When is cardioversion indicated in a patient with atrial flutter?

Cardioversion is indicated in a patient with atrial flutter primarily when the patient is unstable. Unstable patients typically present with significant symptoms such as severe hypotension, altered mental status, or chest pain, which indicates that their hemodynamic status is compromised due to the rapid heart rate associated with atrial flutter. In such cases, immediate intervention is necessary to restore normal sinus rhythm and stabilize the patient, and cardioversion, either synchronized electrical cardioversion or chemical cardioversion, becomes a critical part of the management strategy.

In contrast, stable patients with atrial flutter can often be managed with medications or observation without the need for immediate cardioversion. Therefore, the necessity of urgent cardioversion is primarily dictated by the patient's stability rather than the presence of atrial fibrillation, the normal ventricular rate, or other factors that do not indicate immediate intervention.