Atrial flutter medical therapy

Revision as of 16:16, 16 April 2020 by Roukoz Abou Karam (talk | contribs) (→‎Medical Therapy)
(diff) ← Older revision | Latest revision (diff) | Newer revision → (diff)
Jump to navigation Jump to search

Atrial flutter Microchapters


Patient Information


Historical Perspective




Differentiating Atrial flutter from other Diseases

Epidemiology and Demographics

Risk Factors


Natural History, Complications and Prognosis


Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings


EKG Examples

Chest X Ray


CT scan


Other Imaging Findings

Other Diagnostic Studies


Medical Therapy

2015 ACC/AHA Guideline Recommendations

Acute Treatment of Atrial Flutter
Ongoing Management of Atrial Flutter


Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Atrial flutter medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides


American Roentgen Ray Society Images of Atrial flutter medical therapy

All Images
Echo & Ultrasound
CT Images

Ongoing Trials at Clinical

US National Guidelines Clearinghouse

NICE Guidance

FDA on Atrial flutter medical therapy

CDC on Atrial flutter medical therapy

Atrial flutter medical therapy in the news

Blogs on Atrial flutter medical therapy

Directions to Hospitals Treating Atrial flutter

Risk calculators and risk factors for Atrial flutter medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]


The management of atrial flutter is similar to that of atrial fibrillation with primary goals being control of ventricular rate, restoration of sinus rhythm, and prevention of recurrent episodes and thromboembolic episodes. In the setting of unstable hemodynamics immediate electrical cardioversion is recommended. because of the high success rate and low complication rate radiofrequency ablation is considered superior to medical therapy in atrial flutter.

Medical Therapy

Treatment goals in the management of atrial flutter include:[1][2]

Treatment modalities for atrial flutter include:

Electric Cardioversion

  • Synchronous direct current (DC) cardioversion is used as the initial treatment strategy in the management of hemodynamically unstable atrial flutter patients in the emergency department. External electrical cardioversion is effective in more than 90% of the cases and the initial shock strength used is 50 joules biphasic direct current.[3]
  • Sometimes the first shock may convert an atrial flutter to atrial fibrillation, in such cases a second shock preferable of a higher strength is usually given to restore sinus rhythm.
  • Electric cardioversion increases the risk of stroke and hence pre-treatment with a blood thinner is advised if time permits.

AV Nodal Agents

Antiarrhythmic Agents

Rapid Atrial Pacing

  • As external electrical cardioversion requires anesthesia some doctors prefer atrial overdrive pacing to terminate episodes of atrial flutter.
  • In overdrive pacing the atria are continuously paced at a rate higher than that of the patient's sinus node, which causes an alteration in the atrial rate, propagation and also suppresses the automaticity caused by electrical remodeling in the diseased fibers. Unsuccessful pacing can be due to:[6]

Contraindicated medications

  • Insufficient rate and duration of pacing
  • Bad electrode contact in the atrium
  • Insufficient outlet current


  1. Lanzarotti CJ, Olshansky B (November 1997). "Thromboembolism in chronic atrial flutter: is the risk underestimated?". J. Am. Coll. Cardiol. 30 (6): 1506–11. doi:10.1016/s0735-1097(97)00326-4. PMID 9362409.
  2. January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC; et al. (2014). "2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society". J Am Coll Cardiol. 64 (21): e1–76. doi:10.1016/j.jacc.2014.03.022. PMID 24685669.
  3. Crijns HJ, Van Gelder IC, Tieleman RG, Brügemann J, De Kam PJ, Gosselink AT, Bink-Boelkens MT, Lie KI (January 1997). "Long-term outcome of electrical cardioversion in patients with chronic atrial flutter". Heart. 77 (1): 56–61. doi:10.1136/hrt.77.1.56. PMC 484636. PMID 9038696.
  4. Wellens HJ (2002). "Contemporary management of atrial flutter". Circulation. 106 (6): 649–52. doi:10.1161/01.cir.0000027683.00417.9a. PMID 12163422.
  5. Vos MA, Golitsyn SR, Stangl K, Ruda MY, Van Wijk LV, Harry JD, Perry KT, Touboul P, Steinbeck G, Wellens HJ (June 1998). "Superiority of ibutilide (a new class III agent) over DL-sotalol in converting atrial flutter and atrial fibrillation. The Ibutilide/Sotalol Comparator Study Group". Heart. 79 (6): 568–75. doi:10.1136/hrt.79.6.568. PMC 1728725. PMID 10078083.
  6. Rozsíval V, Kvasnicka J (1984). "Atrial flutter treatment by rapid atrial pacing". Cor Vasa. 26 (3): 167–72. PMID 6478843.

Template:WH Template:WS