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6.8.6. Anticoagulation of Typical Atrial Flutter
COR LOE
Recommendations
1 B-NR 1. For patients with AFL, anticoagulant therapy is recommended
according to the same risk profile used for AF.
1 C-LD 2. In patients with AFL who undergo successful cardioversion
or ablation resulting in restoration of sinus rhythm,
anticoagulation should be continued for at least 4 weeks
postprocedure.
1 A 3. Patients with typical AFL who have undergone successful
cavotricuspid isthmus (CTI) ablation and have had AF
previously detected prior to AFL ablation should receive
ongoing oral anticoagulation postablation as indicated for AF.
1 B-NR 4. Patients with typical AFL who have undergone successful
CTI ablation and are deemed to be at high thromboembolic
risk, without any known prior history of AF, should receive
close follow-up and arrhythmia monitoring to detect silent
AF if they are not receiving ongoing anticoagulation in view
of significant risk of AF.
2b B-NR 5. In patients with typical AFL who have undergone successful
CTI ablation without any known prior history of AF who
are at high risk for development of AF (eg, LA enlargement,
inducible AF, COPD, HF), it may be reasonable to prescribe
long-term anticoagulation if thromboembolic risk assessment
suggests high risk (>2% annual risk) for stroke.
* is section refers to typical right-sided (CTI-dependent) AFL. Le-sided AFLs or ATs that
develop aer ablation of AF should be anticoagulated and managed in a manner similar to AF.
Define typical and atypical AFL elsewhere:
• "Typical" AFL is defined as either typical counterclockwise AFL when the macroreentrant
circuit is dependent on the CTI using the isthmus from the patient's right to le or typical
clockwise AFL when the macroreentrant circuit is dependent on the CTI and uses this
isthmus from the patient's le to right.
• "Atypical" AFL is not dependent on the CTI and may arise from a macroreentrant circuit
in the LA, such as perimitral or LA roof flutter or could be dependent on scar from prior
ablation or surgery.
