Fast Five Quiz: Are You Familiar With Atrial Flutter?

Yasmine S. Ali, MD

Disclosures

February 02, 2017

A main difference between atrial fibrillation and atrial flutter is that more cases of atrial flutter can be cured with RFA. In all available studies, catheter ablation is superior to rate-control and rhythm-control strategies with antiarrhythmic drugs.

Consider catheter-based ablation as first-line therapy in patients with type I typical atrial flutter if they are reasonable candidates. Ablation is usually done as an elective procedure, but it can be done when the patient is in atrial flutter as well. Given the high success rate and low complication rate, RFA is superior to medical therapy. Successful ablation reduces or eliminates the need for long-term anticoagulation and antiarrhythmic medications.

For atrial flutter less than 48 hours in duration, attempt cardioversion as soon as possible. Postconversion anticoagulation is usually unnecessary, although data from TEE studies indicate that postconversion anticoagulation is a reasonable option because appendage blood flow velocity is lowest immediately after conversion.

For episodes of atrial flutter of uncertain duration or greater than 48 hours, begin anticoagulation therapy. If cardioversion is needed sooner, anticoagulate patients with intravenous (IV) heparin and perform TEE as close to the time of cardioversion as possible. Patients continue to require anticoagulation for at least 4 weeks after cardioversion. If thrombus is observed or suspected on the basis of TEE findings, delay cardioversion. Rate control and therapeutic anticoagulation are required for a minimum of 4 weeks.

 

For more on the treatment of atrial flutter, read here.

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