Diagnosis and Treatment of Atrial Flutter

In this article, we will discuss the Diagnosis and Treatment of Atrial Flutter. So, let’s get started.


It is diagnosed on ECG which shows narrow QRS complex tachycardia (atrial rate of >300 bpm) with ventricular rate either half or one-third (2:1, 3:1 block) which is regular. The P-waves produce saw-tooth appearance of the baseline between R-R intervals.


When the diagnosis of atrial flutter is made, then there are three therapeutic modalities to treat it:

  • Drug therapy for ventricular rate control
  • DC cardioversion
  • Catheter ablative therapy

Conversion of atrial flutter to sinus rhythm: First of all ventricular rate is controlled with those drugs which are used in atrial fibrillation. Conversion of atrial flutter to sinus rhythm with class 1A (quinidine, disopyramide, procainamide) or 1C flecainide is difficult to achieve. The class III agent ibutilide has been more successful in converting atrial flutter. About 50-70% revert back within 1 year of treatment. Out of other options, DC cardioversion or pacing is the preferred treatment because class I and III drugs are less effective than these techniques. The initial effective treatment in acute setting is low-energy DC shock (25-50 J) under mild sedation. Higher energy 100J shock is virtually always successful and never harmful, hence, may be considered as initial shock. Precardioversion anticoagulation is not necessary in atrial flutter.

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