From the Guidelines
Atrial flutter treatment options include catheter ablation, antiarrhythmic medications, and rate control medications.
Treatment Options
- Catheter ablation is a recommended treatment option for patients with symptomatic atrial flutter, particularly those with CTI-dependent atrial flutter 1.
- Antiarrhythmic medications such as amiodarone, dofetilide, and sotalol can be used to maintain sinus rhythm in patients with symptomatic, recurrent atrial flutter 1.
- Rate control medications including beta blockers, diltiazem, and verapamil are useful for controlling the ventricular rate in patients with hemodynamically tolerated atrial flutter 1.
Specific Treatment Recommendations
- Catheter ablation of the CTI is recommended for patients with CTI-dependent atrial flutter that is symptomatic or refractory to pharmacological rate control 1.
- Antiarrhythmic therapy with medications such as flecainide or propafenone may be considered for patients without structural heart disease or ischemic heart disease who have symptomatic recurrent atrial flutter 1.
- Antithrombotic therapy is recommended for patients with atrial flutter to align with recommended antithrombotic therapy for patients with AF 1.
Additional Considerations
- Elective synchronized cardioversion is indicated in stable patients with well-tolerated atrial flutter when a rhythm-control strategy is being pursued 1.
- Rapid atrial pacing can be 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 1.
- Catheter ablation may be reasonable for asymptomatic patients with recurrent atrial flutter, particularly those with a high burden of atrial flutter 1.
From the Research
Treatment Options for Atrial Flutter
The treatment options for atrial flutter include:
- Electrical cardioversion and/or antiarrhythmic medications 2, 3
- Type I and Type III antiarrhythmic drugs to terminate or prevent recurrent episodes 3
- Type II (beta-blockers) and Type IV (calcium channel blockers) to control the ventricular rate during atrial flutter 3
- Radiofrequency catheter ablation to interrupt the reentrant circuit and prevent recurrences of atrial flutter 3
- Rate and rhythm control treatment, with the choice of treatment depending on the specific patient population and underlying substrate 4, 5
Nonpharmacological Methods
Nonpharmacological methods, such as radiofrequency catheter ablation, provide new treatment options in the management of patients with drug-resistant or hemodynamically unstable atrial flutter 6, 3
Anticoagulation Therapy
Anticoagulation therapy may be necessary to prevent thromboembolic complications, although the risk is less than that for atrial fibrillation 2, 6, 3
Patient-Specific Treatment
The optimal treatment for atrial flutter may vary depending on the specific patient population, such as those with heart failure, cardiomyopathies, or respiratory disorders 5