What are the ACC/AHA/HRS recommendations for rhythm control in acute 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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Hemodynamically unstable patients [14]

For rhythm control, synchronized cardioversion is recommended. (Class I recommendation)

Hemodynamically stable patients [14]

For rhythm control, the following are recommended (all class I recommendations):

  • Synchronized cardioversion, oral dofetilide, IV ibutilide, and/or rapid atrial pacing
  • Rapid atrial pacing in patients who have pacing wires in place as part of a permanent pacemaker or implantable cardioverter-defibrillator or for temporary atrial pacing after cardiac surgery
  • Elective synchronized cardioversion

Note that synchronized cardioversion or rapid atrial pacing is not appropriate for rhythms that break or spontaneously recur.

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