Because it has less negative inotropic effect than beta blockers, diltiazem, and verapamil and may produce less hypotension, it may be preferred in critically ill patients or in those with tenuous hemodynamic stability. Because of potential toxicity, amiodarone should not be used for long-term rate control in most patients. Although unlikely, amiodarone may result in conversion of atrial flutter to sinus rhythm, so potential risks and benefits should be considered for patients with atrial flutter lasting 48 hours who are not adequately anticoagulated.10 However, amiodarone is typically used for rate control only when other options are greatly limited. For patients with atrial flutter, antithrombotic therapy is recommended according to the same risk profile used for AF. Recommendations for Acute Treatment of Atrial Flutter (Continued) COR LOE Recommendations Recommendations for Ongoing Management of Atrial Flutter COR LOE Recommendations I B-R Catheter ablation of the CTI is useful in patients with atrial flutter that is either symptomatic or refractory to pharmacological See Online Data and 17. Rate control can be difficult to achieve in atrial flutter, and a rhythm control strategy is often chosen. Catheter ablation of CTI-dependent atrial flutter is often preferred to long-term pharmacological therapy; in this rhythm, the CTI represents the optimal target for ablation because a line of ablation between the tricuspid valve annulus and inferior vena cava can effectively interrupt the circuit. A variety of techniques are applicable, including various catheter types, energy delivery systems, and mapping and visualization tools; generally, success depends on creation of a complete line of block and permanent interruption of conduction across the CTI (Table 8). Successful ablation is often heralded by intraprocedural interruption of the arrhythmia and subsequent EP demonstration of bidirectional block across the ablated tissue. 