Atrial flutter medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
===Management of Atrial Flutter in Emergency Department=== | ===Management of Atrial Flutter in Emergency Department=== | ||
Management of atrial flutter in emergency room depends on the hemodynamic state of the patient. Airway, breathing and circulation should be assessed first. Hemodynamically unstable patients are treated by electrical cardioversion initially. Ottawa Aggressive Protocol is a unique approach to cardioversion for ED patients with recent-onset episodes of atrial fibrillation and flutter. This approach is effective, safe and rapid and has the potential to reduce hospital admissions and expedite ED care<ref name="pmid20522282">{{cite journal |author=Stiell IG, Clement CM, Perry JJ, ''et al.'' |title=Association of the Ottawa Aggressive Protocol with rapid discharge of emergency department patients with recent-onset atrial fibrillation or flutter |journal=CJEM |volume=12 |issue=3 |pages=181–91 |year=2010 |month=May |pmid=20522282 |doi= |url=}}</ref>. Treatment options in ED include: | Management of atrial flutter in emergency room depends on the hemodynamic state of the patient. Airway, breathing and circulation should be assessed first. Hemodynamically unstable patients are treated by electrical cardioversion initially. Ottawa Aggressive Protocol is a unique approach to cardioversion for ED patients with recent-onset episodes of atrial fibrillation and flutter. This approach is effective, safe and rapid and has the potential to reduce hospital admissions and expedite ED care<ref name="pmid20522282">{{cite journal |author=Stiell IG, Clement CM, Perry JJ, ''et al.'' |title=Association of the Ottawa Aggressive Protocol with rapid discharge of emergency department patients with recent-onset atrial fibrillation or flutter |journal=CJEM |volume=12 |issue=3 |pages=181–91 |year=2010 |month=May |pmid=20522282 |doi= |url=}}</ref>. Treatment options for atrial flutter in ED include: | ||
* Electric cardioversion | * Electric cardioversion | ||
* Chemical cardioversion | * Chemical cardioversion | ||
Revision as of 01:47, 21 January 2013
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]
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Overview
The management of atrial flutter is similar to that of atrial fibrillation with primary goals being control of ventricular rate, restoration of sinus rhythm, prevention of recurrent episodes and thromboembolic episodes. In the setting of unstable hemodynamics immediate electrical cardioversion is recommended. because of the high success rate and low complication rate radiofrequency ablation is considered superior to medical therapy in atrial flutter.
Medical Therapy
Management of Atrial Flutter in Emergency Department
Management of atrial flutter in emergency room depends on the hemodynamic state of the patient. Airway, breathing and circulation should be assessed first. Hemodynamically unstable patients are treated by electrical cardioversion initially. Ottawa Aggressive Protocol is a unique approach to cardioversion for ED patients with recent-onset episodes of atrial fibrillation and flutter. This approach is effective, safe and rapid and has the potential to reduce hospital admissions and expedite ED care[1]. Treatment options for atrial flutter in ED include:
- Electric cardioversion
- Chemical cardioversion
- Rapid atrial pacing
Electric Cardioversion
Synchronous direct current (DC) cardioversion is used as the initial treatment in the management of atrial flutter in ED. External electric cardioversion is effective in more than 90% of the cases and the initial shock strength used is 50 joules biphasic direct current. This is the initial treatment of choice in hemodynamically unstable patients. Sometimes the first shock may convert an atrial flutter to atrial fibrillation, in such cases a second shock preferable of a higher strength is usually given to restore sinus rhythm.
References