I told my ep that I didn't want a PVI at this point, so just let's treat the aflutter.
So the textbook choice was: (1) to have either a more minor right sided (typical) aflutter ablation first and then, if the afib was still problematic, have a left sided PVI for the afib at a later date or (2) Have both at the same time.
Mjames1 in reply to mrhappydays 1 year agoĪs background, I had both aflutter and afib. No medical training here, but what I have gleamed through research and from my ep, so take that into consideration. Sounds like they know what they're doing but you can always ask them to clarify.
Difference between typical and atypical atrial flutter full#
And if their probing leads them to the left side of the heart, you may end up with essentially a partial or full PVI. More complicated- Often it's really hard to tell from ecg's whether it's really flutter or afib, or perhaps a mix. That is probably why they used the language "if need be". And from what my ep told me, they would not know whether or not to do a right (typical) sided ablation for my flutter or a left (atypical) sided ablation until I was actually on the table when they would try and provoke the flutter to see where it's coming from. It is a more complicated procedure and longer procedure.Ī bit more complicated- At one time I was in your same situation. An "atypical" aflutter ablation is when the flutter originates on the left side of the heart. It is a relatively minor and quick procedure with 95% success rate. Short and sweet - A "typical" aflutter ablation is on the right side of the heart where most aflutter originates. Atypical atrial flutter originating from the right atrium and heart's septum have also been described. Left atrial flutter is considered atypical and is common after incomplete left atrial ablation procedures. Atypical atrial flutter rarely occurs in people who have not undergone previous heart surgery or previous catheter ablation procedures. Type II (atypical) atrial flutter follows a significantly different re-entry pathway to type I flutter, and is typically faster, usually 340–350 beats/minute. The re-entry loop cycles in the opposite direction in clockwise atrial flutter, thus the flutter waves are upright in II, III, and aVF. The flutter waves in this rhythm are inverted in ECG leads II, III, and aVF. Type I flutter is further divided into two subtypes, known as anticlockwise atrial flutter and clockwise atrial flutter depending on the direction of current passing through the loop.Īnticlockwise atrial flutter (known as cephalad-directed atrial flutter) is more commonly seen. The reentrant loop circles the right atrium, passing through the cavo-tricuspid isthmus – a body of fibrous tissue in the lower atrium between the inferior vena cava, and the tricuspid valve. However, this rate may be slowed by antiarrhythmic agents. We define AFL as an arrhythmia with a macroreentrant circuit (>2 cm) distinct from focal atrial tachycardias (or small circuit reentry) with subsequent centrifugal spread.Type I atrial flutter, also known as common atrial flutter or typical atrial flutter, has an atrial rate of 240 to 340 beats/minute. In this chapter, we will review recent advances in our understanding of AFL mechanisms, its heterogeneous nature, and treatment. AFL often occurs in the context of structural heart disease (e.g., valvular, ischemic heart disease, cardiomyopathy) and may also manifest during acute disease process (e.g., sepsis, myocardial infarction). We define AFL as an arrhythmia with a macroreentrant circuit (>2 cm) distinct from focal atrial tachycardias (or small circuit reentry) with subsequent centrifugal spread.ĪB - Atrial flutter (AFL) is one of the most common cardiac arrhythmias in humans, afflicting ∼0.19 million people in the United States in 2005 its prevalence is expected to increase to 0.44 million by 2050 because of the aging population. N2 - Atrial flutter (AFL) is one of the most common cardiac arrhythmias in humans, afflicting ∼0.19 million people in the United States in 2005 its prevalence is expected to increase to 0.44 million by 2050 because of the aging population.
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