Principles
- Three parallel tracks: stability, symptom control (rate/rhythm), and stroke prevention.
- Typical flutter is often best treated definitively with CTI ablation rather than long‑term antiarrhythmics.
Rate control
- Beta blockers (e.g., metoprolol) or non‑DHP calcium channel blockers (diltiazem/verapamil) if appropriate.
- Digoxin may help at rest (often adjunct; less effective on exertion).
- Rate control can be harder in flutter than AF because flutter’s organized atrial activity can drive consistent AV conduction.
Rhythm control options
Electrical cardioversion
- High acute success for typical flutter; see Cardioversion.
Drug cardioversion
- Ibutilide can be effective for flutter conversion in monitored settings (QT prolongation/proarrhythmia risk).
Anticoagulation / stroke prevention
- AFL is generally managed like AF for stroke prevention: use CHA₂DS₂‑VASc risk stratification.
- After successful CTI ablation, AF may still occur; anticoagulation decisions should be individualized (see evidence on new‑onset AF after CTI). citeturn0search21turn0search17