Atrial Appendage Thrombosis Risk Is Lower for Atrial Flutter Compared with Atrial Fibrillation

Huang, Jennifer; Reddy, Sridhar; Truong, Tam; Suryanarayana, Prakash; Alpert, Joseph S.

doi:10.1016/j.amjmed.2017.10.041

Cited by 11 publications

(10 citation statements)

References 16 publications

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“…For the CHD/cardiomyopathy patients only, there continued to be no significant difference between the AFL and The recent data on non-CHD adults showed an 11% prevalence of intracardiac thrombus in patients presenting with AF (n = 114), while no patients with AFL (n = 55) were found to have intracardiac thrombus. 13 Similar findings in the CHD population would be significant, as TEE evaluation and anti-coagulation therapy carry a significant level of morbidity (bleeding, general anesthesia, diminished ventricular function secondary to chronic tachycardia) as well as dedicated time and resources. As the CHD population continues to age with improved survival for more complex disease, the population of patients with AF and AFL will only grow.…”

Section: Resultsmentioning

confidence: 79%

Difference in the prevalence of intracardiac thrombus on the first presentation of atrial fibrillation versus flutter in the pediatric and congenital heart disease population

Meziab

Marcondes

Friedman

et al. 2020

Cardiovasc electrophysiol

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Introduction: Guidelines recommend trans-esophageal echocardiography (TEE) for patients with atrial fibrillation (AF) or atrial flutter (AFL) for >48 h, due to risk of intracardiac thrombus formation. With growing evidence that AFL in adults with structurally normal hearts has less thrombogenic potential compared to AF, and the need for TEE questioned, we compared prevalence of intracardiac thrombus detected by TEE in pediatric and congenital heart disease (CHD) patients presenting in AF and AFL. Methods/Results: Single-center, cross-sectional analysis for unique first-time presentations of patients for either AF, AFL, or intra-atrial reentrant tachycardia (IART) between 2000 and 2019. Patients were categorized by presenting arrhythmia (AF vs. AFL/IART), with the exclusion of other forms of atrial tachycardia, hemodynamic instability, chronic anti-coagulation before TEE, and presentation for a reason other than TEE examination for thrombus. A total of 201 patients had TEE with co-diagnosis of AF or AFL. Of these, 105 patients (29 AF, 76 AFL) met inclusion criteria, with no difference in age between AF (median 24.9 years; IQR 18.6-38.3 years) and AFL/IART (23.3 years; 15.4-38.4 years). The prevalence of thrombus in the entire cohort was 9.5%, with no difference between AF (13.8%) and AFL groups (7.9%), p = .46. Patients with thrombus demonstrated no difference in age, systemic ventricular function, cardiac complexity, or CHADS2/CHA2DS2VASc score at presentation. Conclusions: The risk for intracardiac thrombus is high in the pediatric and CHD population, with no apparent distinguishing factors to warrant a change in the recommendations for TEE, with all levels of cardiac complexity being at risk for clot.

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Section: Resultsmentioning

confidence: 79%

Difference in the prevalence of intracardiac thrombus on the first presentation of atrial fibrillation versus flutter in the pediatric and congenital heart disease population

Meziab

Marcondes

Friedman

et al. 2020

Cardiovasc electrophysiol

View full text Add to dashboard Cite

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“…Compared with the well-established correlation between depressed LAA function and cardiogenic thromboembolism in AF, data on AFL appear heterogeneous and sometimes contradictory in previous studies 2,3,20 . Sakurai et al .…”

Section: Discussionmentioning

confidence: 76%

“…(52.6 ± 18.2 cm/s vs. 31.6 ± 13.1 cm/s) and Huang et al . (63.3 cm/s vs. 44.4 cm/s) 3,7 ; this indicates that patients with AFL, in general, may not be in the same prothrombotic state as those with AF.…”

Section: Discussionmentioning

confidence: 93%

“…However, patients with AFL may not be in the same prothrombotic state when compared with those with AF as previously thought 14 . The reported prevalence of LAA thrombi in patients with AFL varies from 0% to 11% among different populations studied 2,3,23,24 . We also found a low frequency of LAA thrombi in the patients with AFL + PAF (5.3%), which may be attributed to the low incidence of structural heart disease in our study patients.…”

Section: Discussionmentioning

confidence: 97%

“…Patients with AFL are considered to have equivalent thromboembolic risks similar to patients with AF based on limited data 2,3 . However, these patients, in general, may not be in the same prothrombotic state as those with AF 2 .…”

Section: Introductionmentioning

confidence: 99%

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Inverse Correlation Between Left Atrial Appendage Function and CHA2DS2-VASc Score in Patients with Atrial Flutter

Lin

et al. 2019

Sci Rep

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Impaired left atrial appendage ejection fraction (LAA-EF) and peak LAA flow velocity (LAA-FV) are associated with high thromboembolic risks in patients with atrial fibrillation (AF). Herein, we examined LAA function among patients with atrial flutter (AFL) stratified by the CHA2DS2-VASc score using transesophageal echocardiography (TEE). Of 231 consecutive patients with typical AFL, 84 who fulfilled the inclusion criteria were enrolled. Among them, 57 had ongoing AFL and were divided into the isolated AFL (n = 38) and AFL with paroxysmal AF (PAF) (n = 19) groups, depending on whether they had sporadic AF before TEE. The remaining 27 patients with spontaneous sinus rhythm during TEE were designated as controls. Both the LAA-FV (31.9 cm/s vs. 51.5 cm/s, P = 0.004) and LAA-EF (28.4% vs. 36.5%, P = 0.024) measured during AFL were significantly lower in the AFL + PAF group than in the isolated AFL group. Significant inverse correlations between the CHA2DS2-VASc score and LAA-EF were identified in the AFL (P = 0.008) and AFL + PAF (P = 0.032) groups. We observed progressive LAA dysfunction in patients with AFL + PAF compared with that in patients with isolated AFL, and the LAA-EF was inversely correlated with the CHA2DS2-VASc score in these patients. Our findings may have implications on the application of thromboprophylactic therapy in patients with AFL.

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Comprehensive Analysis of Anticoagulant Therapy in Patients with Isolated Atrial Flutter

Ardashev,

Passman,

Zotova

et al. 2024

The American Journal of Cardiology

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Atrial Appendage Thrombosis Risk Is Lower for Atrial Flutter Compared with Atrial Fibrillation

Cited by 11 publications

References 16 publications

Difference in the prevalence of intracardiac thrombus on the first presentation of atrial fibrillation versus flutter in the pediatric and congenital heart disease population

Difference in the prevalence of intracardiac thrombus on the first presentation of atrial fibrillation versus flutter in the pediatric and congenital heart disease population

Inverse Correlation Between Left Atrial Appendage Function and CHA2DS2-VASc Score in Patients with Atrial Flutter

Comprehensive Analysis of Anticoagulant Therapy in Patients with Isolated Atrial Flutter

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