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245: Common Atrial Flutter (Tx (If recurrent after rate control (If…
245: Common Atrial Flutter
Dx
AV nodal blockage to expose flutter waves
Vagal
Beta Blockers
CCBs
History
Old age leading to scar
Prior cardiac surgery leading to scar
Atrial fibrillation with antiarrhythmic drug: flecainide, propafenone, amiodarone
Tx
If hemodynamic instability: Cardioversion
Rate Control: beta blocker, CCB
Anticoagulation based on CHADS2VaSc
Warfarin
Adjust to INR 2-3
NOACs
Apixaban
(reversal agent: andexanet)
Rivaroxaban
(reversal agent: andexanet)
Dabigatran
(reversal agent: Idarucizumab)
If recurrent after rate control
Sotalol
Dofetilide
Disopyramide
Amiodarone
If refractory to antiarrhythmics
Catheter Ablation
Complications
Heart block (rare)