Atrial Flutter

Atrial flutter is a heart condition characterized by abnormal heart rhythm. It can be treated by controlling the ventricular rate or restoring and maintaining sinus rhythm. However, drug treatment for atrial flutter is generally less effective compared to atrial fibrillation. The symptoms of atrial flutter include irregular heartbeats, palpitations, chest discomfort, and shortness of breath.

Treatment

Control of Ventricular Rate:

This is an interim measure to manage symptoms while attempting to restore sinus rhythm. Medications such as beta-blockers, diltiazem hydrochloride (unlicensed indication), or verapamil hydrochloride can be used to control the ventricular rate. In urgent cases, intravenous administration of a beta-blocker or verapamil hydrochloride is preferred. Digoxin can be added if rate control remains inadequate, especially in patients with heart failure.

Conversion to Sinus Rhythm:

This can be achieved through different methods:Electrical cardioversion: Using cardiac pacing or direct current to restore normal heart rhythm.Pharmacological cardioversion: Using medications to convert the heart to sinus rhythm.Catheter ablation: A procedure to eliminate the abnormal electrical pathways causing atrial flutter.

Anti-arrhythmic Drugs:

Their use in atrial flutter is limited, as they are not always successful.

Flecainide acetate or propafenone hydrochloride can be prescribed to slow atrial flutter and achieve 1:1 conduction to the ventricles.

These medications should be used in conjunction with a ventricular rate controlling drug like a beta-blocker, diltiazem hydrochloride (unlicensed indication), or verapamil hydrochloride. Amiodarone hydrochloride may be considered when other drug treatments are contraindicated or ineffective.