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:❑ Chronic heart failure  
:❑ Chronic heart failure  
:❑ Hypotension
:❑ Hypotension
:❑ Acute myocardial infarction <br>
:❑ Acute myocardial infarction <br> ❑ If present, treat as shown in the table below:


<table class="wikitable">
<table class="wikitable">
<tr class="v-firstrow"><th>Proposed therapy</th><th>Recommendation</th></tr>
<tr><td>Conversion</td><td> DC cardioversion ([[ACC AHA guidelines classification scheme|class I, level of evidence C]])</td></tr>
<tr><td>Conversion</td><td> DC cardioversion ([[ACC AHA guidelines classification scheme|class I, level of evidence C]])
<tr><td>Rate control</td><td>[[Beta blockers]] ([[ACC AHA guidelines classification scheme|class I, level of evidence C]])<br> or <br> [[Verapamil]] or [[diltiazem]] ([[ACC AHA guidelines classification scheme|class I, level of evidence A]])<br> or <br> [[Digitalis]] ([[ACC AHA guidelines classification scheme|class IIb, level of evidence C]]) <br> or <br> [[Amiodarone]] ([[ACC AHA guidelines classification scheme|class IIb, level of evidence C]])</td></tr>
<tr><td>Rate control</td><td>[[Beta blockers]] ([[ACC AHA guidelines classification scheme|class I, level of evidence C]])<br> or <br> [[Verapamil]] or [[diltiazem]] ([[ACC AHA guidelines classification scheme|class I, level of evidence A]])<br> or <br> [[Digitalis]] ([[ACC AHA guidelines classification scheme|class IIb, level of evidence C]]) <br> or <br> [[Amiodarone]] ([[ACC AHA guidelines classification scheme|class IIb, level of evidence C]])</td></tr>
</table></div>|C02=<div style="float: left; text-align: left; padding:1em;"> ❑ Administer anticoagulation therapy based on the risk of stroke, if total duration of flutter > 48 hours <br>
</table></div>|C02=<div style="float: left; text-align: left; padding:1em;"> ❑ Administer anticoagulation therapy based on the risk of stroke, if total duration of flutter > 48 hours <br> Rate control therapy as shown in table below:
 
<table class="wikitable">
<tr><td>Rate control</td><td>[[Beta blockers]] ([[ACC AHA guidelines classification scheme|class I, level of evidence C]])<br> or <br> [[Verapamil]] or [[diltiazem]] ([[ACC AHA guidelines classification scheme|class I, level of evidence A]])<br> or <br> [[Digitalis]] ([[ACC AHA guidelines classification scheme|class IIb, level of evidence C]]) <br> or <br> [[Amiodarone]] ([[ACC AHA guidelines classification scheme|class IIb, level of evidence C]])</td></tr>
</table> <br><br> ''THEN'' <br><br> ❑ Attempt conversion as shown in table below: <br>


<table class="wikitable">
<table class="wikitable">
<tr class="v-firstrow"><th>Proposed therapy</th><th>Recommendation</th></tr>
<tr><td>Conversion</td><td>Atrial or transesophageal pacing ([[ACC AHA guidelines classification scheme|class I, level of evidence A]])<br> or <br>DC cardioversion ([[ACC AHA guidelines classification scheme|class I, level of evidence C]])<br> or <br> Ibutilide ([[ACC AHA guidelines classification scheme|class IIa, level of evidence A]])<br> Flecainide ([[ACC AHA guidelines classification scheme|class IIb, level of evidence A]])  <br>Propafenone ([[ACC AHA guidelines classification scheme|class IIb, level of evidence A]]) <br> Sotalol ([[ACC AHA guidelines classification scheme|class IIb, level of evidence C]]) <br> Procainamide ([[ACC AHA guidelines classification scheme|class IIb, level of evidence A]]) <br> Amiodarone ([[ACC AHA guidelines classification scheme|class IIb, level of evidence C]]) </td></tr>
<tr><td>Conversion</td><td>Atrial or transesophageal pacing ([[ACC AHA guidelines classification scheme|class I, level of evidence A]])<br> or <br>DC cardioversion ([[ACC AHA guidelines classification scheme|class I, level of evidence C]])<br> or <br> Ibutilide ([[ACC AHA guidelines classification scheme|class IIa, level of evidence A]])<br> Flecainide ([[ACC AHA guidelines classification scheme|class IIb, level of evidence A]])  <br>Propafenone ([[ACC AHA guidelines classification scheme|class IIb, level of evidence A]]) <br> Sotalol ([[ACC AHA guidelines classification scheme|class IIb, level of evidence C]]) <br> Procainamide ([[ACC AHA guidelines classification scheme|class IIb, level of evidence A]]) <br> Amiodarone ([[ACC AHA guidelines classification scheme|class IIb, level of evidence C]]) </td></tr>
<tr><td>Rate control</td><td>[[Beta blockers]] ([[ACC AHA guidelines classification scheme|class I, level of evidence C]])<br> or <br> [[Verapamil]] or [[diltiazem]] ([[ACC AHA guidelines classification scheme|class I, level of evidence A]])<br> or <br> [[Digitalis]] ([[ACC AHA guidelines classification scheme|class IIb, level of evidence C]]) <br> or <br> [[Amiodarone]] ([[ACC AHA guidelines classification scheme|class IIb, level of evidence C]])</td></tr>
</table> </div> }}
</table> </div> }}
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Revision as of 20:25, 11 March 2014

Therapeutic Approach

Shown below is an algorithm summarizing the therapeutic approach to atrial flutter.[1]

 
 
 
 
 
 
Atrial flutter
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Unstable
 
 
 
 
 
Stable
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
❑ Look for the presence of any of these:
❑ Chronic heart failure
❑ Hypotension
❑ Acute myocardial infarction
❑ If present, treat as shown in the table below:
Conversion DC cardioversion (class I, level of evidence C)
Rate controlBeta blockers (class I, level of evidence C)
or
Verapamil or diltiazem (class I, level of evidence A)
or
Digitalis (class IIb, level of evidence C)
or
Amiodarone (class IIb, level of evidence C)
 
 
 
 
 
❑ Administer anticoagulation therapy based on the risk of stroke, if total duration of flutter > 48 hours
Rate control therapy as shown in table below:
Rate controlBeta blockers (class I, level of evidence C)
or
Verapamil or diltiazem (class I, level of evidence A)
or
Digitalis (class IIb, level of evidence C)
or
Amiodarone (class IIb, level of evidence C)


THEN

❑ Attempt conversion as shown in table below:
ConversionAtrial or transesophageal pacing (class I, level of evidence A)
or
DC cardioversion (class I, level of evidence C)
or
Ibutilide (class IIa, level of evidence A)
Flecainide (class IIb, level of evidence A)
Propafenone (class IIb, level of evidence A)
Sotalol (class IIb, level of evidence C)
Procainamide (class IIb, level of evidence A)
Amiodarone (class IIb, level of evidence C)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
❑ Assess need for therapy to prevent recurrence
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
❑ Administer antiarrythmic therapy to prevent recurrences
❑ Consider catheter ablation if antiarrhythmic therapy fails
 
 
 
 
 
 
 
 
 
 
  1. ↑ "ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias—Executive Summary". Retrieved 15 August 2013.
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