What are the treatment options for symptomatic atrial flutter (AFL)?

Updated: Nov 18, 2019
  • Author: Lawrence Rosenthal, MD, PhD, FACC, FHRS; Chief Editor: Jeffrey N Rottman, MD  more...
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General treatment goals for symptomatic atrial flutter are similar to those for atrial fibrillation. They include the following:

  • Control of ventricular rate: This can be achieved with drugs that block the AV node; intravenous (IV) calcium channel blockers (eg, verapamil and diltiazem) or beta blockers can be used, followed by initiation of oral agents. Concurrent control of resting and activity-associated rates is generally required, and may be difficult to achieve.

  • Restoration of sinus rhythm: This can be achieved by means of electrical or pharmacologic cardioversion or radiofrequency ablation (RFA); successful ablation reduces or eliminates the need for long-term anticoagulation and antiarrhythmic medications.

  • Prevention of recurrent episodes or reduction in their frequency or duration: In general, the use of antiarrhythmic drugs in atrial flutter is similar to that in atrial fibrillation.

  • Prevention of thromboembolic complications: Adequate anticoagulation, as recommended by the American College of Chest Physicians, has been shown to decrease thromboembolic complications in patients with chronic atrial flutter and in patients undergoing cardioversion.

  • Minimization of adverse effects from therapy: Because atrial flutter is a nonfatal arrhythmia, carefully assess the risks and benefits of drug therapy, especially with antiarrhythmic agents.

See Treatment and Medication for more detail.

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