Current concepts and management strategies in atrial flutter

After atrial fibrillation, atrial flutter (AFL) is the most important and most common atrial tachyarrhythmia. Atrial flutter describes an electrocardiographic model of atrial tachycardia >or=240/min, with a uniform and regular continuous wave-form. There is classically a 2:1 conduction across the atrioventricular (AV) node; as a result, the ventricular rate is usually one-half the flutter rate in the absence of AV node dysfunction. AFL can be harmful by impairing the cardiac output and by encouraging atrial thrombus formation that can lead to systemic embolization. There are four major concerns that must be addressed in the treatment of AFL: reversion to normal sinus rhythm (NSR); maintenance of NSR; control of the ventricular rate; and prevention of systemic embolization. Our review will highlight strategies for reverting patients back to NSR and then maintaining them in NSR, with emphasis on the recent updates, including the role of ablation in the management of atrial flutter.