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Therapeutic Approach

Shown below is an algorithm summarizing the therapeutic approach to atrial flutter.

Atrial flutter

Unstable

Stable

❑ Look for the presence of any of these: ❑ Chronic heart failure ❑ Hypotension ❑ Acute myocardial infarction

❑ Administer anticoagulation therapy based on the risk of stroke, if total duration of flutter > 48 hours Proposed therapy Recommendation Conversion Atrial or transesophageal pacing (class I, level of evidence A) or DC cardioversion (class I, level of evidence C) or Ibutilide (class IIa, level of evidence A) Flecainide (class IIb, level of evidence A) Propafenone (class IIb, level of evidence A) Sotalol (class IIb, level of evidence C) Procainamide (class IIb, level of evidence A) Amiodarone (class IIb, level of evidence C) Rate control Beta blockers (class I, level of evidence C) or Verapamil or diltiazem (class I, level of evidence A) or Digitalis (class IIb, level of evidence C) or Amiodarone (class IIb, level of evidence C)

❑ Assess need for therapy to prevent recurrence

❑ Administer antiarrythmic therapy to prevent recurrences ❑ Consider catheter ablation if antiarrhythmic therapy fails