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❑ Consider catheter ablation if antiarrhythmic therapy fails </div>}}
❑ Consider catheter ablation if antiarrhythmic therapy fails </div>}}
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==Anticoagulation Therapy==
Shown below are tables depicting the assessment of risk of stroke and the appropriate anticoagulation therapy among patients with Atrial flutter.<ref name="Fuster-2011">{{Cite journal  | last1 = Fuster | first1 = V. | last2 = Rydén | first2 = LE. | last3 = Cannom | first3 = DS. | last4 = Crijns | first4 = HJ. | last5 = Curtis | first5 = AB. | last6 = Ellenbogen | first6 = KA. | last7 = Halperin | first7 = JL. | last8 = Kay | first8 = GN. | last9 = Le Huezey | first9 = JY. | title = 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. | journal = Circulation | volume = 123 | issue = 10 | pages = e269-367 | month = Mar | year = 2011 | doi = 10.1161/CIR.0b013e318214876d | PMID = 21382897 }}</ref>
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{| style="float: left; cellpadding=0; cellspacing= 0; width: 600px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center; colspan="2"| {{fontcolor|#FFF|Anticoagulation Therapy}}
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| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''''No risk factors''''' ||style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Aspirin]] 81-325 mg daily'''''
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| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |'''''1 Moderate risk factor''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |▸ '''''[[Aspirin]] 81-325 mg daily''''' <br> ''OR'' <br> ▸ '''''[[Warfarin]] (INR 2.0 to 3.0, target 2.5)'''''
|-
|style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |'''''Any high risk factor or <br> more than 1 moderate risk factor''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |▸ '''''[[Warfarin]] (INR 2.0 to 3.0, target 2.5)'''''
|-
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<br>
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| style="padding: 0 5px; font-size: 100%; background: #F5F5F5;" align=center | '''Low Risk Factors'''|| style="padding: 0 5px; font-size: 100%; background: #F5F5F5;" align=center | '''Moderate Risk Factors'''|| style="padding: 0 5px; font-size: 100%; background: #F5F5F5;" align=center | '''High Risk Factors'''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''Female gender'''''<BR>▸ '''''Age 65-74 years'''''<BR> ▸ '''''[[Coronary artery disease]]'''''<BR>▸ '''''[[Thyrotoxicosis]]'''''|| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |▸ '''''Age ≥ 75 years'''''<BR>▸ '''''[[Hypertension]]'''''<BR> ▸ '''''[[Heart failure]]'''''<BR>▸ '''''LV [[ejection fraction]] ≤ 35%'''''<BR>▸ '''''[[Diabetes mellitus]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |▸ '''''Previous [[stroke]], [[TIA]] or [[embolism]]'''''<BR>▸ '''''[[Mitral stenosis]]'''''<BR> ▸ '''''[[Prosthetic heart valve]]'''''
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Revision as of 18:10, 10 March 2014

 
 
 
 
 
 
Atrial flutter
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Unstable
 
 
 
 
 
Stable
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
❑ Look for the presence of any of these:
❑ Chronic heart failure
❑ Hypotension
❑ Acute myocardial infarction
❑ Attempt to terminate flutter with DC cardioversion
 
 
 
 
 
❑ Administer anticoagulation therapy based on the risk of stroke, if total duration of flutter > 48 hours
❑ Administer rate control therapy (AV nodal blockers)

THEN

❑ Attempt conversion
❑ DC cardioversion
❑ Atrial pacing
❑ Pharmacological cardioversion
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
❑ Assess need for therapy to prevent recurrence
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
❑ Administer antiarrythmic therapy to prevent recurrences
❑ Consider catheter ablation if antiarrhythmic therapy fails
 
 
 
 
 
 
 
 
 
 

Anticoagulation Therapy

Shown below are tables depicting the assessment of risk of stroke and the appropriate anticoagulation therapy among patients with Atrial flutter.[1]

Anticoagulation Therapy
No risk factors ▸ Aspirin 81-325 mg daily
1 Moderate risk factor ▸ Aspirin 81-325 mg daily
OR
▸ Warfarin (INR 2.0 to 3.0, target 2.5)
Any high risk factor or
more than 1 moderate risk factor		 ▸ Warfarin (INR 2.0 to 3.0, target 2.5)


Low Risk Factors Moderate Risk Factors High Risk Factors
▸ Female gender
▸ Age 65-74 years
▸ Coronary artery disease
▸ Thyrotoxicosis		 ▸ Age ≥ 75 years
▸ Hypertension
▸ Heart failure
▸ LV ejection fraction ≤ 35%
▸ Diabetes mellitus		 ▸ Previous stroke, TIA or embolism
▸ Mitral stenosis
▸ Prosthetic heart valve
  1. ↑ Fuster, V.; Rydén, LE.; Cannom, DS.; Crijns, HJ.; Curtis, AB.; Ellenbogen, KA.; Halperin, JL.; Kay, GN.; Le Huezey, JY. (2011). "2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines". Circulation. 123 (10): e269–367. doi:10.1161/CIR.0b013e318214876d. PMID 21382897. Unknown parameter |month= ignored (help)
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