Recommendations for Anticoagulation of Typical AFL*
Referenced studies that support the recommendations are summarized in Online Data Supplement.
| COR | LOE | Recommendations |
|---|---|---|
| 1 | B-NR | 1. For patients with AFL, anticoagulant therapy is recommended according to the same risk profile used for AF.1–3 |
| 1 | C-LD | 2. In patients with AFL who undergo successful cardioversion or ablation resulting in restoration of sinus rhythm, anticoagulation should be continued for at least 4 weeks postprocedure.1–4 |
| 1 | A | 3. Patients with typical AFL who have undergone successful CTI ablation and have had AF previously detected before AFL ablation should receive ongoing oral anticoagulation postablation as indicated for AF.5,6 |
| 1 | B-NR | 4. Patients with typical AFL who have undergone successful CTI ablation and are deemed to be at high thromboembolic risk, without any known previous history of AF, should receive close follow-up and arrhythmia monitoring to detect silent AF if they are not receiving ongoing anticoagulation in view of significant risk of AF.7–9 |
| 2b | B-NR | 5. In patients with typical AFL who have undergone successful CTI ablation without any known previous history of AF who are at high risk for development of AF (eg, LA enlargement, inducible AF, chronic obstructive pulmonary disease [COPD], HF), it may be reasonable to prescribe long-term anticoagulation if thromboembolic risk assessment suggests high risk (>2% annual risk) for stroke.5,10–13 |
This section refers to typical right-sided (CTI-dependent) AFL. Left-sided AFLs or atrial tachycardias (ATs) that develop after ablation of AF should be anticoagulated and managed in a manner similar to AF. “Typical” AFL is defined as either typical counterclockwise AFL when the macroreentrant circuit is dependent on the CTI using the isthmus from the patient’s right to left or typical clockwise AFL when the macroreentrant circuit is dependent on the CTI and uses this isthmus from the patient’s left to right. “Atypical” AFL is not dependent on the CTI and may arise from a macroreentrant circuit in the LA, such as perimitral or LA roof flutter or could be dependent on scar from previous ablation or surgery.