Atrial Flutter or Macro-Re-entrant Atrial Tachycardia Without Haemodynamic Instability: When Prior Sinus Rhythm Conversion Has Not Succeeded
This protocol addresses patients with atrial flutter or macro-re-entrant atrial tachycardia who remain haemodynamically stable, and in whom a previous attempt at restoring sinus rhythm did not achieve that goal. In this setting, the clinical objective shifts accordingly.
Clinical Situation
Atrial flutter or macro-re-entrant atrial tachycardia, without haemodynamic instability. The patient remains in the arrhythmia following an unsuccessful rhythm conversion attempt.
Previous Line — Goal Not Achieved
Prior therapy — which may have included low-energy synchronized electrical cardioversion, intravenous or oral antiarrhythmic agents, or high-rate atrial pacing in patients with an implanted pacemaker or defibrillator — targeted conversion to sinus rhythm. This protocol is applied when that goal was not reached.
Next Step (Partial Overview)
An intravenous antiarrhythmic approach is involved, with the aim of achieving control of the ventricular rate. The complete protocol — including specific agent, selection criteria, and clinical sequencing — is available via the link below.
References
DOI: 10.1093/eurheartj/ehz827
i.v. beta-blockers or non-dihydropyridine calcium channel blockers (verapamil or diltiazem) (i.v.), should be considered for control of rapid ventricular rate.
i.v. amiodarone may be tried if the above are not available or desirable.
Amiodarone may not be very effective acutely to re-establish sinus rhythm, but it does help to control the ventricular rate if it is too fast.
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