![]() It may be repeated once, but the provider should be aware it has a potential risk of inducing torsades de pointes, so the patient needs to be monitored carefully for 4-8 hours after drug administration. Ibutilide, a class III antiarrhythmic (Corvert, 1 mg in 10 mL saline infused slowly over 10 minutes) is effective in converting new-onset atrial flutter patients to normal sinus rhythm 90% of the time. If synchronized DC cardioversion is utilized in a non-emergent setting, the provider must be certain that the atrial flutter is new-onset, that a patient does not have thrombosis in the heart via echo, or that the patient has been adequately anticoagulated in order to prevent a thromboembolic event. If a patient is hemodynamically unstable and/or has an excessively rapid ventricular rate you may consider an antiarrhthmic drug or synchronized DC cardioversion. Beta blockers and CCB are effective in prophylactic prevention of atrial flutter after postoperative thoracic or cardiac surgery. Drugs of choice include beta blockers such as esmolol (0.5 mg/kg IV bolus followed by 50-300 ucg/kg/min) and propranolol, or calcium channel blockers such as verapamil (5-10 mg IV) or diltiazem. ![]() Initial treatment of atrial flutter targets the rate control (which is frequently ~150 BPM).
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