How should antiarrhythmic agents be selected for 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

Besides considering the characteristic adverse effects of each antiarrhythmic agent, the choice of medication should take into account the underlying cardiac pathology, as follows:

  • No structural heart disease: Class IC agents can be used safely, but in general, class III agents are more effective for patients with flutter
  • Left ventricular hypertrophy without ischemia or conduction delay: Class III agents, specifically amiodarone, can be used
  • Ischemic heart disease: Sotalol or amiodarone can be used; class IC agents should be avoided
  • Significant systolic dysfunction: Amiodarone or dofetilide may be used; class IC agents should be avoided

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