AHA GUIDELINES Bundle (free trial)

Supraventricular Tachycardia

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Treatment Table 16. Ongoing Management of Atrial Flutter COR LOE Recommendations I B-R Catheter ablation of the CTI is useful in patients with atrial flutter that is either symptomatic or refractory to pharmacological rate control. I C-LD Beta blockers, diltiazem, or verapamil are useful to control the ventricular rate in patients with hemodynamically tolerated atrial flutter. I C-LD Catheter ablation is useful in patients with recurrent symptomatic non–CTI-dependent flutter aer failure of at least 1 antiarrhythmic agent. I B-NR Ongoing management with antithrombotic therapy is recommended in patients with atrial flutter to align with recommended antithrombotic therapy for patients with AF. IIa B-R e following drugs can be useful to maintain sinus rhythm in patients with symptomatic, recurrent atrial flutter, with the drug choice depending on underlying heart disease and comorbidities: a. Amiodarone b. Dofetilide c. Sotalol IIa B-NR Catheter ablation is reasonable in patients with CTI-dependent atrial flutter that occurs as the result of flecainide, propafenone, or amiodarone used for treatment of AF. IIa C-LD Catheter ablation of the CTI is reasonable in patients undergoing catheter ablation of AF who also have a history of documented clinical or induced CTI-dependent atrial flutter. IIa C-LD Catheter ablation is reasonable in patients with recurrent symptomatic non–CTI-dependent flutter as primary therapy, before therapeutic trials of antiarrhythmic drugs, aer carefully weighing potential risks and benefits of treatment options. IIb B-R Flecainide or propafenone may be considered to maintain sinus rhythm in patients without SHD or ischemic heart disease who have symptomatic recurrent atrial flutter. IIb C-LD Catheter ablation may be reasonable for asymptomatic patients with recurrent atrial flutter. 22

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