Prevalence of Thrombus, Spontaneous Echo Contrast, and Atrial Stunning in Patients Undergoing Cardioversion of Atrial Flutter: A Prospective Study Using Transesophageal Echocardiography
Abstract
BACKGROUND: Several studies have shown that patients undergoing cardioversion of atrial fibrillation have a high prevalence of of atrial thrombus and spontaneous echo contrast and frequently develop atrial stunning after restoration of sinus rhythm. These findings are strongly associated with increased risk of embolism in these patients. However, little is known about the prevalence of these markers of thromboembolism in patients undergoing cardioversion of atrial flutter. METHODS AND RESULTS: We performed transesophageal echocardiography in 47 consecutive, nonanticoagulated patients scheduled for elective cardioversion of atrial flutter. In patients who underwent successful cardioversion, mitral inflow velocity was recorded by transthoracic pulsed Doppler examination immediately after restoration of sinus rhythm. All patients were men (mean age, 65 +/- 10 years). Mean duration of flutter was 4 +/- 9 weeks. Atrial thrombus and/or spontaneous echo contrast were found in 16 patients (34%). Left atrial thrombus was seen in 5 patients (11%), either with (n = 4) or without spontaneous contrast. Of 40 patients with successful cardioversion, atrial mechanical activity was absent in 28% immediately after restoration of sinus rhythm. CONCLUSIONS: Our findings suggest that contrary to traditional teaching, atrial thrombus and spontaneous contrast are not uncommon in patients with atrial flutter and cardioversion may be associated with increased risk of thromboembolism.
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In AFL lasting >48h, risk of thromboembolism appears high at the time of cardioversion to sinus rhythm by DC shock, atrial stimulation, or CTI ablation, and anticoagulation is recommended as in AF.
“In patients with AFL lasting .48h the risk of thromboembolism would appear high at the time of cardioversion to sinus rhythm, either by DC shock, atrial stimulation or CTI ablation, 133,134 and anticoagulation is recommended as in 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 [134]
Spontaneous echo contrast and LA appendage stunning have been reported in patients undergoing cardioversion of AFL, suggesting high embolic risk.
“Spontaneous echo contrast and LA appendage stunning have been reported in patients undergoing cardioversion of AFL, suggesting a high embolic risk in this situation.133,134”
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 [134]
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- Authors
- Irani, W. N., Grayburn, P. A., & Afridi, I.
- Affiliations
- Dallas VA Medical Center (US)
- Venue
- Circulation
- Published
- 1997-02-18
- Volume
- 95
- Issue
- 4
- Pages
- 962-966
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2008429532
- Cited by
- 151
- References
- 27
- Citations by year
- 2024: 3 · 2022: 2 · 2021: 2 · 2020: 2 · 2019: 1 · 2018: 4 · 2017: 6 · 2016: 5 · 2015: 4 · 2014: 1 · 2013: 4 · 2012: 3
- FWCI
- 7.06
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (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 › Cardiology and Cardiovascular Medicine › Cardiac tumors and thrombi
- Keywords
- atrial flutter, cardioversion, atrial thrombus, spontaneous echo contrast, atrial stunning, thromboembolic risk, left atrial thrombus, mitral inflow velocity, transesophageal echocardiography
- MeSH terms
- Adult, Aged, Atrial Flutter, Echocardiography, Electric Countershock, Female, Heart Atria, Humans, Male, Middle Aged, Prospective Studies, Thrombosis, Prevalence, Echocardiography, Transesophageal, Myocardial Stunning, Echocardiography, Doppler, Pulsed
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