(See "Management of atrial fibrillation: Rhythm control versus rate control".).Ītrial flutter is characterized by rapid, regular atrial depolarizations at a characteristic rate of approximately 300 beats/min. Exceptions include individuals identified as having reversible triggers such as pneumonia, hyperthyroidism, and other acute medical problems. Rhythm control with either radiofrequency (RF) catheter ablation or antiarrhythmic drug therapy is necessary in most cases, RF catheter ablation is preferred because of the high rate of success and low rate of complications. In addition, the long-term maintenance of sinus rhythm may decrease the risk of stroke. INDICATIONS - We attempt to keep most patients with recurrent atrial flutter in sinus rhythm to decrease symptoms, unlike atrial fibrillation (AF) in which rhythm control and rate control are reasonable strategies. (See "Overview of atrial flutter", section on 'Etiology and risk factors' and "Restoration of sinus rhythm in atrial flutter" and "Embolic risk and the role of anticoagulation in atrial flutter" and "Control of ventricular rate in atrial flutter".) Causes of atrial flutter, rate control therapy, the restoration of sinus rhythm after cardioversion, and the role of anticoagulation in atrial flutter are discussed separately. Issues related to the indications and therapeutic options for the maintenance of sinus rhythm in atrial flutter will be reviewed here. (See "Overview of atrial flutter", section on 'Clinical manifestations' and "Embolic risk and the role of anticoagulation in atrial flutter", section on 'Embolic risk'.) Restoration and maintenance of sinus rhythm improves symptoms and decreases the risk of embolization if atrial flutter recurrence does not occur. ![]() INTRODUCTION - Atrial flutter is a relatively common supraventricular arrhythmia that can impact quality of life and cause stroke or systemic embolization.
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