ABSTRACT
Over 90% of cases have a basic underlying cardiac defect (rheumatic or ischaemic heart disease or atrial septal defect). Less commonly, it is associated with thyrotoxicosis, trauma to the myocardium, myocarditis, and digoxin therapy. These should be excluded before surgery. Most patients find the arrhythmia very distressing, and cardiac failure or angina is commonly precipitated early. Chronic control is by digoxin, verapamil, or ß-adrenoceptor blockers. DC countershock is almost always effective in abolishing atrial flutter, and is the acute treatment of choice. This should be done as a planned procedure before elective surgery, or can be done at the induction of urgent surgery in association with a cardiologist.
