The AHA Guidelines and Scientific Statements Handbook

Table 16.8 Recommendation for long-term management of atrial fl utter

Clinical status/proposed therapy Recommendation Classifi cation Level of evidence

First episode and well-tolerated atrial
fl utter

Cardoversion alone I B

Catheter ablation IIa B
Recurrent and well-tolerated atrial fl utter Catheter ablation I B
Dofetilide IIa C
Amiodarone, sotalol, fl ecainide,†‡ quinidine,†‡
properafenone,†‡ procainamide,†‡ disopyramide†‡

IIb C

Poorly tolerated atrial fl utter Catheter ablation* I B
Atrial fl utter appearing after use of class lc
agents or amiodarone for treatment of
AF

Catheter ablation* I B

Stop current drug and use another IIa C
Symptomatic non-CTI-dependent fl utter
after failed antiarrhythmic drug therapy

Catheter ablation* IIa B

The order in which treatment recommendations appear in this table within each class of recommendation does not necessarily refl ect a preferred sequence of admin-
istration. Please refer to text for details. For pertinent drug dosing information please refer to the ACC/AHA/ESC Guidelines on the Management of Patients With
Atrial Fibrillation.

• Catheter ablation of the AV junction and insertion of a pacemaker should be considered if catheter ablation cure is not possible and the patient fails drug therapy.
  † These drugs should not be taken by patients with signifi cant structural cardiac disease. Use of anticoagulants is identical to that described for patients with
  AF(http://www.acc.org/clinical/guidelines/atrial_fi b/af_index.htm).***
  ‡ Flecainide, propafenone, procainamide, quinidine, and disopyramide should not be used unless they are combined with an AV-nodal-blocking agent.
  AF indicates atrial fl ixillation; AV, atrioventricular; CTI, cavotricuspid isthmus.

Table 16.9 Recommendations for treatment strategies for SVT during pregnancy

Treatment strategy Recommendation Classifi cation Level of evidence

Acute conversation of PSVT Vagel maneuver I C
Adenosine I C
DC cardioversion I C
Metoprolol, propranolol IIa C
Verapamil Ib C

Prophylactic therapy Digoxin I C
Metoprolol I B
Propranolol IIa B
Sotalol,* fl ecainide† IIa C
Quinidine,propafenone,† verapamil Ib C
Procainamide Ib B
Catheter ablation Ib C
Atenolol‡ II B
Amiodarone II C

The order in which treatment recommendations appear in this table within each class of recommendation does not necessarily refl ect a preferred sequence of admin-
istration. Please refer to text for details. For pertinent drug dosing information please refer to the ACC/AHA/ESC Guidelines on the Management of Patients With
Atrial Fibrillation.

• Beta-blocking agents should not be taken in the fi rst trimaster, if possible.
  † Consider AV-nodal–blocking agents in conjunction with fl ecainide and propatenone for certain tachycardias (see Section V).
  ‡ Atenolol is categorized in class C (drug classifi cation for use during pregnancy) by legal authorities in some European countries.
  AV indicates atrioventricular; DC, direct current; PSVT, paroxysmal supraventricular tachycardia.