MANAGEMENT OF ATRIAL FLUTTER


Hakan Paydak, M.D., University of Arkansas for Medical Sciences, Little Rock, AR, USA

Atrial flutter affects nearly 1 million people in the United States, particularly the older age group and men. It is frequently seen in patients with heart failure, hypertension, diabetes mellitus, COPD and in postoperative states.

Atrial flutter entails an annual stroke rate of approximately 3 %. Like, atrial fibrillation, atrial flutter can be managed by rate control versus rhythm control along with anticoagulation depending on the risk profile.

Acute management of atrial flutter consists of:
1. Direct current cardioversion
2. Chemical cardioversion with Ibutilide
3. Radiofrequency catheter ablation
4. Antitachycardia pacing

Unlike atrial fibrillation, catheter ablation of typical atrial flutter is a technically simpler procedure with efficacy close to 95 % and complication rates less than 1%. Termination of atrial flutter along with bidirectional block in the tricuspid valve annulus- inferior vena cava isthmus has emerged as a standard endpoint for the ablation procedure.

Atypical incisional atrial flutter after congenital heart surgery is a challenging problem. Recently, atypical left atrial flutter after atrial fibrillation ablation has emerged as another important subset.

According to the ACC/AHA and HRS guidelines, even though DC cardioversion is a Class I indication for acute management of atrial flutter; due to high recurrence rates, catheter ablation is the most effective treatment for long term management.