Atrial Flutter: The Daily PANCE Blueprint

The answer is E. Catheter ablation

Atrial flutter is a macroreentrant atrial arrhythmia characterized by a regular atrial rate and constant P-wave morphology. Clinical features may include palpitations, dyspnea, fatigue, and lightheadedness, though some patients remain asymptomatic. The hallmark electrocardiographic finding in typical (counterclockwise) atrial flutter consists of “sawtooth” flutter waves that are predominantly negative in the inferior leads (II, III, aVF) and positive in lead V1. Atrial flutter is particularly common in patients with prior cardiac surgery and structural heart disease. The management depends on the patient and clinical situation. Hemodynamically unstable patients require urgent electrical cardioversion. For stable patients, treatment options include rate control or rhythm control strategies. Rate control can be achieved with beta blockers, diltiazem, or verapamil. Catheter ablation is the preferred long-term treatment for symptomatic or medically refractory atrial flutter (Class I recommendation). Ablation is superior to medical management in terms of safety, efficacy, and clinical outcomes. The procedure achieves success rates of approximately 92%. It is important to keep in mind that patients with atrial flutter have the same thromboembolic risk as those with atrial fibrillation and require anticoagulation based on CHA₂DS₂-VASc score.