Risk of thromboembolic events in patients with atrial flutter
Abstract
Based on multiple studies, clear, guided anticoagulation therapy is recommended for patients with atrial fibrillation. The value of anticoagulation therapy in patients with atrial flutter, however, is less well established. Little is known about the incidence of thromboembolism in patients with atrial flutter. We evaluated the risk of thromboembolism in 191 consecutive unselected patients referred for treatment of atrial flutter. A history of embolic events was noted in 11 patients. Acute embolism (<48 hours) occurred in 4 patients (3 after direct current cardioversion, 1 after catheter ablation). During follow-up of 26+/-18 months, 9 patients experienced thromboembolic events. During the follow-up, the overall embolic event rate (including acute embolism and thromboembolic events during follow-up) was 7 % in this patient population. Risk indicators for an embolic event in an univariate analysis were organic heart disease (p = 0.037), depressed left ventricular function (p = 0.02), history of systemic hypertension (p = 0.004), and diabetes mellitus (p = 0.0038). Using multivariate analysis, a history of hypertension was the only independent predictor for elevated embolic risk in this patient population (odds ratio = 6.5; 95% confidence intervals 1.5 to 45). Thus, the thromboembolic risk is higher than previously recognized for patients with atrial flutter. Anticoagulation therapy may decrease this risk.
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Systemic embolism occurs in AFL about 30% as frequently as in AF, a difference that disappears when AFL is associated with AF episodes.
“Systemic embolism occurs in AFL about 30% as frequently as in AF, 168 -170 a difference that disappears when AFL is associated with AF episodes.”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [170]
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Do Different Atrial Flutter Types Carry the Same Thromboembolic Risk?
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Atrial Flutter and the Risk of Thromboembolism: A Systematic Review and Meta-Analysis
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- Authors
- Seidl, K., Hauer, B., Schwick, N. G., Zellner, D., Zahn, R., & Senges, J.
- Affiliations
- Klinikum Ludwigshafen (DE)
- Corresponding author
- Seidl, Karlheinz
- Venue
- The American Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 1998-09
- Volume
- 82
- Issue
- 5
- Pages
- 580-583
- ISSN
- 0002-9149 (ISSN-L)
- OpenAlex
- W2023282715
- Cited by
- 135
- References
- 19
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2022: 4 · 2021: 2 · 2019: 2 · 2018: 2 · 2017: 3 · 2016: 4 · 2015: 4 · 2014: 4 · 2012: 8
- FWCI
- 6.32
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Keywords
- atrial flutter, thromboembolism, anticoagulation, hypertension, left ventricular function, organic heart disease, diabetes mellitus, cardioversion, catheter ablation, atrial fibrillation
- MeSH terms
- Aged, Anticoagulants, Atrial Flutter, Intracranial Embolism and Thrombosis, Electric Countershock, Female, Follow-Up Studies, Humans, Male, Middle Aged, Recurrence, Risk, Thromboembolism, Odds Ratio, Catheter Ablation
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