Sustained atrial flutter after cardiac surgery: successful termination by rapid atrial pacing

For termination of sustained atrial flutter, 28 rapid atrial stimulations were performed in 26 patients undergoing cardiac surgery, including coronary bypass surgery, and valvular heart surgery as well as surgery for primum and secundum atrial septal defect and anomalous connection of the pulmonary veins. In 18 patients rapid atrial pacing was successful in directly converting a flutter to a sinus rhythm, in 5 patients after a short period of transient atrial fibrillation. Atrial flutter could be changed to atrial fibrillation in a further 3 patients who remained in permanent atrial fibrillation and subsequently underwent DC cardioversion. Our results demonstrate that rapid atrial pacing is very effective in the treatment of sustained atrial flutter in patients following cardiac surgery and may be used alternatively to DC countershock.