Atrial flutter treated by atrial override pacing?

correction

by golden_snitch - 2011-01-09 01:01:24

I meant, it paces you at a high rate in the ventricles, of course, not atriums.

Question

by golden_snitch - 2011-01-09 01:01:41

Hi!

I wonder how that works that the pacer switches modes, and you don't feel the flutter or tachycardia at all. I mean, as long as you have a working AV-node, it will let the fast impulses from the atriums pass through and activate the ventricles. The only thing I can imagine is that when the pacer switches modes, and ignores the atriums, it paces you at a quite high rate in the atriums because it needs to override what's being passed on by the AV-node. Or how that does work? Or do you have a complete heart block all the time?

Thanks
Inga

DDIR

by biker72 - 2011-01-09 06:01:11

My Boston Scientific PM was switched to DDIR mode to fix my A-Fib/Flutter. No problems since the switch.

Atrial flutter

by Selwyn - 2011-01-09 07:01:40

Thanks for all the advice, very grateful .
No doubt about the flutter- I have an event recorder - typical saw-tooth pattern. Every so often there is a period of asystole and the pacemaker kicks in.The AV node has just about had it or I would have a ventricular rate in excess of the resting rate of 62 bpm with flutter. The pacemaker predominantly has stopped ( the base rate was set for 60 bpm and I am now exceeding this, with the odd pause when it is activated). The activation of the AMS mode is protecting my ventricles from being paced. Normally I get a print out of AMS activity at the pacer check up - to date it had been not significant in duration or numbers.
I will definately ask whether any of the settings need to be altered. Thank you all.

Follow up

by parmeterr - 2011-01-09 10:01:34

Inga,

You are correct, the reason I did not know is because I have complete heart block. No pulse between the atrials and ventriculars. Been on a pacemaker for 13 1/2 years. The Adapta is my second pacemaker. Had a Thera originally.

Also have had AV nodal re-entry tachycardia which was ablated many years ago. Fighting low EF now and have non ischemic cardiomyopathy. Taking 50 mg/day of Coreg. Doing ok for now.

Been there, it's been fixed

by parmeterr - 2011-01-09 12:01:03

I have been through an atrial flutter episode. It is usually treated with an ablation, which I had done. Igna is correct, atrial flutter is a constant 300-350 "flutters" a minute. Makes a "sawtooth" pattern on the EKG. The pulse from the sinus node travels around and around the atrials through a bridge, which the EP "cuts" during the ablation. I have an Adapta pacemaker by Medtronic and it changed modes automatically and adjusted to make sure the ventriculars just kept on beating at a constant pace. Didn't even know it was happening. EP discovered the condition in a check up. Put me on Coumadin and two months later did the ablation after my INR value had risen to an acceptable level. My EF during the flutter was 25%.

Not sure...

by golden_snitch - 2011-01-09 12:01:40

Hi!

Are you sure it's atrial flutter and not fibrillation? Just wondering because you wrote that you detected an irregular heart rate, and in most cases flutter doesn't cause an irregular heart beat, but tachycardia at a regular rate (have had it myself, and underwent successful ablation).

Not sure if the pacer's override function can help. I mean, not sure, but wouldn't that override need to be pretty fast, and stimulate at a rate of something around 200-400 beats per minute in the atriums to override atrial flutter or fibrillation? With an upper heart rate limit of 180-220 bpm all pacers models I know couldn't do that. The study is not about rapid atrial pacing provided by a pacemaker, they used a different kind of stimulator.

Now, I do know that most pacer's today have atrial fibrillation and PACs/PVCs suppression modes but as far as I know they don't work by overriding the arrhythmia in the atriums. Not sure, though. Since they all have that upper rate limit, I would not know how these modes could override arrhythmias like AF.

Best wishes
Inga

Update after cardiologist visit.

by Selwyn - 2011-01-10 07:01:22

Just an update on the great NHS service ( which may be news to my overseas friends!).
Today, saw cardiologist in the hospital clinic, had ECG, echocardiogram, chest X ray, blood tests, started on heparin injections, commenced warfarin ( drugs picked up from hospital pharmacy without charge), arrangements made for monitoring dose with junior doctor - all in 3 hours!

Plan is to anticoagulate, and do an elective cardioversion of the atrial flutter rhythm in 1 month, then 1 year of warfarin ( I am getting my own new CoaguChek meter from Roche for £199- replacement- the test strips are available on NHS prescription so this is a big saving as normally 42 strips are £240, I believe; £7-20 for the prescription offers good value. I plan to do my own anticoagulation tests - a lot better than messing with a clinic, especially as I have holidays abroad in the middle of nowhere). Should the cardioversion fail, then ablation treatment is possible, however my cardiologist said this is not without some serious complications. There was not an option to use the pacemaker to stop the arrhythmia.
The idea of using a home anticoagulation meter may appeal to those on warfarin/coumarin meds. In the UK test strips are prescribable.

Finally an electrocardioversion

by Selwyn - 2016-12-08 19:50:43

I have been lucky to date, having avoided a cardioversion at the last minute the ECG ( EKG)  always  finally showing sinus rhythm, on the three occasions I have had atrial flutter. I even looked at a transoesophageol ultrasound all lubricated to be swallowed!

Not so lucky last week - thought exercise excess may have caused atrial flutter again ( typical irregular pulse, shotness of breath on exercise, and my ECG showing  a flutter pattern - on my one line monitor).

Presented myself to A&E and had 24 hours in coronary care ( my troponin A was a little raised) followed by a successful electrocardioversion.

I am pleased to say that apart from a little soreness from the electrodes, there have been no other problems. The pacemaker has checked out OK after the procedure.

I am back to swimming and table-tennis.  I am totally decaffeinated since this event.   

My Flecainide has been increased from 200mg total daily dose to 300mg.

Interesting the cardiologist thought that the episode was not related to exercise.  I think he is wrong. I plan to only do two exercise activities per day now, whilst I think this episode was due to spending most of the waking day doing exercise ( swimming a mile in the morning, clearing 6 builders bags of leaves in the afternoon, and playing competitive table- tennis in the evening).  

It is now 3 years since my flutter ablation which really did not cause me any side effects at the time. Perhaps I will consider a redo if I have any more problems.