Right Atrial Stimulation in the Treatment of Atrial Flutter

The use of right atrial stimulation in the treatment of atrial flutter was evaluated in 10 patients. Atrial flutter was present in these patients from 6 to 96 hr before the procedure. Eight patients were receiving digitalis preparations. In seven patients a unipolar platinum-tipped electrode was positioned in the right atrium by monitoring the intra-atrial electrocardiogram; in three patients a bipolar pacing catheter was positioned in the right atrium under fluoroscopic guidance. Atrial stimulation was performed utilizing either a battery-powered or electrically powered pulse generator. Right atrial stimulation was performed at 180/min in seven patients and 400 to 600/min in three patients. Right atrial stimulation produced conversion to a stable sinus rhythm in seven patients and a transient sinus rhythm in an additional patient. In all but one patient transient unstable atrial fibrillation was observed immediately before conversion to a sinus mechanism. Postconversion arrhythmias or complications directly attributed to the procedure were not observed. In certain patients with atrial flutter-especially those unable to tolerate anesthesia, large doses of antiarrhythmic drugs, or withdrawal from digitalis—atrial stimulation seems to be the initial treatment of choice.