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European Heart Journal 2001 22(12):1042-1051; doi:10.1053/euhj.2000.2427
Copyright © 2001 by the European Society of Cardiology.
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Thromboembolic risk in atrial flutter. The FLASIEC (FLutterAtrialeSocietàIaliana diEcografiaCardiovascolare) multicentre study

G Corradoa,f1, A Sgalambrob, A Manteroc, F Gentiled, M Gasparinie, R Bufalinoe, A Morabitof, G Trocinog, R Schiavinag, S Mandorlah, R Mangiai, D Tovenaj, K Savinok, F Jacopil, E.M Pellegrinom, F Agostinin, G Centonzeo, F Bovenzip, E Caprinoq, G Tadeoa and M Santarone for the FLASIEC investigatorsa

a Unità Operativa di Cardiologia, Ospedale Generale Valduce, Como, Italy
b Servizio di Diagnostica Policardiografica con Unità Coronarica, Ospedale Civico, Codogno, Italy
c Servizio Centrale di Cardiologia, Ospedale Niguarda, Milano, Italy
d Divisione di Cardiologia, Ospedale Bassini, Cinisello Balsamo, Italy
e Dipartimento di Cardiologia, Istituto Clinico Humanitas, Rozzano, Italy
f Istituto di Statistica Medica e Biometria, Università degli Studi di Milano, Italy
g Divisione di Cardiologia, Ospedale San Gerardo dei Tintori, Monza, Italy
h Divisione di Cardiologia, Ospedale Silvestrini, Perugia, Italy
i Divisione di Cardiologia, Ospedale Cardinale Panico, Tricase, Italy
j Divisione di Cardiologia, Ospedale Maggiore, Crema, Italy
k Cattedra di Cardiologia, Università degli Studi di Perugia, Italy
l Dipartimento di Cardiologia, Ravenna-Faenza-Lugo, Sede di Faenza, Italy
m Divisione di Cardiologia, Ospedale Sacro Cuore di Gesù, Gallipoli, Italy
n Ospedale Carlo Poma, Mantova, Italy
o Servizio Autonomo di Cardiologia, Ospedale di Matera, Italy
p Divisione di Cardiologia, Policlinico di Bari, Italy
q Divisione di Cardiologia, Ospedale Civile, Vigevano, Italy

revised August 20, 2000; accepted August 23, 2000

Abstract

Aims Patients with atrial flutter are believed to be at lower risk of thromboembolism than patients with atrial fibrillation. However, the incidence of atrial thrombi and the need for anticoagulation in patients with atrial flutter is not well established.

Methods and Results A prospective observational multicentre study was undertaken to assess the frequency of atrial thrombi and spontaneous echocontrast and the prevalence for aortic complex atherosclerotic lesions in a cohort of unselected patients with atrial flutter. We evaluated 134 patients (102 male, aged 70±9 years); exclusion criteria were history of atrial fibrillation, rheumatic mitral valve disease and mitral mechanical prosthesis. The median of atrial flutter duration was 33 days. Twelve patients had been taking warfarin for more than 7 days. One hundred and twenty-four patients (94%) underwent a transoesophageal echocardiogram, which revealed left atrial appendage thrombi in two patients (1·6%) and right atrial thrombi in one patient (1%). At least moderate left atrial echocontrast was found in 16/124 patients (13%). Complex atherosclerotic aortic plaques were detected in 10 patients (8%). Atrial flutter conversion was attempted in 93/134 patients (69%). At the 1-month follow-up, two patients experienced a thromboembolic event following restoration of sinus rhythm.

Conclusions Atrial thrombi and echocontrast, and complex aortic atherosclerotic plaques are relatively uncommon in patients with atrial flutter. Post-cardioversion embolism was observed in two patients in our study population.

Key Words: Atrial flutter, echocardiography, thromboembolism

f1 Correspondence: Dr Giovanni Corrado, Unità Operativa di Cardiologia, Ospedale Generale Valduce, Via Dante 11, 22100 Como, Italy.


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