Sandbox vidit

Atrial flutter

Unstable

Stable

❑ Look for the presence of any of these: ❑ Chronic heart failure ❑ Hypotension ❑ Acute myocardial infarction

❑ Administer anticoagulation therapy based on the risk of stroke, if total duration of flutter > 48 hours ❑ Administer rate control therapy (AV nodal blockers) THEN ❑ Attempt conversion ❑ DC cardioversion ❑ Atrial pacing ❑ Pharmacological cardioversion

❑ Assess need for therapy to prevent recurrence

❑ Administer antiarrythmic therapy to prevent recurrences ❑ Consider catheter ablation if antiarrhythmic therapy fails

Anticoagulation Therapy

Shown below are tables depicting the assessment of risk of stroke and the appropriate anticoagulation therapy among patients with Atrial flutter.

Anticoagulation Therapy No risk factors ▸ Aspirin 81-325 mg daily 1 Moderate risk factor ▸ Aspirin 81-325 mg daily OR ▸ Warfarin (INR 2.0 to 3.0, target 2.5) Any high risk factor or more than 1 moderate risk factor ▸ Warfarin (INR 2.0 to 3.0, target 2.5)

Low Risk Factors	Moderate Risk Factors	High Risk Factors
▸ Female gender ▸ Age 65-74 years ▸ Coronary artery disease ▸ Thyrotoxicosis	▸ Age ≥ 75 years ▸ Hypertension ▸ Heart failure ▸ LV ejection fraction ≤ 35% ▸ Diabetes mellitus	▸ Previous stroke, TIA or embolism ▸ Mitral stenosis ▸ Prosthetic heart valve

Antiarrhythmic Therapy

Maintenance of Sinus Rhythm ▸ Amiodarone (100 to 400 mg) OR ▸ Disopyramide (400 to 750 mg) OR ▸ Dofetilide (500 to 1000 mcg) OR ▸ Flecainide (200 to 300 mg) OR ▸ Procainamide (1000 to 4000 mcg) OR ▸ Propafenone (450 to 900 mg) OR ▸ Quinidine (600 to 1500 mg) OR ▸ Sotalol (160 to 320 mg)