Sandbox vidit: Difference between revisions
Jump to navigation
Jump to search
| Line 2: | Line 2: | ||
Shown below is an algorithm summarizing the therapeutic approach to [[atrial flutter]].<ref name="circ.ahajournals.org">{{Cite web | last = | first = | title = ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias—Executive Summary | url = http://circ.ahajournals.org/content/108/15/1871 | publisher = | date = | accessdate = 15 August 2013 }}</ref> | Shown below is an algorithm summarizing the therapeutic approach to [[atrial flutter]].<ref name="circ.ahajournals.org">{{Cite web | last = | first = | title = ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias—Executive Summary | url = http://circ.ahajournals.org/content/108/15/1871 | publisher = | date = | accessdate = 15 August 2013 }}</ref> | ||
{{familytree/start}} | {{familytree/start}} | ||
{{familytree | | | | | | | A01 | | | | | | | | | | |A01=[[Atrial flutter]] }} | {{familytree | | | | | | | A01 | | | | | | | | | | |A01=[[Atrial flutter]]</div> }} | ||
{{familytree | | | |,|-|-|-|^|-|-|-|.| | | | | | | | }} | {{familytree | | | |,|-|-|-|^|-|-|-|.| | | | | | | | }} | ||
{{familytree | | | B01 | | | | | | B02 | | | | | | |B01=Unstable |B02=Stable }} | {{familytree | | | B01 | | | | | | B02 | | | | | | |B01=Unstable |B02=Stable }} | ||
| Line 14: | Line 14: | ||
<tr><td>▸ '''''Conversion'''''</td><td> ▸ '''''DC cardioversion ([[ACC AHA guidelines classification scheme|class I, level of evidence C]])'''''</td></tr> | <tr><td>▸ '''''Conversion'''''</td><td> ▸ '''''DC cardioversion ([[ACC AHA guidelines classification scheme|class I, level of evidence C]])'''''</td></tr> | ||
<tr><td>▸ '''''Rate control'''''</td><td>▸ '''''[[Beta blockers]] ([[ACC AHA guidelines classification scheme|class IIa, level of evidence C]])'''''<br> or <br>▸ '''''[[Verapamil]] or [[diltiazem]] ([[ACC AHA guidelines classification scheme|class IIa, level of evidence C]])'''''<br> or <br>▸ '''''[[Digitalis]] ([[ACC AHA guidelines classification scheme|class IIb, level of evidence C]])'''''<br> or <br>▸ '''''[[Amiodarone]] ([[ACC AHA guidelines classification scheme|class IIb, level of evidence C]])'''''</td></tr> | <tr><td>▸ '''''Rate control'''''</td><td>▸ '''''[[Beta blockers]] ([[ACC AHA guidelines classification scheme|class IIa, level of evidence C]])'''''<br> or <br>▸ '''''[[Verapamil]] or [[diltiazem]] ([[ACC AHA guidelines classification scheme|class IIa, level of evidence C]])'''''<br> or <br>▸ '''''[[Digitalis]] ([[ACC AHA guidelines classification scheme|class IIb, level of evidence C]])'''''<br> or <br>▸ '''''[[Amiodarone]] ([[ACC AHA guidelines classification scheme|class IIb, level of evidence C]])'''''</td></tr> | ||
</table></div>|C02=<div style="float: left; text-align: left; padding:1em;"> ❑ Administer anticoagulation therapy based on the risk of stroke, if total duration of flutter > 48 hours <br> Rate control therapy as shown in table below: | </table></div>|C02=<div style="float: left; text-align: left; width:30em; padding:1em;"> ❑ Administer anticoagulation therapy based on the risk of stroke, if total duration of flutter > 48 hours <br> Rate control therapy as shown in table below: | ||
<table class="wikitable"> | <table class="wikitable"> | ||
<tr><td>▸ '''''Rate control'''''</td><td>▸ '''''[[Beta blockers]] ([[ACC AHA guidelines classification scheme|class IIa, level of evidence C]])'''''<br> or <br>▸ '''''[[Verapamil]] or [[diltiazem]] ([[ACC AHA guidelines classification scheme|class IIa, level of evidence C]])'''''<br> or <br>▸ '''''[[Digitalis]] ([[ACC AHA guidelines classification scheme|class IIb, level of evidence C]])'''''<br> or <br>▸ '''''[[Amiodarone]] ([[ACC AHA guidelines classification scheme|class IIb, level of evidence C]])'''''</td></tr> | <tr><td>▸ '''''Rate control'''''</td><td>▸ '''''[[Beta blockers]] ([[ACC AHA guidelines classification scheme|class IIa, level of evidence C]])'''''<br> or <br>▸ '''''[[Verapamil]] or [[diltiazem]] ([[ACC AHA guidelines classification scheme|class IIa, level of evidence C]])'''''<br> or <br>▸ '''''[[Digitalis]] ([[ACC AHA guidelines classification scheme|class IIb, level of evidence C]])'''''<br> or <br>▸ '''''[[Amiodarone]] ([[ACC AHA guidelines classification scheme|class IIb, level of evidence C]])'''''</td></tr> | ||
</table> < | </table> </div> }} | ||
{{familytree | | | |!| | | | | | | |!| | | | | | | | | }} | |||
{{familytree | | | |!| | | | | | | G01 | | | | | | | |G01=<div style="float: left; text-align: left; padding:1em;"> ❑ Attempt conversion as shown in table below: <br> | |||
<table class="wikitable"> | <table class="wikitable"> | ||
<tr><td>▸ '''''Conversion'''''</td><td>▸ '''''Atrial or transesophageal pacing ([[ACC AHA guidelines classification scheme|class I, level of evidence A]])'''''<br> or <br>▸ '''''DC cardioversion ([[ACC AHA guidelines classification scheme|class I, level of evidence C]])'''''<br> or <br>▸ '''''Ibutilide ([[ACC AHA guidelines classification scheme|class IIa, level of evidence A]])'''''<br> or <br>▸ '''''Flecainide ([[ACC AHA guidelines classification scheme|class IIb, level of evidence A]])'''''<br> or <br>▸ '''''Propafenone ([[ACC AHA guidelines classification scheme|class IIb, level of evidence A]])'''''<br> or <br>▸ '''''Sotalol ([[ACC AHA guidelines classification scheme|class IIb, level of evidence C]])'''''<br> or <br>▸ '''''Procainamide ([[ACC AHA guidelines classification scheme|class IIb, level of evidence A]])'''''<br> or <br>▸ '''''Amiodarone ([[ACC AHA guidelines classification scheme|class IIb, level of evidence C]])''''' </td></tr> | <tr><td>▸ '''''Conversion'''''</td><td>▸ '''''Atrial or transesophageal pacing ([[ACC AHA guidelines classification scheme|class I, level of evidence A]])'''''<br> or <br>▸ '''''DC cardioversion ([[ACC AHA guidelines classification scheme|class I, level of evidence C]])'''''<br> or <br>▸ '''''Ibutilide ([[ACC AHA guidelines classification scheme|class IIa, level of evidence A]])'''''<br> or <br>▸ '''''Flecainide ([[ACC AHA guidelines classification scheme|class IIb, level of evidence A]])'''''<br> or <br>▸ '''''Propafenone ([[ACC AHA guidelines classification scheme|class IIb, level of evidence A]])'''''<br> or <br>▸ '''''Sotalol ([[ACC AHA guidelines classification scheme|class IIb, level of evidence C]])'''''<br> or <br>▸ '''''Procainamide ([[ACC AHA guidelines classification scheme|class IIb, level of evidence A]])'''''<br> or <br>▸ '''''Amiodarone ([[ACC AHA guidelines classification scheme|class IIb, level of evidence C]])''''' </td></tr> | ||
| Line 29: | Line 30: | ||
<table class="wikitable"> | <table class="wikitable"> | ||
<tr><td>▸ '''''First episode and well-tolerated atrial flutter'''''</td><td>▸ '''''Cardioversion alone ([[ACC AHA guidelines classification scheme|class I, level of evidence B]])''''' <br> or <br> ▸ '''''Catheter ablation ([[ACC AHA guidelines classification scheme|class IIa, level of evidence B]])'''''</td></tr> | <tr><td>▸ '''''First episode and well-tolerated atrial flutter'''''</td><td>▸ '''''Cardioversion alone ([[ACC AHA guidelines classification scheme|class I, level of evidence B]])''''' <br> or <br> ▸ '''''Catheter ablation ([[ACC AHA guidelines classification scheme|class IIa, level of evidence B]])'''''</td></tr> | ||
<tr><td>▸ '''''Recurrent and well-tolerated atrial flutter'''''</td><td>▸ '''''Catheter ablation([[ACC AHA guidelines classification scheme|class I, level of evidence B]])'''''<br> or <br>▸ '''''Dofetilide ([[ACC AHA guidelines classification scheme|class IIa, level of evidence C]])'''''<br> or <br>▸ '''''Amiodarone ([[ACC AHA guidelines classification scheme|class IIb, level of evidence C]]) <br>or<br> Sotalol <br>or<br> Flecainide <br>or<br> Quinidine <br>or<br> Propafenone <br>or<br> Procainamide <br>or<br> Disopyramide''''' </td></tr> | <tr><td>▸ '''''Recurrent and well-tolerated atrial flutter'''''</td><td>▸ '''''Catheter ablation([[ACC AHA guidelines classification scheme|class I, level of evidence B]])'''''<br> or <br>▸ '''''Dofetilide ([[ACC AHA guidelines classification scheme|class IIa, level of evidence C]])'''''<br> or <br>▸ '''''Amiodarone ([[ACC AHA guidelines classification scheme|class IIb, level of evidence C]]) <br>or<br> Sotalol <br>or<br> Flecainide <br>or<br> Quinidine <br>or<br> Propafenone <br>or<br> Procainamide <br>or<br> Disopyramide''''' </td></tr> | ||
| Line 35: | Line 35: | ||
<tr><td>▸ '''''Atrial flutter appearing after use of class Ic agents or amiodarone for treatment of AF'''''</td><td>▸ '''''Catheter ablation ([[ACC AHA guidelines classification scheme|class I, level of evidence B]])''''' <br> or <br>▸ '''''Stop current drug and use another ([[ACC AHA guidelines classification scheme|class IIa, level of evidence C]])'''''</td></tr> | <tr><td>▸ '''''Atrial flutter appearing after use of class Ic agents or amiodarone for treatment of AF'''''</td><td>▸ '''''Catheter ablation ([[ACC AHA guidelines classification scheme|class I, level of evidence B]])''''' <br> or <br>▸ '''''Stop current drug and use another ([[ACC AHA guidelines classification scheme|class IIa, level of evidence C]])'''''</td></tr> | ||
<tr><td>▸ '''''Symptomatic non–CTI-dependent flutter after failed antiarrhythmic drug therapy'''''</td><td>'''''Catheter ablation ([[ACC AHA guidelines classification scheme|class IIa, level of evidence B]])'''''</td></tr> | <tr><td>▸ '''''Symptomatic non–CTI-dependent flutter after failed antiarrhythmic drug therapy'''''</td><td>'''''Catheter ablation ([[ACC AHA guidelines classification scheme|class IIa, level of evidence B]])'''''</td></tr> | ||
</table>---- | </table> | ||
---- | |||
❑ Consider catheter ablation if antiarrhythmic therapy fails </div>}} | ❑ Consider catheter ablation if antiarrhythmic therapy fails </div>}} | ||
{{familytree/end}} | {{familytree/end}} | ||
Revision as of 20:56, 11 March 2014
Therapeutic Approach
Shown below is an algorithm summarizing the therapeutic approach to atrial flutter.[1]
| Atrial flutter | |||||||||||||||||||||||||||||||||||||||||||||||
| Unstable | Stable | ||||||||||||||||||||||||||||||||||||||||||||||
❑ Look for the presence of any of these:
| ❑ Administer anticoagulation therapy based on the risk of stroke, if total duration of flutter > 48 hours Rate control therapy as shown in table below:
| ||||||||||||||||||||||||||||||||||||||||||||||
❑ Attempt conversion as shown in table below:
| |||||||||||||||||||||||||||||||||||||||||||||||
❑ Assess need for therapy to prevent recurrence | |||||||||||||||||||||||||||||||||||||||||||||||
❑ Administer antiarrythmic therapy to prevent recurrences as shown below:
❑ Consider catheter ablation if antiarrhythmic therapy fails | |||||||||||||||||||||||||||||||||||||||||||||||
- ↑ "ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias—Executive Summary". Retrieved 15 August 2013.