Timeframe: from diagnosis until effective therapy of atrial flutter

Setting: outpatient setting, inpatient setting, and emergency department

Including:

investigation and assessment of underlying causes

acute and long-term rhythm management

stroke prevention

integrated care

Excluding: performing ablations (specialist management)

• Medical expert

• Communicator

• Collaborator

• Leader

• Professional

• Describe predisposing conditions, and the epidemiology and pathophysiology of atrial flutter

• Classify the types of atrial flutter

• Describe the clinical features and electrocardiographic characteristics of atrial flutter

• Discuss additional diagnostic procedures tailored to the individual need

• Explain how to assess the risk of atrial thrombosis and embolic complications

• Outline the principles of isthmus ablation

• Discuss the indications, contraindications, side effects, and complications of:

  •   – Anticoagulant therapy and, when necessary, combination with antiplatelet therapy

  •   – Rhythm vs. rate control therapy

  •   – Pharmacological control of ventricular rate

  •   – Anti-arrhythmic drug therapy

  •   – Pharmacological cardioversion

  •   – Electrical cardioversion

  •   – Atrial overdrive pacing

  •   – Isthmus ablation

• Take a relevant history and perform an appropriate physical examination

• Recognize atrial flutter on the ECG and differentiate it from other rhythm disorders

• Assess the risks of thromboembolism and bleeding

• Determine the best strategy for prevention of ischaemic stroke and systemic embolism

• Implement appropriate treatment:

  •   – Anticoagulant therapy and, where necessary for other indications, combination with antiplatelet therapy

  •   – Switch from one anticoagulant drug to another

  •   – Rate control vs. rate plus rhythm control

  •   – Anti-arrhythmic drug therapy

  •   – Pharmacological cardioversion

  •   – Pharmacological control of ventricular rate

  •   – Electrical cardioversion

• Identify patients for referral for flutter ablation

• Appreciate the distress from symptoms of atrial flutter and anxiety over anticoagulant therapy and invasive management

• Explain the limitations and potential risks of anti-arrhythmic drug therapy

• Emphasise the importance of anticoagulant therapy

• Communicate the success rate and risks of ablation therapy

• Direct observation/WBA (e.g. DOPS, Mini-CEX, fieldnotes)

• CbD (case-based discussion)/EbD (entrustment-based discussion)

• 5. Able to teach (no supervision)