Stable atrial flutter (TP) can almost always be stopped by a low-amplitude electrical discharge (50 J). It is generally accepted that, whenever possible, cardioversion should be preceded by anticoagulant therapy, as with AF. The need for anticoagulation is higher in patients with episodes of AF in the past.
In half the cases, sooner or later, atrial flutter (TP) may recur, although, according to the author, recurrences of arrhythmia are less common if it developed in the early postoperative period after cardiac surgery.
Recurrence of atrial flutter (TP) after cardioversion requires consideration of the issue of RFA. If the intervals between the recurrences of the arrhythmia are long enough, then as an alternative, you can choose to repeat cardioversion.
Antiarrhythmic drugs for atrial flutter (TP)
Atrial flutter (TP) can be stopped with sotalol, flecainide and propafenone. However, it should be borne in mind that in case of failure, these drugs can increase the frequency of ventricular contractions by reducing the frequency of atrial contractions, which leads to a decrease in AV-conduction rate and a “paradoxical” increase in the frequency of ventricular contractions.
The use of ibutilide (available only for intravenous administration) and dofetilide can be effectively used to stop recent atrial flutter (TP). Both drugs increase the duration of the QT interval, which may be the cause of tachycardia of the “pirouette” type.
Drugs that can prevent AF can also be effective in preventing recurrence of TA. Amiodarone can successfully maintain sinus rhythm when other drugs have proven ineffective. Even if the TA has a persistent flow, the drug, reducing the frequency of atrial contractions and suppressing AV-conduction, contributes to a significant reduction in the frequency of ventricular contractions.
Controlling the frequency of ventricular contractions Intravenous administration of verapamil or diltiazem will help to quickly reduce the frequency of ventricular contractions in TP. However, it is often not possible to control the frequency of ventricular contractions when taking these drugs orally. Amiodarone is more effective.