Incidence and predictors of atrial flutter in the general population
Open accessAbstract
Objectives The goal of our study was to determine the incidence and predictors of atrial flutter in the general population.Background Although atrial flutter can now be cured, there are no reports on its epidemiology in unselected patients.Methods The Marshfield Epidemiological Study Area (MESA), a database that captures nearly all medical care among its 58,820 residents was used to ascertain all new cases of atrial flutter diagnosed from July 1, 1991 to June 30, 1995. To identify predisposing risk factors, we employed an age- and gender-matched case-control study design using eight additional variables.Results A total of 181 new cases of atrial flutter were diagnosed for an overall incidence of 88/100,000 person-years. Incidence rates ranged from 5/100,000 in those <50 years old to 587/100,000 in subjects older than 80. Atrial flutter was 2.5 times more common in men (p < 0.001). The risk of developing atrial flutter increased 3.5 times (p < 0.001) in subjects with heart failure and 1.9 times (p < 0.001) for subjects with chronic obstructive pulmonary disease. Among those with atrial flutter 16% were attributable to heart failure and 12% to chronic obstructive lung disease. Three subjects (1.7%) without identifiable predisposing risks were labeled as having "lone atrial flutter."Conclusions This study, the first population-based investigation of atrial flutter, suggests this curable condition is much more common than previously appreciated. If our findings were applicable to the entire U.S. population, we estimate 200,000 new cases of atrial flutter in this country annually. At highest risk of developing atrial flutter are men, the elderly and individuals with preexisting heart failure or chronic obstructive lung disease.
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These data translate to 200,000 new cases of AFL in the USA annually, with the arrhythmia being more common in men, the elderly, and individuals with pre-existing heart failure or chronic obstructive lung disease.
“These data translate to 200 000 new cases of AFL in the USA annually, the arrhythmia being more common in men, the elderly and individuals with pre-existing heart failure or chronic obstructive lung disease.”
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 [11]
In MESA, AFL had an incidence of 0.09% and 58% of patients also had AF.
“In MESA, AFL had an incidence of 0.09% and 58% of the patients also had AF.”
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 [11]
Atrial flutter was 3.5-fold more common in subjects with heart failure.
“3.5-fold more common in subjects with heart failure”
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 [11]
For AFL, one MESA report of 181 new cases estimated an overall incidence of 88 per 100,000 person-years.
“For AFL, one report from MESA of 181 new cases of AFL estimated an overall incidence of 88/100 000 person-years.11”
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 [11]
AFL incidence rates ranged from 5 per 100,000 in those under 50 years old to 587 per 100,000 in subjects older than 80 years.
“Incidence rates ranged from 5/100 000 in those ,50 years old to 587/100 000 in subjects older than 80 years.”
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 [11]
Atrial flutter was 1.9-fold more common in subjects with chronic obstructive pulmonary disease.
“and 1.9-fold more common in subjects with chronic obstructive pulmonary disease.”
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 [11]
In MESA, only 3 subjects (1.7%) were labelled as having 'lone AFL'.
“Only 3 subjects (1.7%) were labelled as having 'lone AFL'.”
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 [11]
Atrial flutter was 2.5-fold more common in men.
“Atrial flutter was 2.5-fold more common in men”
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 [11]
Male sex is more prevalent in AFL (≈80%) than AF.
“Male sex is more prevalent in AFL (≈80%) than AF.11”
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 [11]
Multiple circuits are possible in AFL, including CTI-dependent AFL which remains the most common type even after surgery or ablation.
“Multiple circuits are possible, including CTI-dependent AFL which still is the most common type even in these situations.11,159,160”
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 [11]
The prevalence of atrial flutter is less than one-tenth of the prevalence of AF.
“The prevalence of atrial flutter is less than one-tenth of the prevalence of AF. 159”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [159]
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- Authors
- Granada, J., Uribe, W., Chyou, P.-H., Maassen, K., Vierkant, R., Smith, P. N., Hayes, J., Eaker, E., & Vidaillet, H.
- Affiliations
- Marshfield Clinic (US)
- Clínica Medellín SAS (CO)
- Mayo Clinic (US)
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2000-12
- Volume
- 36
- Issue
- 7
- Pages
- 2242-2246
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2153191832
- Cited by
- 375
- References
- 28
- Citations by year
- 2026: 9 · 2025: 16 · 2024: 16 · 2023: 33 · 2022: 26 · 2021: 22 · 2020: 14 · 2019: 9 · 2018: 16 · 2017: 29 · 2016: 17 · 2015: 9 · 2014: 16 · 2013: 21 · 2012: 16
- FWCI
- 4.94
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- atrial flutter, incidence, risk factors, heart failure, chronic obstructive pulmonary disease, sex differences, older adults, population-based epidemiology
- MeSH terms
- Adult, Aged, Aged, 80 and over, Atrial Flutter, Humans, Middle Aged, Risk Factors, Wisconsin, Incidence, Case-Control Studies
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