Ablation is now regarded as an excellent treatment for atrial flutter. The procedure is usually successful and has a low complication rate.
Atrial flutter is a condition in which a rhythm develops from a circuit in the right atrium. The rhythm is often fast so the atria (chambers at the top of the heart) beat very quickly. A small piece of conduction tissue called the atrioventricular node (AVN) sits between the atria (top chambers) and ventricles (bottom chambers) and limits the number of beats getting from the atria to ventricles. However, even when 1 in every 2, 3 or 4 atrial beats are allowed through to the ventricles, this can cause symptoms. However, many people don’t have symptoms. An important aspect of atrial flutter is that it increases the risk of stroke.
Atrial flutter ablation is now the first-line treatment for atrial flutter. It is very effective in creating a blockage against the electrical circuit in the right atrium that is responsible for atrial flutter.
In this procedure, fine wires or catheters are usually inserted into the heart of patients through the large veins located at the top of the leg. These wires have electrodes at their tips that are used to detect the electric signals produced from the different parts of the heart. In this procedure they are used to deliver radiofrequency energy to alter tissue in the right atrium that allows atrial flutter to continue.
This procedure involves the insertion of catheters into the heart through the vein at the neck or the top of the leg or groin. These catheters can transmit radiofrequency energy to the myocardium to targeted areas in the right atrium to modify the tissue so that it can no longer conduct as part of a rapid circuit.
The duration of this procedure is usually 1 – 2 hours and in many cases you can go home the same day but occasionally you may need to stay overnight.
You will be asked not to eat or drink anything on the morning of the procedure. A small plastic tube (cannula) will be inserted into a vein in the arm to give you any medications that are required as part of the procedure. You will be brought to the operating room and the team will introduce themselves before you are given some oxygen and some sedation medication.
As you become sleepy a drape will be placed over you and local anaesthetic injected at the top of the leg. Some fine wires will be inserted through needles into the blood vessels at the top of the leg and fed round to the heart under X-ray guidance. Once the wires are in the correct place, the correct tissue in the heart will be ablated carefully.
The catheters (thin tubes) will then be withdrawn from the heart and pulled back through the top of the leg. After they are removed there will be pressure applied to the top of the leg to reduce bruising.
The procedure is almost always successful at the time but in around 1 in 20 patients a further procedure will be required because the circuit restarts. Around half of patients will at some point develop a different rhythm problem called atrial fibrillation but this is not thought to be due to having the atrial flutter ablation and would have happened anyway.
The risks are very low (<1%) but include damage to the walls of the heart causing a build-up of fluid around the heart, damage to the conducting system of the heart (needing a pacemaker) and bleeding or bruising from where the tubes are inserted at the top of the leg. There is also a small risk of stroke but you will be advised to take medications to thin your blood beforehand and if needed a transoesophageal echocardiogram will also be undertaken to check for clot in the heart.
After the procedure, you will return to the ward to be observed. You will be asked to lie flat for a few hours to reduce the risk of you bleeding from the top of the leg. You will be allowed to drink and then eat when you are no longer drowsy. You may have a focussed ultrasound (echo) of your heart to check there has not been a build-up of fluid in the sac around the heart.
You will normally be able to go home either late that day or the morning after your procedure. You may have a sore feeling and other slight discomforts in your chest for a few days and feel tired for a week or two. The dressing at the top of your leg can be removed the day afer you come home. You are not allowed to drive for two days and you should avoid lifting, heavy exercise and flying for a week afterwards.
Atrial flutter ablation is a low-risk and usually successful procedure, but requires careful discussion and explanation by our expert Consultant Cardiologists. Our cardiologists are available for consultation on any day of the week and weekends as well.
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