21. “Will an ablation take care of both A-Fib and Flutter? Does one cause the other? Which comes first A-Fib or Flutter?”
A typical catheter ablation can fix both A-Fib and A-Flutter at the same time.
It’s relatively easy to ablate for A-Flutter and it’s highly successful (95%). It usually involves making a single line in the right atrium which blocks the A-Flutter (Caviotricuspid Isthmus line).
Many doctors make this line while doing an A-Fib ablation (in the left atrium) even if you don’t have A- flutter at the time.
At the beginning of an ablation, doctors enter the heart through the right atrium. While in the right atrium they make the right atrium ablation line which usually only takes 10-20 minutes. Then they go through the wall separating the left and right atrium (Transseptal Wall) to do an ablation for A-Fib in the left atrium. (They can also make this right atrium ablation line at the end of an ablation when they are leaving the left atrium for the right atrium.)
But others say one should “do no harm” and not make this ablation line if there is no A-Flutter. It can always be done later at little risk to the patient.
Note: Most Maze/Mini-maze surgical approaches don’t access the right atrium, and therefore can’t fix A-Flutter. You have to have a catheter ablation to fix it.
While you can have A-Flutter without A-Fib, more often than not, they are linked. When you have A-Flutter, A-Fib often lurks in the background or develops later.
In a small study people did much better if they had an ablation for both A-Fib and a A-Flutter at the same time even though they only seemed to have A-Flutter.
But right now we can’t say for sure if one causes the other. We do know that A-Flutter usually comes from the right atrium, while A-Fib usually comes from the left atrium.
(I think of Flutter as a better or improved version or form of A-Fib. During an A-Fib ablation, as the EP makes ablation burns, the highly disorganized A-Fib signals turn into the more organized Flutter signals. As more burns are made, the Flutter turns into simple tachycardias. Once the tachycardias are stopped and can’t be induced, the ablation is usually considered finished.)
Kaarisalo, MM, et al. Atrial Fibrillation and Stroke, Mortality and Causes of Death After the First Acute Ischemic. Stroke. 1997; 28: 311-315 doi: 10.1161/01.STR.28.2.311 http://stroke.ahajournals.org/cgi/content/full/strokeaha;28/2/311.
Thanks to Olivia Levy Wallace for this excellent question.
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