Left atrial appendage function in patients with atrial flutter.

Abstract

Objective-To determine whether echocardiographic markers of thromboembolic risk differ between patients with pure atrial flutter and patients with atrial flutter and intermittent atrial fibrillation. Design-Patients with atrial flutter were followed up prospectively for 12 months to identify intermittent atrial fibrillation. After the follow up period, transthoracic and multiplane transoesophageal echocardiography were performed to assess left atrial chamber and appendage size, peak emptying velocities, and emptying fraction of the left atrial appendage. The presence of spontaneous echo contrast was also determined. Setting-Tertiary cardiac care centre.Patients-20 consecutive patients with atrial flutter; 11 healthy subjects in sinus rhythm served as controls. Results-Intermittent atrial fibrillation was documented in 11 patients by Holter monitoring or surface ECG; atrial fibrillation was not found in the other nine patients. Compared with the patients with pure atrial flutter, patients with atrial flutter and intermittent atrial fibrillation had larger left atrial chamber (mean (SD) 4*5 (0.6) v 3-8 (0.5) cm; 95% confidence interval 0*2 to 1*2; P = 0.01) and appendage areas (6.7 (2.2) v 4-8 (4-9) cm; 95% CI 0-4 to 3-5; P = 0.02), lower left atrial appendage emptying fractions (33 (11)% v 52 (ll)%; 95% CI 8 to 29; P = 0.008), and also lower left atrial appendage emptying velocities (0.44 (0.21) v 0 79 (0.27) mIs; 95% CI 0-13 to 0-56; P = 0.005). In addition, a higher incidence of spontaneous echo contrast (11% v 36%) was observed in patients with atrial flutter and intermittent atrial fibrillation.Conclusions-Left atrial appendage function is depressed and spontaneous echo contrast more frequent in patients with atrial flutter and intermittent atrial fibrillation, as opposed to patients with pure atrial flutter. These data support the concept that patients with atrial flutter and intermittent atrial fibrillation have an increased risk of thromboembolic events and should therefore receive adequate anticoagulant treatment.

Left Atrial Appendage Function and Pulmonary Venous Flow in Patients with Nonrheumatic Atrial Fibrillation and Their Relation to Spontaneous Echo Contrast

“…In atrial utter, the LAA function seems to be preserved as expressed by higher LAA velocities and lower rates of SEC. 21 Our study found no correlation between the frequency of LAA contractions and its emptying velocity. Only three of our patients had frequency of LAA contractions # 5 Hz.…”

Antithrombotic Therapy in Atrial Fibrillation

“…Utilizing TEE, further depression of left atrial appendage ejection velocities, more intense left atrial spontaneous echocardiographic contrast, and even new thrombus formation have been described after external DC, internal DC, and spontaneous cardioversion. [235][236][237][238] These data underscore the importance of therapeutic anticoagulation during the peri-cardioversion period. Following restoration of normal atrial electrical activity on the surface ECG, the mechanical contraction of the body of the left atrium may remain dysfunctional for as long as 2 to 4 weeks after cardioversion.…”

Electrocardiographic Characteristics in Patients with Nonrheumatic Atrial Fibrillation and Their Relation to Echocardiographic Parameters

“…Atrial flutter is known to result in a higher LAA flow velocity than AF or fibrillation-flutter. 19,20 Although in contrast to the findings of Li et al, 4 one would then expect a better LAA function in patients with coarse AF. 21 This was noted partially in patients in the current study.…”