ICD 10 Code = I48.0-4/I48.9
Definition
Atrial rate >250 bpm with no flat baseline.
Can be difficult to recognise if 2:1 atrioventricular (AV) block, as the first of the two p waves preceding each QRS complex might be confused with the T-wave of the preceding beat.
Vagal stimulation might slow the ventricular rate (usually approximately 150 bpm) and make the dysrhythmia more obvious.
Synchronised direct current (DC) cardioversion is occasionally necessary in haemodynamic instability.
Medicine Treatment
Midazolam IV, 1–2.5 mg, administered over 2-3 minutes.
- Monitor and repeat dose after 2-3 minutes, as necessary
If flutter has been present longer than 48 hours, defer cardioversion until after 4 weeks’ anticoagulation with warfarin, unless severe symptoms or heart failure require urgent cardioversion.
DC cardioversion is the most effective therapy.
Do not use verapamil as it will not convert flutter to sinus rhythm and may cause serious hypotension.
Anticoagulants if sustained (see Atrial fibrillation). Most consider that the thromboembolic risks in atrial flutter and atrial fibrillation are similar.
Long-term therapy
Recurrent atrial flutter is an indication for referral as many may be relatively simply cured by radio-frequency catheter ablation.
Further information about atrial flutter is here.