-heart-health/

It is important to accept that every heart has PACs, but they don't all have AF. Healthy hearts will have between 1 and 10 PACs each day. As those numbers climb, they indicate some electrophysiological irregularity.

Neither PACs nor AF will kill you. They are NOT lethal arrhythmias. Both indicate potential and rising issues that will almost certainly need to be treated in time. AF, particularly, should be controlled early and stopped with either drugs or a catheter ablation. The latter, ablation, is now accepted as the 'gold standard of care'. If they block the signals and return the heart to regular and reliable rhythm, you can look forward to many years trouble free in most cases. Sometimes an ablation must be repeated down the road as a 'touchup'.