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| ===Therapeutic Approach===
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| 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>
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| {{familytree/start}}
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| {{familytree | | | | | | | A01 | | | | | | | | | | |A01=[[Atrial flutter]]}}
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| {{familytree | | | |,|-|-|-|^|-|-|-|.| | | | | | | | }}
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| {{familytree | | | B01 | | | | | | B02 | | | | | | |B01=Unstable |B02=Stable }}
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| {{familytree | | | |!| | | | | | | |!| | | | | | | | }}
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| {{familytree | | | C01 | | | | | | C02 | | | | | | |C01=<div style="float: left; text-align: left; width:28em; padding:1em ">❑ Look for the presence of any of these: <br>
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| :❑ [[Chronic heart failure]]
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| :❑ [[Hypotension]]
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| :❑ [[Acute myocardial infarction]] <br>
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| ❑ If present, attempt direct DC cardioversion and then rate control measures as shown in the table below:
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| <table class="wikitable">
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| <tr><td>▸ '''''Conversion'''''</td><td> ▸ '''''DC cardioversion ([[ACC AHA guidelines classification scheme|class I, level of evidence C]])'''''</td></tr>
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| <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>
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| </table></div>|C02=<div style="float: left; text-align: left; width:28em;padding:1em "> ❑ Administer anticoagulation therapy based on the risk of stroke, if total duration of flutter > 48 hours <br> ❑ Administer rate control therapy as shown in table below:
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| <table class="wikitable">
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| <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>
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| </table> </div> }}
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| {{familytree | | | |!| | | | | | | |!| | | | | | | | | }}
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| {{familytree | | | |!| | | | | | | G01 | | | | | | | |G01=<div style="float: left; text-align: left; width:28em;padding:1em "> ❑ Attempt conversion as shown in table below: <br>
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| <table class="wikitable">
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| <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>
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| </table> </div> }}
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| {{familytree | | | |`|-|-|-|v|-|-|-|'| | | | | | | | }}
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| {{familytree | | | | | | | D01 | | | | | | | | | | |D01=<div style="float: left; text-align: left;padding:1em "> ❑ Assess need for therapy to prevent recurrence </div> |D02=}}
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| {{familytree | | | | | | | |!| | | | | | | | | | | | }}
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| {{familytree | | | | | | | E01 | | | | | | | | | | |E01=<div style="float: left; text-align: left; width:25em; padding:1em "> ❑ Administer antiarrythmic therapy to prevent recurrences as shown below: <br>
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| <table class="wikitable">
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| <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>
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| <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>
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| <tr><td>▸ '''''Poorly tolerated atrial flutter'''''</td><td> ▸ '''''Catheter ablation ([[ACC AHA guidelines classification scheme|class I, level of evidence B]])'''''</td></tr>
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| <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>
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| <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>
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| </table>
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| ----
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| ❑ Consider catheter ablation if antiarrhythmic therapy fails </div>}}
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| {{familytree/end}}
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