Patient handout

Atrial flutter (typical and atypical)

PRODUCTION

1. Your condition

This handout is for atrial flutter (typical and atypical). Your care team identified this based on: palpitations or fluttering sensation.

Other reasons your team may use this plan: dyspnea, fatigue, decreased exercise tolerance; syncope or pre-syncope; flutter on 12-lead ecg or telemetry.

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
metoprolol_tartrate	5 mg IV q5min × 3 then PO 25–50 mg BID	IV/PO	IV q5min × 3 → PO BID	AVN slowing; HR target 80–110 — ACC/AHA 2024 (PMID 38033089)
apixaban	5 mg BID (2.5 mg if 2 of: ≥80 yr, ≤60 kg, Cr ≥1.5)	PO	BID	ARISTOTLE (Granger NEJM 2011 PMID 21870978) — same indication as AF; ACC/AHA 2024 Class I

Plan: Atrial flutter — phenotype-stepwise master ladder (typical CTI / atypical / unstable / post-cardiac-surgery / stable RVR) — ACC/AHA 2024 (Joglar PMID 38033089); ESC 2024 (PMID 39210723); Calkins HRS/EHRA/ECAS 2007 (PMID 28506916)

3. When to call your provider

Contact your care team if any of the following happen:

Recurrent flutter despite ablation → repeat EP — HRS 2017
New AF after CTI ablation → AF management — ACC/AHA/HRS 2023 (Joglar)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

SBP <90, AMS, ischemia, or pulmonary edema with flutter RVR — ACC/AHA/HRS 2023 (Joglar)(life-threatening)
HR >120 despite max BB or non-DHP CCB — ACC/AHA/HRS 2023 (Joglar)
Cardioversion planned but no documented therapeutic AC ≥3 wks — ACC/AHA/HRS 2023 (Joglar)
QTc >500 or rising 60 ms on dofetilide / sotalol / ibutilide — ACC/AHA/HRS 2023 (Joglar)
Pre-excitation + flutter (rapid pre-excited conduction) — ACC/AHA/HRS 2023 (Joglar)(life-threatening)

5. Follow-up

EP referral for CTI ablation; cardiology q3–6 mo; chronic AC review; lifestyle (alcohol, weight, OSA)

6. Sources

Guideline: 2024 ACC/AHA/ACCP/HRS AF + AFL Joint Guideline (Joglar Circulation 2024 PMID 38033089); ESC 2024 AF (Van Gelder EHJ 2024 PMID 39210723); HRS/EHRA/ECAS 2017 catheter ablation expert consensus (Calkins PMID 28506916)