Atrial Flutter is due to a short circuit in one of the upper chambers of your heart termed the right atrium. In some hearts, an abnormal heart rhythm develops when an electrical impulse starts from a different location, other than the SA node or follows a route (or pathway) that is not normally present. This is what happens in Atrial Flutter.
Atrial flutter ablation is a procedure to block the electrical signals that cause a fluttering heartbeat.
The heart is a pump responsible for maintaining the blood supply to the body. It has four chambers. The two upper chambers (the right and left atrium) and the chambers that receive blood as it returns from the body via the veins. The lower chambers (the right and left ventricle) are the chambers responsible for pumping the blood out to the body via the arteries. Like any pump, the heart has an electrical system that controls how it functions.
In order for the heart to do its work (pumping blood throughout the body), it needs an electrical impulse to generate a heartbeat. Normally this electrical impulse begins in the upper right chamber of the heart (in the right atrium) in a place called the Sino-Atrial (SA) node. The SA node is the natural pacemaker of the heart. It provides the electrical spark that drives the heart to beat approximately 60 to 100 times per minute. If you are exercising, doing strenuous activity or are under a lot of stress, your heart may be faster. When you rest or sleep your heart rate will slow down. Certain medications may also slow the heart rate. All of this is appropriate.
From the SA node, the electrical impulse is relayed along the heart’s conduction system. It spreads throughout both the right and left atria causing them to contract evenly. When the impulse spreads over the right atrium and reaches the Atrio-Ventricular (AV) node. This is a very important structure in the heart because it is the only electrical connection between the top chambers and the bottom chambers. It is therefore the only way in which an electrical impulse can reach the pumping chambers (the ventricles). The impulse spreads through the AV node and down into the lower chambers or ventricles of the heart. This causes them to contract and pump blood to the body.
In some hearts, an abnormal heart rhythm develops when an electrical impulse starts from a different location, other than the SA node or follows a route (or pathway) that is not normally present. This is what happens in Atrial Flutter.
Atrial Flutter is due to a short circuit in one of the upper chambers of your heart termed the right atrium. This rapid short circuit has several consequences:
Radiofrequency ablation is the most common means of ablation used around the world today. It is a low power, high-frequency energy that causes a tiny region of the heart near the tip of the catheter to increase in temperature, thus ablating (or cauterising) a small area of abnormal tissue. Radiofrequency energy has been used for decades by surgeons to cut tissue or to stop bleeding. For the treatment of palpitations, a much lower power of radiofrequency energy is used.
If you have persistent Atrial Flutter, you may be asked to take a blood thinner for at least 3 weeks prior to your procedure, your cardiologist will discuss your medications prior to you. In addition, you may be asked to undertake a trans-oesophageal echocardiogram to exclude the presence of any preformed clots within your heart. However, if you have remained in normal rhythm (sinus rhythm) in the weeks prior to your procedure, then these precautions will not be necessary. If these arrangements have not been discussed with you or if you are unsure please call the Rhythm and Cardiac Specialists.
You will usually be admitted to the hospital on the day of your procedure. You will be required to fast for at least six hours before the study. Prior to the procedure, you will require an ECG. Once in the Electrophysiology Laboratory (EP Lab) you will be given a light sedative and your groin will be shaved.
The EP Lab has a patient table, X-Ray tube, ECG monitors and various equipment. The staff in the lab will all be dressed in hospital theatre clothes. Many ECG monitoring electrodes will be attached to your chest area and patches to your chest and back. These patches may momentarily feel cool on your skin. A nurse or doctor will insert an intravenous line usually into the back of your hand. This is needed as a reliable way to give you medications during the study without further injections. You will also be given further sedation if and as required. You will also have a blood-pressure cuff attached to your arm that will automatically inflate at various times throughout the procedure. The oxygen level of your blood will also be measured during the EP study and a small plastic device will be fitted on your finger for this purpose. Your groin area and possibly your neck will be washed with an antiseptic cleansing liquid and you will be covered with sterile sheets leaving these areas exposed.
The procedure is performed under general anaesthesia and will be discussed with you prior to the procedure by the anaesthetist. If the procedure is performed under local anaesthetic, the doctor will inject the anaesthetic into the area in the groin where the catheters are to be placed. After that, you may feel pressure as the doctor inserts the catheters but you should not feel pain. If there is any discomfort, you should tell the nursing staff so that more local anaesthetic and sedative medication can be given. Occasionally it is also necessary to place a catheter in a vein on the side of the neck.
The catheters are positioned in your heart using X-Ray guidance. Once the catheters are in place you may feel your heart being stimulated and usually, your abnormal heart rhythm will be induced. When the type of abnormal rhythm has been identified and the abnormal tissue localised, the radiofrequency ablation will be applied to this spot. The short-circuit is localised electrically and a small burn is created at the weak link in the short-circuit. This may cause a transient warm discomfort in the chest. The Atrial Flutter ablation procedure may take approximately 2 to 3 hours on average.
After your procedure you will be transferred back to your ward where you will have to lie flat for 4 to 6 hours. During this time, it is important to keep your legs straight and your head relaxed on the pillow. Most patients stay in hospital overnight and their heart rhythm may be monitored during this time. The groin area may feel sore and bruised for a couple of weeks after the procedure. You should avoid strenuous physical activity and sports for 2 weeks after the procedure until this has settled. Most people take approximately one week off work. Some people may experience minor chest discomfort and brief palpitations due to extra beats of the heart several days after the procedure. This is due to the irritation caused by the ablation in the heart and will settle. If this persists or is not mild, it should be reported to the Rhythm and Cardiac Specialists immediately.
The radiofrequency ablation procedure is a very low-risk procedure and should a complication arise, it will be dealt with at once. The worldwide complication rate for electrophysiology studies and radiofrequency ablation procedures is less than 0.5%. Although most people undergoing radiofrequency ablation procedures do not experience any complications, you should be aware of the following risks:
