I C-LD Rapid atrial pacing is useful for acute conversion of atrial flutter in patients who have pacing wires in place as part of a permanent pacemaker or implantable cardioverter-defibrillator or for temporary atrial pacing after cardiac surgery.360 364 See Online Data and 17. Atrial pacing is effective at terminating flutter in >50% of cases.364 Atrial pacing is more commonly applied in situations in which atrial wires are already in place, such as in the postoperative setting or in patients with programmable cardiac implanted electrical devices. A temporary pacing wire may also be placed and atrial pacing for termination of atrial flutter can be useful when sedation is contraindicated, or in the setting of digitalis toxicity, in which DC cardioversion is contraindicated. Pace-termination is performed by pacing the atrium at a rate starting approximately 5% to 10% above the atrial flutter rate to achieve atrial entrainment and by maintaining pacing for 15 seconds, with repeated attempts at incrementally faster rates (reducing the pacing cycle length by 5 to 10 ms until normal sinus rhythm or AF occurs.364 When AF is precipitated, this is often more easily rate-controlled and may subsequently revert to sinus rhythm. Recommendations for anticoagulation with regard to pace-termination of atrial flutter are the same as those for chemical or electrical conversion of AF. 7.4. Ongoing Management: Recommendations I B-NR Acute 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. 