Risk of Thromboembolism in Chronic Atrial Flutter

Wood, Kathryn A.; Eisenberg, Susan J.; Kalman, Jonathan M.; Drew, Barbara J.; Saxon, Leslie A.; Lee, Randall J.; Lesh, Michael D.; Scheinman, Melvin M.

doi:10.1016/s0002-9149(97)00044-1

Cited by 96 publications

(37 citation statements)

References 28 publications

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“…Although patients with Afl have been shown to be at risk for thromboembolism and for left atrial appendage (LAA) thrombus, it is unknown whether risk varies by type of flutter. 16,17 Because the left atrium and left atrial appendage are activated in C Afl similarly to NSR, our results suggest the hypothesis that patients with C Afl might have more normal LAA contractile function and reduced risk of thromboembolism compared with patients with CC Afl.…”

Section: Discussionmentioning

confidence: 66%

Different Patterns of Interatrial Conduction in Clockwise and Counterclockwise Atrial Flutter

et al. 2001

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Background-The terms counterclockwise (CC) and clockwise (C) atrial flutter (Afl) are used to describe right atrial activation around the tricuspid valve in the left anterior oblique view. The manner in which the left atrium is activated, as reflected by coronary sinus (CS) recordings, has not been systematically evaluated. Methods and Results-Nine patients with both CC and C Afl underwent electrophysiological study with CS recordings during both rhythms with the use of a decapolar catheter with the tip placed in the distal CS. Patterns of CS activation during each type of Afl as well as during during sinus rhythm were categorized into 1 of 3 patterns: sequential proximal-to-distal, sequential distal-to-proximal, and fused, indicating activation from different directions. In 7 of 9 patients, the pattern of CS activation in CC Afl and C Afl differed, with a proximal-to-distal pattern in CC Afl and a fused pattern in C Afl. In 2 patients, pacing the high right atrial septum near the presumed site of Bachmann's bundle in sinus rhythm showed a similar fused pattern of CS activation. Conclusions-These results demonstrate different patterns of CS activation in CC Afl and C Afl in the majority of patients and are consistent with a model in which the left atrium is activated predominantly over Bachmann's bundle during C Afl and over the CS os in CC Afl. These findings may have implications for maintenance of Afl, interpretation of flutter wave morphology on surface ECG, and left atrial mechanical function in

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Section: Discussionmentioning

confidence: 66%

Different Patterns of Interatrial Conduction in Clockwise and Counterclockwise Atrial Flutter

et al. 2001

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“…Atrial flutter is uncommon as a chronic arrhythmia, and the risk of thromboembolism is not as well established as it is for AF but is generally estimated as higher than that for patients with sinus rhythm and less than that for those with persistent or permanent AF. On the basis of multivariate analysis, Wood et al 430 reported hypertension as the only significant correlate of previous thromboembolism for patients with chronic atrial flutter. From a review of 8 y of retrospective data from 749 988 hospitalized older patients, including 17 413 with atrial flutter and 337 428 with AF, 3 of 4 patients with atrial flutter also had or developed AF.…”

Section: Fuster Et Al Acc/aha/esc Practice Guidelines E303mentioning

confidence: 99%

2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation

Fuster¹,

Rydén²,

Cannom³

et al. 2011

Circulation

804

463

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“…54 LA appendage thrombi, spontaneous echo contrast and low appendage emptying velocities have been detected in cases of flutter submitted to cardioversion, 55 although to a lesser extent than in AF, 56 and normalisation can occur days after return to sinus rhythm. 57 The frequency of systemic embolism in flutter is about one-third that in AF, 36,58,59 but this difference disappears when both flutter and fibrillation occur in the same patient.…”

Section: Clinical Presentationmentioning

confidence: 99%

Atrial Flutter, Typical and Atypical: A Review

Cosío

2017

Arrhythmia &Amp; Electrophysiology Review

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Clinical electrophysiology has made the traditional classification of rapid atrial rhythms into flutter and tachycardia of little clinical use. Electrophysiological studies have defined multiple mechanisms of tachycardia, both re-entrant and focal, with varying ECG morphologies and rates, authenticated by the results of catheter ablation of the focal triggers or critical isthmuses of re-entry circuits. In patients without a history of heart disease, cardiac surgery or catheter ablation, typical flutter ECG remains predictive of a right atrial re-entry circuit dependent on the inferior vena cava–tricuspid isthmus that can be very effectively treated by ablation, although late incidence of atrial fibrillation remains a problem. Secondary prevention, based on the treatment of associated atrial fibrillation risk factors, is emerging as a therapeutic option. In patients subjected to cardiac surgery or catheter ablation for the treatment of atrial fibrillation or showing atypical ECG patterns, macro-re-entrant and focal tachycardia mechanisms can be very complex and electrophysiological studies are necessary to guide ablation treatment in poorly tolerated cases.

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Risk of Thromboembolism in Chronic Atrial Flutter

Cited by 96 publications

References 28 publications

Different Patterns of Interatrial Conduction in Clockwise and Counterclockwise Atrial Flutter

Different Patterns of Interatrial Conduction in Clockwise and Counterclockwise Atrial Flutter

2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation

Atrial Flutter, Typical and Atypical: A Review

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