What are the ACC/AHA/HRS recommendations for rhythm control in ongoing 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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After assuring adequate anticoagulation or excluding left atrial thrombus by transesophageal echocardiography (TEE) before conversion, catheter ablation is preferred to long-term pharmacologic therapy for cavotricuspid isthmus (CTI)-dependent atrial flutter.(Class I recommendation) Other indications for catheter ablation include the following:

  • For non–CTI-dependent flutter after failure of at least one antiarrhythmic agent (class I)
  • For CTI-dependent atrial flutter that occurs as the result of flecainide, propafenone, or amiodarone used to treat atrial fibrillation (AF)  (class IIa) or as primary therapy, before antiarrhythmic drugs, after carefully weighing the potential risks and benefits of treatment options (class IIa)
  • For patients undergoing catheter ablation of AF who also have a history of  CTI-dependent atrial flutter (class IIa)
  • For asymptomatic patients with recurrent atrial flutter (class IIb)

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