What is the initial emergency department (ED) treatment for atrial flutter?

Updated: Nov 09, 2018
  • Author: Jesse Borke, MD, FACEP, FAAEM; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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At the time of this update, there is no consensus on the optimal management of atrial flutter in the emergency department, due to a lack of robust evidence, as well as a wide variation in typical management. Hemodynamic concerns should always dictate initial treatment: This begins with an adequate and immediate assessment of the patient’s airway, breathing, and circulation ("ABCs").

Treatment goals include the following:

  • Conversion to normal sinus rhythm

  • Keeping the patient in normal sinus rhythm

  • Control of the ventricular rate

  • Preventing thromboembolic disease

Treatment options for atrial flutter include the following [1] :

  • Direct-current (DC) cardioversion

  • Antiarrhythmic drugs/nodal rate control agents

  • Rapid atrial pacing to terminate atrial flutter

Blood pressure can be supported and rate controlled with medication.

Look for underlying causes for atrial flutter. At times, treatment of the underlying disorder (eg, thyroid disease, valvular heart disease) is necessary to effect conversion to sinus rhythm.

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