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  • Q&A with Australian Health Practitioners

    Is it safe to leave A.F. and A. flutter untreated apart from aspirin?

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    Atrial Fibrillation Cardiology & Vascular Health
    I am 50yrs young and have been diagnosed with A.F. and flutter on a stress test where my heart rate went above 300 in the recovery stage. I felt a little light-headed but only momentarily. My heart raced for 10 hours following the study before returning to normal.

    There have been 2 other exercise related similar incidents and 2 occasions at rest. I have been told I need an ablation but that I need to wait till I experience another ‘bad’ episode and get another ECG tracing at the time. I feel that it will take for me to actually pass out before I can be treated.

    I have gone to casualty on one occasion where my heart was racing but it only lasted a few hrs and by the time I could get there my trace was normal. Despite this I had xrays, venous and arterial blood samples all for nothing and so I feel reluctant to do that again. Every day I experience short episodes of fast,irregular or fluttery heart beats which I realise leaves me at risk of a stroke.Is it safe to keep waiting?
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    • Dr Michael Davis
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    Dr Michael Davis

    Cardiologist (Heart Specialist)

    Electrophysiologist and pioneer in catheter ablation and in the management of atrial fibrillation. Expertise in arrhythmia device therapy, coronary care, echocardiography. View Profile

    I would be concerned about your documented 1:1 conduction of flutter and at the very least would want you on a beta blocker or calcium channel blocker to prevent such rapid conduction.  There may be a case for flutter ablation. This is a fairly simple and safe procedure which could eliminate the 300 bpm and may also stop fibrillation in your case. The applicability of this in your case would be easily determined by seeing the ECG documentation of the flutter during the stress test. I presume you've had an echocardiogram. 

    Your risk of stroke is not defined by how much rhythm disturbance you have but rather by your CHA2DS2VASc score. Aspirin has no real role in protecting you. If your CHA2DS2VASc is 2 or more then you should be considered for warfarin or one of the new oral anticoagulants, regardless of how your arrhythmia itself is managed. 

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