Atrial Flutter and ablation

What is Atrial Flutter?

This is a short circuit which originates from and travels around the right atrium (upper heart chamber). The short circuit drives the heart very rapidly and commonly results in a heart rate of around 150 beats a minute.

Atrial Flutter from Khan Academy.

Atrial Flutter can cause palpitations, breathlessness and tiredness. In some people, it can cause heart failure. Ineffective circulation of blood in the atrium from flutter can leave patients at risk of stroke, similar to Atrial Fibrillation.

What are the treatment priorities for Atrial Flutter?

There are two main issues to address in treating Atrial Flutter.

Stroke risk. This is minimised by using blood thinning medications, which act by preventing blood clots in the heart. A risk assessment for stroke due to Atrial Flutter will be calculated. If your risk is high, your doctor may recommend Warfarin or one of the newer agents (novel oral anticoagulant, or NOAC).
Symptoms due to a fast heart beat. The main reason to cure Atrial Flutter aside from treating the symptoms is to avoid the risk of heart failure related to a persistently high heart rate.

What treatments are available for Atrial Flutter?

Medications. Tablet treatments can be effective in some patients. However, in most patients, Atrial Flutter can be challenging to manage with medications alone. Blood thinning medications will be recommended to reduce the risk of stroke for most people with Atrial Flutter. Your doctor will discuss this with you.
DC Cardioversion. This is a treatment to revert Atrial Flutter back to a normal rhythm by delivering an electric shock under brief general anaesthesia. This is an effective treatment, although at least half of those who undergo an initially successful cardioversion will have another episode of Atrial Flutter over the next year.
Radiofrequency ablation. This is a procedure performed by an Electrophysiologist to provide a cure for Atrial Flutter and is explained in detail below.

How do I prepare for Atrial Flutter ablation?

Please refer to the section on EPS. If you have persistent Atrial Flutter, you may be asked to take Warfarin for at least 4 weeks prior to your procedure. You would usually be asked not to stop your Warfarin for the procedure; you should clarify this with your Electrophysiologist, especially if you are taking a different blood-thinning medication. Some patients may require a trans-oesophageal echocardiogram to exclude the presence of any clots within your heart.

How is Radiofrequency Ablation performed for Atrial Flutter?

Please refer to the section on EPS on how EPS is performed.

Radiofrequency ablation is usually carried out during the same session following your EPS as the necessary catheters within the heart are already in place.

Radiofrequency ablation can be performed under local anaesthetic with sedative medications or sometimes under general anaesthesia. This will be discussed with you.

Radiofrequency energy is applied to the short circuit in the right atrium. Patients may feel a transient warm discomfort in the chest during the delivery of radiofrequency ablation energy.

The ablation procedure including EPS will take between 1 and 2 hours.

What is the success rate for ablation for Atrial Flutter?

This procedure carries an approximately 95% chance of curing your Atrial Flutter. There is a 5% chance of Atrial Flutter recurring after an apparently successful procedure.

What are the risks of Atrial Flutter ablation?

Ablation for Atrial Flutter is commonly performed and is a low-risk procedure. The worldwide complication rate for ablation procedures is less than 0.5%. Although most patients who undergo ablation for Atrial Flutter do not experience any complications, you should be aware of the following risks:

Blood vessel problems: bleeding, bruising, damage to the vessel wall, abnormal connections and blood clots can form in the blood vessel in your groin or higher up near the heart. Usually these settle by themselves, but sometimes medications, injections or small operations are required to fix them.
Abnormal heart rhythms: these are deliberately provoked during the procedure, but can become unstable requiring an electric “shock” to restore a normal heart rhythm. There is a very small risk of requiring a pacemaker if the normal and necessary electrical system of the heart is damaged.
Perforation: there is a very small chance of causing a leak of blood around your heart. This usually settles without treatment but can also be dealt with by inserting a drain from the chest wall.
Life-threatening complications like stroke or heart attack are very rare.

What happens after the Atrial Flutter ablation?

You will be required to lie flat for 2-4 hours. You may have a compression clamp over your groin area during this time. Your nurse will check on you to see if there is bleeding or swelling at the groin site. Most people can start eating and drinking water within 4-6 hours after the procedure. Most patients stay in the hospital overnight and their heart rhythm may be monitored. Your Electrophysiologist may stop, switch or commence you on new medications after the procedure. It is important to clarify your plan for blood thinning medications (e.g. Warfarin) for the 4 weeks after the procedure with the Electrophysiologist. In some instances, your Electrophysiologist may advise you to stay on blood thinning medications lifelong.

You should avoid strenuous physical activity and sports for 2 weeks after the procedure. Most people take approximately 1 week off work. Some patients may experience minor chest discomfort and brief palpitations several days after the procedure. This may be due to the irritation caused by the ablation and will usually settle. If this persists, please consult your Electrophysiologist. You should not drive for at least 48 hours although we usually recommend that you do not drive for a week.

Your groin site might be sore for several days. A small bruise at the groin site is normal but if it starts to bleed, you can contact your local doctor or the Electrophysiologist.