Atrial Flutter

Posted by feality @feality, Sep 27 7:03am

Recently diagnosed with atrial flutter. I have had symptoms since July(asymmetrical edema and shoulder pain) I requested blood work in July. Informing neurologist that heart disease runs in my family. Of course I was treated like an hysterical hypochondriac female and told to wait until my appointment in September. Well blood work had my peptide level at 3,300, it was 84 in March. Doctors told me to go to an emergency room. I refused. What can they do at an emergency room? I have an appointment with a cardiologist December 16, earlier if they have a cancellation.Th Apple Watch ECG indicates my heart is erratic and beating fast. I leave on a cruise tomorrow, again , what can they do in an emergency room, .

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@gloaming

The drug of choice for strokes with heart patients, particularly with dysrhythmias, is apixaban or xarelto. Aspirin is too limited in that function. If you have flutter, you should probably/certainly be on apixaban.

An ER can stabilize you, improve your condition, delay heart failure due to rapid heartbeat, ...........AND....get ahold of a decent cardiologist or electrophysiologist and have you treated asap. Your flutter is not a good thing to have. A friend of mine was ablated inside of ten days once they knew he had flutter. Why the urgency? Because neither he, nor the diagnosis/admitting EP, knew how long he had been in flutter. If it were weeks, they needed to treat it urgently.

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Thanks for sharing your knowledge

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@lindy9

Are you drinking or eating ANYTHING with caffeine?? Coffee, teas, chocolate, Mountain Dew, etc. If you do, quit completely and maybe don't need any scary meds or treatments.

For me, 1/4 cup of coffee ice cream or a couple little pieces of dark chocolate can get my heart fluttering and scary episodes. And I LOVE chocolate and ice cream. Also a lot of sugary deserts.

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Thanks, actually caffeine in moderation seems to calm he heart

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@katiekateny

The risk is throwing a blood clot. Stroke.
The prescription blood thinners will reduce that risk to very low.
I have read that the highest risk for blood clot comes days AFTER an episode.
Better to just stay on blood thinner till it is resolved.

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Thank you for the advice

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@harveywj


There is less risk for clotting with Aflutter that with Afib. The irregular beats are more organized with Flutter vs Fib. Clotting is still an issue but not as great. I used aspirin for a couple of years with intermittent Aflutter but then mine became more frequent.
My first experience with Aflutter my HR was 300. After that I just had intermittent events with much lower HRs and with often self-converting. The more and longer you are in flutter the more stress it puts on your heart but the same can be said for Afib. Still I think knowing what I know now I would have used blood thinners. Ablations are much easier and more successful with Flutter than with Afib. My flutter ablation took 1 hour and was 100% successful since 2012. I just went through my 2nd Afib ablation 3 days ago as breakthrough Afib was becoming more frequent.
BUT you indicate your peptide level at 3300 is very high indicating that you heart is working hard. This is a red flag and means getting to a diagnosis and treatment possibly sooner rather than later is more important. I myself wouldn't go on a cruise with these peptide levels and I would be on blood thinners. You mention having a neurologist and bringing up Freidriechs ataxia. FA (or FS) Freidriechs syndrome both cause heart arrhythmias which complicates matters. You didn't say you have FA but you bring it up suggesting you are knowledgeable about it makes me wonder if you are being seen for it. But then you also mention Addisons disease so that is confusing.

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I’m seen at 2 places for FA , Mayo Clinic in Rochester and and university of Chicago.

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@feality

Thanks, actually caffeine in moderation seems to calm he heart

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From my experience, it can cause the flutter. Cardiologists reported here the same. You might not feel the flutter immediately but.... If you test and have none for a month, and have no more flutters? Better than what the docs will suggest in way of meds and treatments.

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@lindy9

From my experience, it can cause the flutter. Cardiologists reported here the same. You might not feel the flutter immediately but.... If you test and have none for a month, and have no more flutters? Better than what the docs will suggest in way of meds and treatments.

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The meds , especially warfarin, is a pain when my Father was on it. I have read they can electrically reset that upper chamber so it doesn’t beat erratically. I read it was an 80 percent success rate. Anyone had that done?

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@feality

The meds , especially warfarin, is a pain when my Father was on it. I have read they can electrically reset that upper chamber so it doesn’t beat erratically. I read it was an 80 percent success rate. Anyone had that done?

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Many people have ablations @fealiity and some suggested if for you here ...

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@feality

The meds , especially warfarin, is a pain when my Father was on it. I have read they can electrically reset that upper chamber so it doesn’t beat erratically. I read it was an 80 percent success rate. Anyone had that done?

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"...The meds , especially warfarin, is a pain when my Father was on it. I have read they can electrically reset that upper chamber so it doesn’t beat erratically. I read it was an 80 percent success rate. Anyone had that done?"

The 'reset' is called cardioversion. It's a lot like paddling the heart of a patient having a heart attack, except there's no urgency and the patient is helped to be unconscious (like most having a bad heart attack and needing CPR) by the administration of propofol...and sometimes a wee dash of fentanyl thrown in. The success rate of cardioversion depends on the heart being cardioverted, but one factor is the duration of time, and history of fibrillation or flutter. Hearts left in arrhythmia for long periods are notoriously difficult to treat. So, the idea is to get one's heart cardioverted ASAP. Mind you, my BIL was in flutter for about two years and did respond to a single cardioversion which has left him in stable normal sinus rhythm (NSR) since late May of this year....so go figure. Each of us is a different animal when in an ER.

The quoted success rate you state above might be that for catheter ablation to stop fibrillation or flutter, or PACs, or SVT. [premature atrial complexes/contractions and supra-ventricular tachycardia respectively). Across all electrophysiologists performing ablations, the general success rate for an 'index', or first, ablation is about 75% with variance of about 10%. Sometimes the patient's fibrillating heart will enter NSR as the EP is using the catheter RF needle or cryo needle, at which the assumption is that the signal has just been blocked. The EP should normally 'challenge' the heart using adenosine and/or isoproterenol to check. If the heart stays in NSR, all reasonable people would take it that the signal has indeed been successfully blocked and the patient is wheeled out to recovery. However, after a couple of calming weeks, the lesions formed by the catheter needle might reduce in size and reveal a clear pathway for a few volts to get through the lesions around it. At that, the heart has a restored spurious path and the atrium will recommence fibrillating. Again, happens in roughly 25% of first/index ablations. The solution...go back for a redo in a few months and hope any new lesions will permanently block the path of the voltage emitting from the focus where the signal entered the atrium previously. This was my personal experience. I was in my local ER with a rapidly pulsating atrium six whole days after my index ablation. Six months later, the very nice gentleman had a second run at my left atrium and told me when he came bedside that they all watched my heart go hard into NSR as we has ablating the tissue around my third pulmonary vein. High fives, and he said he didn't even cardiovert me, which is his normal practice before letting a patient out of his operatory. He didn't need to.

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