Pacemaker & Flutter

Hello,

I have had paroxysmal afib for 30 years. It wsa treated at Cleveland 16 years ago and my heart worked great. But then I had back surgery at Barnes Jewish in St. Louis and afib returned. Another ablation converted the afib to left side flutter, but I can't seem to get rid of that. Had a third useless ablation with no benefit.

So now my cardio guy want to ablate my AV node and install a pacemaker. From reading notes here this does not sound like it works all that well since many people still report having flutteringi n the chest.

 

Is av ablation + pacemaker a good solution for flutter?

 

Thanks

2 Comments

av ablation

by Tracey_E - 2023-02-28 20:54:00

This is the last resort when nothing else works. Many people have it and live active lives after. However, I've never heard of flutter as a reason to do it. Afib, yes. Flutter is generally considered annoying but not dangerous or debilitating. Is it affecting your day to day life? If yes, then at least look into it. We have several members who have had it. I'm sure one of them will chime in soon (talking at YOU, AgentX!)

Ffib => atypical Aflutter

by AgentX86 - 2023-02-28 23:38:50

Wow, do I know that one from one end to the other (thanks for being the straight man Tracey 😉).

I was diagnosed with Afib in 2007 and cardioverted a few months later.  Fast forward until 2014 when it came back with a vengence.  Shortly after that I needed a CABG. While they were in there they tried a maze and LAA clip for the Afib. I came out of it with permanent atypical flutter (left side).  I was highly symptomatic so had three ablations and almost every antiarrythmic in the book to try to have a normal life (couldn't sleep). 

The last, Sotolol, damaged my SI node so needed a pacemaker.  My EP had been discussing a pace and ablate so he could increase the antiarrhythmic doses to try to stop the AFL.  Since I needed a pacemaker anyway, an AV ablation didn't seem to be a big stretch anymore.

I had the AV ablation and PM in February 2018.  It's worked very well.  No more problems with flutter and I have no major problems with the pacemaker.  I have had (and still have) intermittent PVCs.  They're a RPITA but at least they're not permanent. They tend to come after exercise and not at night.

AV ablations work (Afib ablations are iffy) but are very a serious matter.  You will be pacemaker dependent and likely without an escape rhythm (no more AV node or Bundle of His). It's a tradeoff that only you can make. You have to discuss your situation with your EP and go in with eyes wide open.  It's not something you do because you get a little flutter in the chest once in a while. The chances of success are very high but so is the cost. Before you go this far you have to decide that you can't stand where you are and it's truly affecting your quality of life.

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