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Background Afib associated with some underlying heart disease causing large atrium, increased atrial pressures or inflammation Typical Aflutter reentrant circuit involves the cavo- tricuspid isthmus sawtooth negative flutter waves in the leads II, III, and aVF Any disorder that causes Afib can also cause Aflutter Also commonly occurs after treating Afib with an antiarrythmic or ablation It is an uncommon complication of acute MI in the absence of other symptoms Echo Looking at size of artia and ventricles, ventricular function, and valves and TEE if plan for cardioversion without optimal anticoagulation Rate Control Same general approach as Afib, but harder to achieve Use non- dihydropyridine CCB or BB Consider dig or amio if decompensated HF Cardioversion should be urgently in patients with rates 150 or in those who have hemodynamic compromise or who have WPW Ablation is the treatment of choice given the high rate of recurrence of aflutter and the high success rate of the procedure Limited data to suggest the optimal approach to anticoagulation in atrial flutter given rarity of persistent A flutter and the frequency of co- existence with Afib Thromboembolic risk may be lower than in Afib, but most recommend approaching anticoagulation the same as they would in a patient with Afib as these patients may also be having episodes of Afib. can i drink alcohol while taking doxycycline

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