This maneuver should be performed only by a physician in a monitored setting. Atrial flutter is associated with most types of organic heart disease, including ischemic, hypertensive, and valvular heart disease, and cardiomyopathy. It may also occur after cardiac or thoracic surgery and in conditions with no underlying cardiac pathology, such as pulmonary embolism, chronic ventilatory failure, thyrotoxicosis, and alcohol intoxication. Like other tachyarrhythmias, atrial flutter can cause varying degrees of hemodynamic compromise. Signs and symptoms, which may include dyspnea, fatigue, palpitations, chest pain, and hypotension, vary based on the patient's ventricular rate and left ventricular function and the chronicity of the flutter.
Therapy aims to slow the ventricular rate, restore normal sinus rhythm, and prevent recurrence.
In either case, the recommended energy setting is 50 joules. Radiofrequency ablation of the intra-atrial reentrant circuit is a therapeutic option for patients with chronic flutter. But the long-term effectiveness of this treatment hasn't been determined. Anticoagulation for chronic atrial flutter is controversial. The risk of thromboembolism in atrial flutter may be too small to warrant this treatment.