Conversion of atrial flutter: rapid atrial pacing as a bedside technique

Eleven patients with atrial flutter underwent intracardiac right atrial pacing at bedside in an attempt to terminate this dysrhythmia. Nine of the eleven patients were converted to sinus rhythm; the remaining two patients were converted to atrial fibrillation with a slower ventricular rate. There were no complications. The potential hazards of direct current cardioversion (anesthesia, fractures, muscle strain, myocardial injury, etc.) were avoided. In contrast to rapid atrial pacing in the electrophysiology laboratory, the bedside technique did not require a special laboratory setting, electronic or x-ray equipment, or technical personnel. Transportation of critically ill patients was obviated. Atrial flutter can be converted at the bedside to a more favorable rhythm; the expediency, safety, and low cost of this bedside cardioversion technique not only makes it feasible, but also it is often the procedure of choice.