Atrial fibrillation: diagnosis and management.

National Institute for Health and Care Excellence. Ĭonsider a longer-term rhythm control strategy for these patients using transoesophageal-guided or conventional cardioversion. In the absence of evidence for choice of initial management strategy in patients with atrial flutter, use a similar approach to atrial fibrillation:Įither a rate control or rhythm control strategy if the onset of atrial flutter is definitely 48 hours, or uncertain National Institute for Health and Care Excellence. 2019 ESC guidelines for the management of patients with supraventricular tachycardia - the Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC). Brugada J, Katritsis DG, Arbelo E, et al ESC Scientific Document Group. In practice, start a rate control drug if the patient is tachycardic while you are initially assessing them, before deciding whether to use a rate control or rhythm control strategy.Įlectrical cardioversion is generally preferred over pharmacological cardioversion, because anti-arrhythmic drugs are usually not effective in patients with atrial flutter. For most patients, therefore, the aim of treatment is to restore sinus rhythm. ĭrug treatment is often ineffective in controlling the rate in patients with atrial flutter. If the patient is haemodynamically stable and presents acutely, use a rate control strategy or a rhythm control strategy (using cardioversion, either electrical or pharmacological). Myocardial ischaemia – see our topics ST-elevation myocardial infarction and Non ST-elevation myocardial infarctionĪcute, severe heart failure (characterised by acute pulmonary oedema or raised jugular venous pressure) – see our topic Acute heart failure. Organise emergency electrical cardioversion for any patient with features of haemodynamic instability, which include: Brugada J, Katritsis DG, Arbelo E, et al ESC Scientific Document Group.

Typical atrial flutter