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.
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