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Hief C et al.  
Can atrial flutter be converted to sinus rhythm by antiarrhythmic drugs or should atrial pacing be performed?

Journal of Clinical and Basic Cardiology 1999; 2 (1): 78-80

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Fig. 1: Vorhofflattern - Antiarrhythmika

Keywords: AntiarrhythmikumVorhofflatternantiarrhythmic drugsatrial flutter

There are serious deficiencies in our knowledge of the susceptibility of atrial flutter to drug therapy. Therefore feasibility and efficacy of antiarrhythmic drugs in patients with atrial flutter were evaluated in a prospective study. A stepwise protocol was applied in 37 consecutive patients (30 men, 7 women, mean age: 65 12 years) with permanent atrial flutter type 1. Step 1: digitoxine, 0.75 mg i.v., followed by 0.1 mg orally. Step 2: propafenone, 750 mg per day orally (3?4 days). Step 3: sotalol, 400 mg per day orally (44 days). Step 4: burst stimulation of the right atrium. In 3 patients termination of atrial flutter by pacing was immediately needed because of haemodynamic compromise. In 22 of 37 patients (59 %) the stepwise approach was feasible. Atrial flutter converted to sinus rhythm on drug therapy in 12 patients (32 %). In 5 patients sinus rhythm was achieved with step 1, in one patient with step 2 and in 6 patients with step 3. In 10 patients atrial pacing was carried out resulting in sinus rhythm in 8 of them. Due to side effects of the drug, lack of compliance or haemodynamic compromise, the protocol was not completed in 12 patients. In 10 of these 12 patients burst stimulation was performed and restored sinus rhythm in all of them. Thirty-three of 37 (89 %) patients were discharged in sinus rhythm. Our data showed that the success rate of antiarrhythmic drug therapy given orally in patients with stable type I atrial flutter was low, only 12 patients converted to sinus rhythm under drug therapy. J Clin Basic Cardiol 1999; 2: 78-80.
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