Conversion of atrial flutter to sinus rhythm by carotid sinus pressure

Conversion of atrial flutter to normal sinus rhythm via carotid sinus stimulation by manual pressure is not a well-known phenomenon. Two cases of atrial flutter in which carotid sinus pressure restored the sinus rhythm are presented. Since this procedure is usually benign, it is recommended that it be tried on patients having atrial flutter with fast ventricular rate accompanied by hemodynamic decompensation. This may be particularly useful if the patient has been receiving digoxin, that is, when cardioversion may become potentially problematic. Electrophysiological mechanisms of conversion of atrial flutter to sinus rhythm are discussed.