What are the ACC/AHA/HRS emergent treatment guideline for hemodynamically stable patients with 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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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.

For rate control, beta blockers, diltiazem, or verapamil is recommended. (Class I recommendation) [5]  IV amiodarone is recommended when beta blockers are contraindicated. (Class IIa recommendation)

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