Atrial flutter and thromboembolic risk: a systematic review
Abstract
Atrial flutter confers a thromboembolic risk, but contrary to atrial fibrillation the relationship has only been addressed in few studies. This study performs an up to date systematic review of the literature to investigate the association between atrial flutter and thromboembolic events. Articles were found by MEDLINE, EMBASE search and a manual search of references list in included articles. International guidelines, meta-analyses, reviews, case reports, studies reporting thromboembolic events in relation to ablation, or cardioversion procedures, echocardiography, and observational studies were found eligible in this review. A total of 52 articles were included in this review. During cardioversion, thromboembolic event rates varied from 0% to 6% with a follow-up from 1 week to 6 years. Echocardiographic studies reported prevalence of thrombus material from 0% to 38% and a prevalence of spontaneous echo contrast (SEC) from 21% to 28%. One ablation study in non-anticoagulated patients reported thromboembolic events at 13.9%. Observational studies reported an overall elevated stroke risk (risk ratio 1.4, 95% CI 1.35 to 1.46) and mortality risk (HR 1.9, 95% CI 1.2 to 3.1) with long time follow-up compared with a control group in both studies. Given the limitations and heterogeneity of the data, a meta-analysis was not a part of this systematic review. Notwithstanding the limitations of observational studies and indirect data from echocardiographic studies, this systematic review confirms that clinical thromboembolic events, left atrial thrombus and SEC are highly prevalent in atrial flutter.
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The stroke risk in patients with atrial flutter is not much different from that in AF.
“Based on the available evidence, the stroke risk in patients with atrial flutter is not much different from that in AF. 827”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [827]
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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
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Self-citation2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
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Joglar, J. A., Chung, M. K., Armbruster, A. L., Benjamin, E. J., Chyou, J. Y., Cronin, E. M., Deswal, A., Eckhardt, L. L., Goldberger, Z. D., Gopinathannair, R., et al. (2024) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2023.08.017 · Cited by 933 · see citing works
- Authors
- Vadmann, H., Nielsen, P. B., Hjortshøj, S. P., Riahi, S., Rasmussen, L. H., Lip, G. Y. H., & Larsen, T. B.
- Affiliations
- Aalborg University Hospital (DK)
- Aalborg University (DK)
- Birmingham City Hospital (GB)
- Corresponding author
- Larsen, Torben Bjerregaard
- ORCID
- Venue
- Heart
- Publisher
- BMJ
- Published
- 2015-07-06
- Volume
- 101
- Issue
- 18
- Pages
- 1446-1455
- ISSN
- 1355-6037 (ISSN-L)
- 1468-201X
- OpenAlex
- W1914705848
- Cited by
- 72
- References
- 67
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 5 · 2023: 4 · 2022: 7 · 2021: 7 · 2020: 10 · 2019: 6 · 2018: 9 · 2017: 6 · 2016: 5 · 2015: 1
- FWCI
- 1.21
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Heart (publishedVersion)
- PubMed (publishedVersion)
- VBN Forskningsportal (Aalborg Universitet) (submittedVersion)
- 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 › Pulmonary and Respiratory Medicine › Cardiovascular and Diving-Related Complications
- Keywords
- atrial flutter, thromboembolic risk, stroke, cardioversion, catheter ablation, left atrial thrombus, spontaneous echo contrast, mortality, anticoagulation
- MeSH terms
- Anticoagulants, Atrial Flutter, Echocardiography, Electric Countershock, Humans, Thromboembolism, Catheter Ablation, Risk Assessment, Disease Management
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