Supraventricular tachycardia AHA recommendations for Management of Atrial Flutter
Supraventricular tachycardia Microchapters |
Differentiating Among the Different Types of Supraventricular Tachycardia |
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Differentiating Supraventricular Tachycardia from Ventricular Tachycardia |
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Treatment |
2015 ACC/AHA Guideline Recommendations |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]
Overview
Management of Atrial Flutter
Acute treatment of Atrial Flutter
Class I |
"1.Oral dofetilide or intravenous ibutilide is useful for acute pharmacological cardioversion in patients with atrial flutter "(Level of Evidence: A ) " |
"2.Intravenous or oral beta blockers, diltiazem, or verapamil are useful for acute rate control in patients with atrial flutter who are hemodynamically stable"(Level of Evidence: B-R) " |
"3.Elective synchronized cardioversion is indicated in stable patients with well-tolerated atrial flutter when a rhythm-control strategy is pursued "(Level of Evidence:B-NR ) " |
"4.Synchronized cardioversion is recommended for acute treatment of patients with atrial flutter who are hemodynamically unstable and do not respond to pharmacological therapies "(Level of Evidence: B-NR ) " |
"5.Rapid atrial pacing is useful for acute conversion of atrial flutter in patients who have pacing wires in place as part of a permanent pacemaker or implantable cardioverter-defibrillator or for temporary atrialpacing after cardiac surgery"(Level of Evidence: C-LD ) " |
"6.Acute antithrombotic therapy is recommended in patients with atrial flutter to align with recommended antithrombotic therapy for patients with AF "(Level of Evidence:B-NR ) " |
Class IIa |
"1.Intravenous amiodarone can be useful for acute control of the ventricular rate (in the absence of pre-excitation in patients with atrial flutter and systolic heart failure, when beta blockers are contraindicated or ineffective"(Level of Evidence:B-R ) " |
Management of ongoing Atrial Flutter
Class I |
"1.Catheter ablation of the CTI is useful in patients with atrial flutter that is either symptomatic or refractory to pharmacological rate control"(Level of Evidence:B-R ) " |
"2.Beta blockers, diltiazem, or verapamil are useful to control the ventricular rate in patients with hemodynamically tolerated atrial flutter"(Level of Evidence:C-LD ) " |
"3.Catheter ablation is useful in patients with recurrent symptomatic non–CTI-dependent flutter after failure of at least 1 antiarrhythmic agent"(Level of Evidence:C-LD ) " |
"4.Ongoing management with antithrombotic therapy is recommended in patients with atrial flutter to align with recommended antithrombotic therapy for patients with AF"(Level of Evidence:B-NR ) " |
Class IIa |
"1.The following drugs can be useful to maintain sinus rhythm in patients with symptomatic, recurrent atrial flutter, with the drug choice depending on underlying heart disease and comorbidities:
a. Amiodarone b. Dofetilide c. Sotalol"(Level of Evidence:B-R ) " |
"2.Catheter ablation is reasonable in patients with CTI-dependent atrial flutter that occurs as the result of flecainide, propafenone, or amiodarone used for treatment of AF"(Level of Evidence:B-NR ) " |
"3.Catheter ablation of the CTI is reasonable in patients undergoing catheter ablation of AF who also have a history of documented clinical or induced CTI-dependent atrial flutter "(Level of Evidence:C-LD ) " |
"4.Catheter ablation is reasonable in patients with recurrent symptomatic non–CTI-dependent flutter as primary therapy, before therapeutic trials of antiarrhythmic drugs, after carefully weighing potential risks and benefits of treatment options"(Level of Evidence:C-LD ) " |