What is the role of ventricular rate control 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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Ventricular rate control is a priority in atrial flutter because it may alleviate symptoms. Rate control is typically more difficult for atrial flutter than for atrial fibrillation.

Ventricular rate control can be achieved with drugs that block the atrioventricular (AV) node. Intravenous calcium channel blockers (eg, verapamil, diltiazem) or beta blockers can be used, followed by the initiation of oral agents.

Hypotension and negative inotropic effects are concerns with the use of these medications. A history of Wolff-Parkinson-White syndrome or evidence of ventricular preexcitation should be determined, because agents that act exclusively at the level of the AV node may enhance accessory pathway conduction.

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