Treatment
Atrial Flutter
Table 15. Acute Treatment of Atrial Flutter
COR
LOE Recommendations
I A Oral dofetilide or IV ibutilide is useful for acute pharmacological
cardioversion in patients with atrial flutter.
I B-R IV or oral beta blockers, diltiazem, or verapamil are useful
for acute rate control in patients with atrial flutter who are
hemodynamically stable.
I B-NR Elective synchronized cardioversion is indicated in stable patients
with well-tolerated atrial flutter when a rhythm control strateg y
is being pursued.
I B-NR Synchronized cardioversion is recommended for acute treatment
of patients with atrial flutter who are hemodynamically unstable
and do not respond to pharmacological therapies.
I C-LD 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 atrial pacing aer cardiac surgery.
I B-NR Acute antithrombotic therapy is recommended in patients with
atrial flutter to align with recommended antithrombotic therapy
for patients with AF.
IIa B-R IV 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.
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