Robert's Journal

Petey Bello  Hang in there Robert, I had things like that following the weeks after my surgery. Some of these things are very normal after surgery while your heart/valves adjust!

Larry Ring  Hi Robert....
Sounds like we are following a similar path. EKG revealed atrial flutter on Day 1 of cardio rehab, which was about 5 weeks post surgery.
Back to the cardiologist for a change-up in the med cocktail in the hopes the heart would go back to normal sinus. No go. So, four days ago, I had a cardioversion. That brought my heart back in to normal sinus.
I was told that meds, and even a couple more cardioversions, if necessary, are the course of treatment before any talk of ablation. I was happy to hear that. I want them to stop messing with my heart.
Let me know if you learn the same...
Hang in there.
PS - For me, I had no symptoms. Had no idea my heart had converted from normal sinus to atrial flutter. That kind of freaked me out. Found the Kardia sensor that gives you a mini EKG via your smartphone. Incredible device. For me, worth the $99.00 to know!
Look forward to hearing back from you.

Robert McElrath  Hi Larry,
Like you, I had no idea I was in A-flutter. My cardiologist mentioned cardioversion, but, unlike you, he quite preferred ablation as the first choice, something along the line that flutter is highly responsive to ablation and the sooner my flutter is cured the better for me. In my case, there's never been any talk about a med cocktail. I'm on Metoprolol because of brief A-fib I experienced two days after surgery (which reverted to sinus after a few hours), and baby aspirin, and that's it. Well, that WAS it ... I started Eliquis this evening specifically because of the A-flutter. Anyway, I'm scheduled for ablation on 9 May, but need to have a consultation with the electrophysiology doctor asap. I still have many questions and I have not yet met him. Based on your story, I now have a few more important topics to cover, like cardioversion and medications, and why was I steered into ablation so quickly?

My rehab begins tomorrow and I can't wait. I'm chomping at the bit to get some exercise. Conservatism seems to dominate postop recovery philosophy here and I was even grounded from walks around my hilly neighborhood that I began two weeks post surgery until cardio rehab starts. If they can deal with this A-flutter issue in between rehab sessions, I will be very happy.

Robert McElrath  Petey - thanks so much. What you say makes sense. I know the surgery is a bit traumatic to the heart. My old aortic valve was so constricted that I wonder if my heart doesn't quite know what to do now that the valve is a wide-open super highway.

I was frustrated about the flutter, but really, I don't have anything to complain about. Like I said in my profile story, I believe knee and hip replacement patients have a rougher time than us open hearters.

Larry Ring  This is interesting....you are getting advice that is 180 degrees different from the advice I got from my cardiologist (actually, I had two weigh in on the subject).
From everything I've been told, A-flutter is not uncommon after OHS. "30% of OHS patients have it" is the statistic I've been told. It is not immediately dangerous and does not cause immediate damage to the heart tissue. It is a situation that needs to be watched and ultimately resolved.
There is an increased risk of blood clots while in A-flutter, hence the need to renew blood thinners (I was put on Eliquis, too...no INR checks and I was told the safety profile is a little bit better than warfarin,).
Some people will return to normal sinus without any intervention. Others can be brought back in to normal sinus with medication. Cardioversion (shocking the heart) is usually a very predictable way to bring the heart back in to normal sinus. If none of the above work, invasive, 'hit and miss' ablation is the answer. But ablation is an invasive procedure...scarring the heart tissue to interrupt electrical signaling...and it is not foolproof. There are times when they can't find the right spot to ablate, and so a pacemaker is the last resort.
I, personally, always want to go the most conservative route possible...not jump in at the finish line. I am also very adverse to undergoing another invasive procedure to my heart unless absolutely necessary.
I am almost one week post cardioversion and I remain in normal sinus (thanks to my handy Kardia monitor, I can check that via my IPhone.) I trust that my heart muscle is healing and that I will not be kicked in to atrial flutter again...but if I am, it will be another cardioversion for me. Ablation is the last thing I want to have done.
I am really interested in following your journey, Robert...keep me posted!

Robert McElrath  Hi Larry,

Apologies for taking so long to reply. You’re right; it seems I received different advice than you in that I was steered towards ablation as the doctor-recommended first course of action.

My background: Atrial flutter was found during a postop week 5 visit to my general cardiologist. It was my first EKG since hospital discharge. I was normal sinus at discharge, so flutter began sometime before week 5. I’m now at week 7, and in the past two weeks, the flutter has been persistent as documented by a 24 hour Holter and regular EKGs run during cardiac rehab sessions. It was still there during my consultation with the ElectroPhysiology cardiologist yesterday.

The general cardiologist described my choice as 1) cardioversion or 2) ablation. When asked of his recommendation, without hesitation he said ablation. “Flutter responds well to ablation. It should cure it. Cardioversion may not”. My primary care doctor and the ElectroPhysiology cardiologist strongly agree.

The consultation with the EP doctor was interesting. He mentioned that I could potentially have "organized atrial fibrillation" which is more difficult to deal with than vanilla right atrial flutter. He also said that "all bets are off" for patients like me who just had open heart surgery -- that the heart can make complex arrhythmias following open heart that cannot be fully diagnosed with standard EKGs and he wouldn't know what he's dealing with until he is doing the procedure. If it's simple right atrial flutter, he said he will be done in 45 minutes. Hope so. But if it's not, he opened the door to needing additional procedures. I don't like the sound of that one.

From what all of my doctors say, and from what I read, the ablation procedure is very low risk, recoup time is a week at best, and if the arrhythmia goes away, then I’m off of Metoprolol right away and Eliquis in a month. Getting off meds, especially blood thinner, is a big driver for me. Plus, the flutter-induced palpitations make me feel pretty bad, so I’m ready.

I'm over the hump if I can shake this flutter. The sternum feels good, and cardio stamina is pretty much back to normal already. Progress has been fast in cardiac rehab. The exercise is what makes you feel great again.

Ablation is scheduled for next Tuesday, 9 May.

Bob