Thromboembolism in Chronic Atrial Flutter: Is the Risk Underestimated?

Lanzarotti, Charles; Olshansky, Brian

doi:10.1016/s0735-1097(97)00326-4

Cited by 96 publications

(40 citation statements)

References 31 publications

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“…12 The relationship between atrial arrhythmia rate and complexity and thromboembolic risk is not well established. Whereas some studies suggest that the stroke risk with atrial flutter (an organized, macroreentrant arrhythmia) is similar to that of AF, 13,14 others suggest a continuum of stroke risk that increases with greater atrial rate and disorganization. 15,16 The putative mechanisms of thromboembolism in AF include development of mechanical dysfunction and a proinflammatory and procoagulant state, with resultant thrombus formation in the complex, pectinate-rich structure of the left atrial appendage (LAA) (Figure 1), [17][18][19] although the possibility that AF is merely a marker for the presence of stroke risk factors exists.…”

Section: The Spectrum Of Atrial Tachyarrhythmias and Stroke Risksmentioning

confidence: 99%

Prolonged Rhythm Monitoring for the Detection of Occult Paroxysmal Atrial Fibrillation in Ischemic Stroke of Unknown Cause

2011

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Section: The Spectrum Of Atrial Tachyarrhythmias and Stroke Risksmentioning

confidence: 99%

Prolonged Rhythm Monitoring for the Detection of Occult Paroxysmal Atrial Fibrillation in Ischemic Stroke of Unknown Cause

2011

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“…Since the major trials of anticoagualation therapy for atrial fibrillation excluded patients with atrial flutter the risk for thromboembolism is unclear [1][2][3][4][5] . During the last year, two reports have addressed this issue, concluding that treatment with anticoagulation should be considered in patients with atrial flutter because of a substantial risk of thromboembolism [49,50] . Post-cardioversion thromboembolism has been described despite exclusion of thrombi in the left atrial appendage [27] .…”

Section: Atrial Fluttermentioning

confidence: 99%

Transoesophageal echocardiography-guided cardioversion of atrial fibrillation or flutter. Selection of a low-risk group for immediate cardioversion

Roijer

Eskilsson

Olsson

2000

European Heart Journal

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Aims Despite exclusion of left atrial thrombi by transoesophageal echocardiography, cardioversion-related thromboembolism has been reported in atrial fibrillation or flutter. To define a low-risk group for cardioversion without previous anticoagulation, patients were selected for immediate cardioversion if there were no thrombi, no echo spontaneous contrast and the outflow velocity of the left atrial appendage was greater than 0·25 m . s 1 on transoesophageal echocardiography. Methods and ResultsTwo hundred and forty-two consecutive patients referred for cardioversion of atrial fibrillation or flutter with a duration of more than 2 days and no anticoagulation therapy were examined with transoesophageal echocardiography. After the transoesophageal echocardiography examination, patients who were eligible for immediate cardioversion were anticoagulated with low molecular weight heparin (dalteparin) subcutaneously, together with warfarin prior to cardioversion. Dalteparin treatment was continued until the patient had reached therapeutic prothrombin values.Based on the transoesophageal echocardiographic findings the patients were divided into two groups: immediate cardioversion, group A, with a mean age of 62 13 years (n=162); or conventional warfarin treatment before cardioversion, group B, with a mean age of 67 10 years (P<0·05) (n=80). In group A, lone atrial fibrillation or flutter was more common (53%; 95% CI: 45-61) compared to group B (34%; 95% CI: 23-44, P<0·05), while heart disease was more common in group B (45%; 95% CI: 34-56) compared to group A (31%; 95% CI: 24-39, P<0·05). Echocardiography revealed thrombi in 5% (95% CI: 2·6-8) of the patients, left atrial size was larger, fractional shortening lower, and a higher proportion had impaired left ventricular function in group B. No thromboembolic event occurred at or after cardioversion in any of the patients; however, before planned cardioversion one transitory ischaemic attack, one lethal stroke and one cardiac death occurred in three of the patients with thrombi despite warfarin therapy. One-month follow-up maintenance of sinus rhythm was 75% in group A compared to 45% in group B (P<0·01).Conclusion After using our transoesophageal echocardiographic exclusion criteria (no thrombi, no spontaneous echo contrast and left atrial appendage outflow velocity d0·25 m . s 1 ) cardioversion can safely be performed in 2/3 of patients with atrial fibrillation or flutter without previous anticoagulation therapy. These patients maintained sinus rhythm significantly better after 1 month compared to patients with prolonged warfarin therapy before cardioversion.

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“…Die Einteilung in die drei Manifestationen ist für die Therapie des Vorhofflimmerns hilfreich, hat aber keinen oder nur im Extremfall Einfluss auf die Indikation zur Antikoagulanzientherapie [28]. Das Risiko für Thromboembolien wird bei Patienten mit chronischem Vorhofflattern höher als bei Patienten mit Sinusrhythmus, aber niedriger als bei Patienten mit Vorhofflimmern eingeschätzt [8,37,48]. Obgleich keine definitiven Befunde vorliegen, sollten Patienten mit Vorhofflattern wie Patienten mit Vorhofflimmern behandelt werden.…”

Section: Risikostratifikation Für Thromboembolische Ereignisseunclassified

Prävention arterieller Thromboembolien bei Patienten mit Vorhofflimmern

Schuchert¹,

Meinertz²

2002

Herz

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Patients with a low risk need no anticoagulation or can take aspirin. Patients with a high risk should receive oral anticoagulation with an INR range from 2.0 to 3.0. Newer guidelines recommend also for patients with intermediate level of stroke risk instead of aspirin the prescription of oral anticoagulation. Patients with a medium risk can interrupt the oral anticoagulation before surgery or invasive diagnostic procedures for 1 week, patients with a high risk should receive heparin. 3-4 weeks before and after cardioversion the standard therapy is oral anticoagulation.

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Thromboembolism in Chronic Atrial Flutter: Is the Risk Underestimated?

Abstract: Patients with chronic atrial flutter are at an increased risk of thromboembolic events. Effective anticoagulation may decrease this risk.

Cited by 96 publications

References 31 publications

Prolonged Rhythm Monitoring for the Detection of Occult Paroxysmal Atrial Fibrillation in Ischemic Stroke of Unknown Cause

Prolonged Rhythm Monitoring for the Detection of Occult Paroxysmal Atrial Fibrillation in Ischemic Stroke of Unknown Cause

Transoesophageal echocardiography-guided cardioversion of atrial fibrillation or flutter. Selection of a low-risk group for immediate cardioversion

Prävention arterieller Thromboembolien bei Patienten mit Vorhofflimmern

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