FOR APPs & PRIMARY CARE CLINICIANS
Atrial flutter — Quick reference
First steps, urgent findings, referral guidance, and handoff essentials.
First steps
Confirm the EKG, assess rate and stability, address stroke risk, and distinguish likely typical versus atypical flutter. Rate control may be difficult. Calculate CHA2DS2-VASc: OAC is recommended at ≥2 in men or ≥3 in women, unless contraindicated. At 1 in men or 2 in women, consider OAC after individualized discussion.
Recognize the urgent patient
Instability, ischemic discomfort, acute HF, or severe symptoms during rapid flutter require hospital assessment.
When to refer
Refer to EP for ablation assessment; typical CTI flutter often has an effective ablation option. Evaluate coexisting AF.
What to send with the referral
12-lead EKG; rhythm duration; symptoms; anticoagulation history; rate-control medications; previous ablations or cardiac surgery.
Avoid this pitfall
A regular ventricular rhythm near 150/min may be 2:1 flutter. EKG morphology alone does not establish every circuit.
Reviewed October 11, 2026. This quick reference summarizes the linked guide; use the full guide for context and clinical references.