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Typical Atrial Flutter — EECC MCQ

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EasyArrhythmia & ElectrophysiologyTypical Atrial FlutterEECC

A 60-year-old man presents with regular palpitations and breathlessness. ECG shows a regular narrow-complex tachycardia at 150 bpm with a sawtooth baseline pattern best seen in leads II, III, aVF, and V1. Carotid sinus massage transiently increases the AV block, revealing flutter waves at 300/min. What is the most appropriate definitive treatment?

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Correct answer: E — Catheter ablation of the cavotricuspid isthmus

Typical (CTI-dependent) atrial flutter has a characteristic sawtooth pattern at ~300 bpm with 2:1 AV block producing a ventricular rate of ~150 bpm. Catheter ablation of the cavotricuspid isthmus (CTI) is the recommended definitive treatment (Class I) with success rates >95% and low recurrence. Flecainide is relatively contraindicated in atrial flutter as it can slow the flutter rate and paradoxically lead to 1:1 AV conduction with haemodynamic collapse (should only be used with an AV nodal blocking agent). DC cardioversion terminates flutter but has high recurrence without ablation. Anticoagulation assessment (CHA₂DS₂-VA) should be performed as for AF.

Reference: ESC (2024): Guidelines for the Management of Atrial Fibrillation (includes atrial flutter recommendations)