QRS complexes usually are normal. Carotid sinus massage usually increases atrioventricular block and better exposes the ECG abnormalities. Similarly, adenosine reveals the atrial arrhythmia but does not terminate it. Treatment Medical therapy is more likely to slow the ventricular response than restore sinus rhythm. Thus, digoxin, verapamil, and -blockers are useful through their blocking effect on the atrioventricular node.
Digoxin usually slows the ventricular response rate but only occasionally restores sinus rhythm.
If class I drugs are used, pretreatment with digoxin is advised. RF ablation is emerging as an important approach for medically refractory atrial flutter. A line of RF lesions interrupts conduction near the orifice of the coronary sinus. Some patients develop AF after the procedure. All rights reserved.