What is the first-line treatment option for atrial flutter?

The first-line treatment option for atrial flutter typically involves vagal maneuvers and rate control. Vagal maneuvers can help to restore normal rhythm by increasing vagal tone, which often slows the conduction through the atrioventricular (AV) node and can terminate the arrhythmia. These techniques include actions such as bearing down (Valsalva maneuver) or applying cold to the face, which can stimulate the parasympathetic nervous system.

Rate control is also essential in managing atrial flutter, especially if it leads to a rapid heart rate. Medications such as beta-blockers or calcium channel blockers are often utilized to achieve adequate rate control, making this approach critical in initial management strategies.

Surgical interventions and cardiac catheterization are more invasive options that may be considered later, typically when the arrhythmia is persistent or symptomatic, and conservative measures have not been effective. Anticoagulants play a key role in preventing thromboembolic events in patients with atrial flutter, but they do not address the immediate management of the rhythm itself. Thus, while anticoagulation is important, it is not the first step in treating the flutter directly.