Treatment of Atrial Flutter Without Haemodynamic Instability
This protocol addresses the acute management of atrial flutter in haemodynamically stable patients — those presenting with rapid ventricular rate but without signs of haemodynamic compromise.
Haemodynamically stable patients with atrial flutter. The absence of haemodynamic instability allows for a structured, non-emergent acute approach targeting either ventricular rate or restoration of sinus rhythm.
Conversion to sinus rhythm; control and reduction of the rapid ventricular rate; termination of atrial flutter.
Acute therapy involves two main strategies: rate control using intravenous pharmacological agents, and restoration of sinus rhythm via electrical or pharmacological means. The specific agents, sequencing, and when high-rate atrial pacing applies depend on the full structured regimen.
References
DOI: 10.1093/eurheartj/ehz467
- Haemodynamically stable patients
- i.v. beta-blockers or non-dihydropyridine calcium channel blockers (verapamil or diltiazem) (i.v.), should be considered for control of rapid ventricular rate.
- Low-energy (≤100 J biphasic) electrical cardioversion is recommended for conversion to sinus rhythm.
- i.v. ibutilide or i.v. or oral (in-hospital) dofetilide are recommended for conversion to sinus rhythm.
- High-rate atrial pacing is recommended for termination of atrial flutter in the presence of an implanted pacemaker or defibrillator.