Atrial flutter is a heart rhythm disturbance which is typically confined to the right atrium, the chamber which receives blood from the veins of the body. Patients may be predisposed to this condition because of the presence of lung disease or certain types of heart disease, In many cases, however, there is no obvious cause. The electrical activity within the heart chamber is revolving in a circle around the perimeter of the chamber, often at rapid rates which can result in an awareness of the heart beating rapidly. As the normal control over heart rate is lost, patients frequently also complain of breathless ness or tiredness.
The circuit for atrial flutter is well defined and because it is easy to pass catheters up a vein in the body to enter this chamber, it is often possible to cure this heart rhythm disturbance with a technique known as radiofrequency ablation.
How is the procedure done?
The procedure involves passing two or three catheters up a vein in the leg until they are sitting in the heart. You are not aware of the catheters being there as the heart has very little sensation. One of these catheters is known as an ablation catheter and has the ability to heat up the tissues with which it is in contact. This causes localised burning of the tissue on the floor of the chamber, eliminating a critical part of the circuit used by the flutter waves.
The procedure is performed under local anaesthetic and with some sedation given by injection to make you relaxed and sleepy during the procedure. The procedure takes around 30 minutes although there is often a waiting period after this to ensure that the circuit does not recover from the treatment which could mean a recurrence of atrial flutter. It is normal to feel some discomfort from time to time during the procedure although this is usually bearable and very short lived. The total amount of actual treatment or ablation throughout the procedure is often less than 5 minutes and is delivered in short bursts.
Patients can usually get out of bed 4 to 6 hours after the procedure and go home the same day. The long term success rate of the procedure is in excess of 90%, and in the small proportion of patients who have a recurrence, a repeat procedure can easily be performed.
Do I need to stop medication before the procedure?
Normally we do not stop patients medication before the procedure. We would generally continue anticoagulation such as warfarinor coumarin before the procedure.
What are the risks?
Ablation procedures are very safe and the risk of life threatening complications is extremely low. However, some patients will suffer bruising or bleeding at the top of the leg where the tubes were inserted into the vein. This is generally minor and does not require any specific treatment other than some light pressure if bleeding is occurring. In approximately 0.5% of patients there can be bleeding around the outside of the heart. If this occurs, it can be necessary to insert a needle under the ribs to drain any collection of blood. This procedure is performed under local anaesthetic and the bleeding almost always stops spontaneously. There is a very small risk of damage to the normal conduction system in the heart and in extreme cases this can result in a slow heart rhythm and the need for a permanent pacemaker. This probably happens in approximately 1 in 1000 cases.
What will happen after the procedure?
It is not uncommon to experience short episodes of palpitations or extra heart beats in the first few weeks after the procedure. This is often just a reflection of the minor irritation caused to your heart and generally settles down. The DVLA regulations state that patients must not drive a car or any other vehicle for 7 days after the procedure.
Patients who take warfarin may be able to stop it one month after the procedure. Before this, it is usually necessary to confirm that the heart is still in a normal rhythm by performing an ECG. Your heart rhythm specialist will probably want to see you in an outpatient clinic at some point after the ablation to ensure that the procedure has been a success and make any necessary changes to your medication.