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   Catheter Ablation | Atrial Flutter Ablation

Catheter Ablation

Key points:

  • Atrial flutter is often a recurrent arrhythmia, and drug treatment is often ineffective at preventing attacks
  • In these cases radiofrequency ablation is often the recommended treatment and is successful in about 90% of patients
  • Following successful ablation, patients remain at some risk of either recurrence of atrial flutter, or developing a related arrhythmia called atrial fibrillation

Treatment

There are a number of approaches to the treatment of atrial flutter.

General advice: Moderate alcohol and caffeine intake. This may help to reduce the frequency of attacks, but rarely leads to elimination of attacks.

Drug treatment: A large number of medications may be used to either treat an acute episode or be taken regularly to try to prevent attacks. Simple drugs such as beta-blocking agents or calcium antagonists are often the first choice. They are usually well tolerated although beta-blockers in particular sometimes cause tiredness and should not be used in asthmatics. More powerful drugs are also available, such as flecainide and sotalol.

Drugs are often ineffective at preventing attacks of atrial flutter, and occasionally side effects may limit drug use, and, with the more powerful drugs, rarely the arrhythmia is exacerbated.

Invasive treatment: For many patients with atrial flutter, cure can be achieved with a cauterising procedure called ablation and is described below.

Fine wires called catheters are passed into the heart through veins in the leg. These wires can stimulate (pace) the heart and also record electrical activity.  Many patients are in atrial flutter at the time of the procedure. In these cases another catheter is introduced and positioned in the right atrium (upper chamber). A series of applications of energy (usually radiofrequency) is delivered between a heart valve and a large blood vessel, and in most cases the atrial flutter will break and a normal rhythm supervene. By detailed electrical testing and often a number of further energy deliveries, a success rate of 90% can usually be achieved.

As the procedure is largely based upon a detailed knowledge of heart anatomy, a successful procedure can usually be obtained even if the patient is in a normal rhythm at the time of the procedure – atrial flutter does not need to be stimulated for a successful ablation to be performed.

Complications

Although the procedure is safe and effective in the large majority of patients there are small risks which must be considered before submitting to the treatment. These include the following:

  1. Damage to vein(s) at the top of the leg. In approximately 1 in 500 cases a small operation is required to repair vein.
  2. Cardiac perforation. In about 1 in 200 ablations a leak of blood occurs into the sac surrounding the heart. This causes a drop in blood pressure and is readily recognised and treated by inserting a small tube through the skin below the breast bone to drain the blood.
  3. In approximately one percent of cases ablation damages the normal electrical wiring of the heart, resulting in a very slow heart beat. This is treated with an artificial pacemaker.
  4. There is a very small risk of stroke with this procedure, approximately 1 in 1000. It should be remembered that the condition itself is associated with a very small risk of stroke. For this reason many patients are treated with blood thinning medications called anticoagulants, such as warfarin.
  5. Pain. In a small number of cases patients find the procedure painful despite the use of strong painkillers. In these cases the use of a different form of energy which is painless (cryoablation) may be used.
  6. Recurrence of palpitations. In approximately 10% of cases atrial flutter recurs. In these cases a repeat procedure is usually effective in curing the condition. However:
  7. A related abnormality of rhythm, called atrial fibrillation, is very common in patients with atrial flutter. This arrhythmia may be seen following an entirely successful ablation for atrial flutter, particularly in elderly patients. Atrial fibrillation is discussed in a separate sections. 

Your doctor will carefully discuss the procedure, including all the potential risks with you, and will obtain informed consent before starting.

Practical points about the procedure

Usually you will be asked to stop any cardiac medications you are taking to control the palpitations for about three days before coming into hospital. Many patients with atrial flutter are taking blood thinning medications (such as warfarin). A blood thinning check (INR) will usually be required a few days before the procedure, and your doctor will advise on if and when to stop any blood thinning treatment.

The procedure takes about two hours and you will be required to lie fairly flat for about three hours afterwards to prevent any bleeding from the puncture sites at the top of your leg.

Most patients are discharged the following day feeling well. You may well have a little bruising at the top of your leg, and some patients feel a little sore in the chest. This usually resolves in a few days and simple analgesia with paracetomol may help.

The DVLA regulations preclude driving for one week.   

 


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