When are rate- and rhythm-control strategies indicated in the treatment of 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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Answer

In patients who are not candidates for catheter-based ablation, rate- and rhythm-control strategies should be considered. Because of the arrhythmia risk, drugs such as ibutilide, sotalol, and dofetilide should be initiated in an inpatient setting. Pause-dependent torsade de pointes can occur after conversion to sinus rhythm. The risk of proarrhythmia is probably greatest during the first 24-48 hours after the initiation of antiarrhythmics.


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