Acute Termination of Atrial Flutter: Class III Drugs or Transesophageal Pacing?

摘要

Atrial flutter (AFL) is an arrhythmia which occurs frequently. Epidemiological data show an incidence of 88/100 000 new cases per year in the general population in USA, with 200 000 new cases every year [1], The main predictors of this arrhythmia are heart failure and chronic obstructive pulmonary disease. It often coexists with atrial fibrillation (AF); moreover, it is not unusual that patients undergoing antiarrhythmic treatment with class IC drugs or amio-darone for the treatment of AF develop episodes of AFL. Often AFL is poorly tolerated due to the high ventricular response. This happens even in patients with good control of ventricular rate at rest, who do not tolerate AFL during effort, since ventricular rate increases suddenly.Today radiofrequency ablation is the first-line therapy in selected patients with AFL [2]. However, immediate treatment is often necessary for the patient who comes to hospital with AFL. Sinus rhythm can be obtained through various techniques: external direct current cardioversion-defibrillation (DC shock), transesophageal pacing (TEP), or drug-based reconversion. The first is certainly the most efficient and is the first choice in an emergency. TEP has been proved to be a valid alternative to DC shock, since no general anesthesia is required. Reconversion with class IA and 1C [3-5] drugs or amiodarone and sotalol has low efficacy. The class III drugs dofetilide and ibutilide [6-17] have proved to be so highly effective in AFL reconversion that they have become a valid alternative to other therapies.