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No

Yes

Yes

Yes No

Yes

No

No

i.v. beta-blocker or i.v. diltiazem or verapamil

(IIa B)

Low-energy synchronized cardioversion

(I B)

i.v. ibutilide or dofetilide i.v. or oral (in-hospital)

(I B) Ηigh-rate atrial pacing

(I B)

i.v. amiodarone

(IIb C) Invasive or non-invasive

high-rate atrial pacing

(IIb B)

Rhythm control

strategy

Electrical cardioversion

preferred

PPM/ICD present?

Haemodynamic

instability

Synchronized cardioversion

(I B)

If not available or contra-indicated

Atrial flutter/MRAT

Figure 11 Acute therapy of stable atrial flutter or macro-re-entrant atrial tachycardia. ICD = implantable cardioverter defibrillator; i.v. = intravenous; MRAT = macro-re-entrant atrial tachycardia; PPM: permanent pacemaker. Downloaded from academic.oup.com/eurheartj/article/41/5/655/5556821 by guest on 07 October 2026