The location of the circuit determines ablation approach and risks. Observational data support the relative effectiveness and safety of catheter ablation in experienced centers.134,327 Many of the atrial flutters that are observed during the first 3 months after catheter ablation or cardiac surgery will not persist beyond the periprocedural period, so attempts at ablation can be deferred unless pharmacological therapy and/or cardioversion are unsuccessful.327 Page et al 2015 ACC/AHA/HRS SVT Guideline e543 I B-NR Ongoing management with antithrombotic therapy is recommended in patients with atrial flutter to align with recommended antithrombotic therapy for patients with AF.365 See Online Data and 17. The risk of stroke associated with AF is well established, and several RCTs have demonstrated the efficacy of anticoagulation for stroke prevention in patients with additional risk factors.366 Anticoagulation has also been shown to prevent stroke when administered during the weeks immediately before and after cardioversion.367 Whether atrial flutter carries a risk of stroke similar to that in patients with AF has been debated in the past but is now supported by limited evidence from mechanistic, observational, and prospective studies that include patients primarily with atrial flutter.365 369 Several reports have suggested that the risk of stroke in patients with atrial flutter is mitigated by anticoagulation. 