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Anyone have experience with left atrium ablation afluttet

Posted by cmcouture @cmcouture, 22 hours ago

I had a right side ablation for atrial flutter in October. They noticed "errant" circuits in upper left side. Have had 2 episodes this year. Looking at left side ablation. Anyone have this done?

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gloaming | @gloaming | 17 hours ago

AFL happens most often in the right atrium, and it enjoys, if you could call it that, a very high rate of success in being 'fixed' with ablation. It's much less common in the LA, but it can happen. Happened to me once, but only the one time: the rest was always fibrillation.

AFL in the left atrium can be managed by AAR (anti-arrhythmic drugs) or ablation. Ablating tissues to control/reduce flutter and fibrillation is always the same: blocking the re-entrant signal from contacting the endothelium and spreading across the endothelium to force a contraction of the underlying myocytes. By scarifying the tissues surrounding the focus or re-entrant, just as they do for a simple PVI (pulmonary vein isolation, which is what 90% of first-time ablatees get from their electrophysiologist (EP), the electrical wave stalls at the dead/scar tissue. The signal dies there, surrounded. And that lets the SA node and AV node do their 'thing' naturally and peacefully, and your heart beats away normally.

The main thing to take away is that AFL is the easiest of the tachyarrhythmias to treat, no matter where it crops up, left or right. Yes, it is now 'atypical' AFL if it appears in the left atrium, but it's still AFL and if it can be found, the re-entrant can be isolated just as they do for the pulmonary veins. It's a pain to have to endure it all again, but it 'should' go quite well for you. Even if that's just my opinion, without knowing a thing about you, your EP will/should tell you honestly what he thinks his chances are of finding the right spot and then simply isolating it with RF or PFA.

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cmcouture | @cmcouture | 11 hours ago
In reply to @gloaming "AFL happens most often in the right atrium, and it enjoys, if you could call it..." + (show)
Profile picture for gloaming @gloaming

AFL happens most often in the right atrium, and it enjoys, if you could call it that, a very high rate of success in being 'fixed' with ablation. It's much less common in the LA, but it can happen. Happened to me once, but only the one time: the rest was always fibrillation.

AFL in the left atrium can be managed by AAR (anti-arrhythmic drugs) or ablation. Ablating tissues to control/reduce flutter and fibrillation is always the same: blocking the re-entrant signal from contacting the endothelium and spreading across the endothelium to force a contraction of the underlying myocytes. By scarifying the tissues surrounding the focus or re-entrant, just as they do for a simple PVI (pulmonary vein isolation, which is what 90% of first-time ablatees get from their electrophysiologist (EP), the electrical wave stalls at the dead/scar tissue. The signal dies there, surrounded. And that lets the SA node and AV node do their 'thing' naturally and peacefully, and your heart beats away normally.

The main thing to take away is that AFL is the easiest of the tachyarrhythmias to treat, no matter where it crops up, left or right. Yes, it is now 'atypical' AFL if it appears in the left atrium, but it's still AFL and if it can be found, the re-entrant can be isolated just as they do for the pulmonary veins. It's a pain to have to endure it all again, but it 'should' go quite well for you. Even if that's just my opinion, without knowing a thing about you, your EP will/should tell you honestly what he thinks his chances are of finding the right spot and then simply isolating it with RF or PFA.

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labexperiment | @labexperiment | 2 hours ago

Left sided atypical flutter as it's known is becoming more common especially following Farapulse PFA. It is being seen because of linear line ablation within the left atrium. Apparently Farapulse doesn't produce a good lesion. It is seen commonly found around the mitral anulus. It is a renterant circut so results are promising using Aferra combination RFA and PFA.

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