atrial flutter Flashcards
how well does it respond to treatment
responds less well to drug treatment than AF
treatment options
ventricular rate control (this is usually interim measure pending restoration of sinus rhythm)
restoring and maintaining sinus rhythm
discuss the use of rate control
usually an interim measure before restoring sinus rhythm
rate control treatment cascade
- BB or RL CCB
- can add digoxin if above inadequate, may be particularly useful in pt with HF
what to use if rapid rate control needed
IV BB or verapamil
how to achieve rhythm control
electrical cardioversion (cardiac pacing or direct current)
pharmacological cardioversion
catheter ablation
what to do if duration of atrial flutter is unknown or has been >48 hours
do not attempt cardioversion until patient has been fully anticoagulated for at least 3 weeks
if not possible,
1. rule out left atrial thrombus
2. start parenteral AC
3. give oral AC after cardioversion and continue for at least 4 weeks
what is the treatment of choice when rapid conversion to sinus rhythm needed e.g. atrial flutter with haemodyanmic compromise
direct current cardioversion
what is preferred for treatment of recurrent atrial flutter
catheter ablation
discuss use of anti arrhythmic drugs
limited role as use is not always successful
fleicanide and propafenone can slow atrial flutter resulting in 1:1 conduction to ventricles
thus always co prescribe with ventrciular rate controlling drug e..g BB or RLCCB
why do you always need to prescribe flecainide or propafenone in conjunction with a ventriculasr rate controlling drug e.g. BB or RLCCB
Flecainide or propafenone can slow atrial flutter, resulting in 1:1 condution to ventricles. Thus should be prescribed in conjunction with a ventricular rate controlling drug e.g. BB or RL-CCBs
This can lead to dangerously high ventricular rates, potentially reaching up to 300 beats per minute, causing symptoms like palpitations, low blood pressure, or even collapse. Adding a rate-controlling drug (such as a beta-blocker or a non-dihydropyridine calcium channel blocker like diltiazem or verapamil) helps slow down the conduction through the AV node.
when other drug treatments are CI or ineffective, which drug can you use
amiodarone
do you need to assess stroke risk
yes as with AF
