Impaired Atrial Contraction in Patients With Atrial Flutter and Gradual Recovery After Cardioversion

Abstract

The risk of thromboembolism after cardioversion of atrial flutter is controversial. The present study provides evidence for blood stasis in the atria of patients with atrial flutter and for gradual recovery of atrial contraction after cardioversion, which justifies prophylactic treatment at cardioversion, as for atrial fibrillation. We examined atrial thrombi and peak flow velocity in the left atrial appendage as an index of blood stasis in 5 consecutive patients with atrial flutter. Transesophageal echocardiography revealed a thrombus in 1 patient, and peak flow velocity in the left atrial appendage was inversely correlated with left atrial dimension (r = -0.90, p < 0.05). After restoration of sinus rhythm, transmitral flow velocity in late diastole was also examined to evaluate the recovery of atrial contraction. The recovery of transmitral flow velocity the next day and 1 week after cardioversion was correlated with flow velocity in the left atrial appendage before cardioversion (r = 0.89, p < 0.05; r = 0.97, p < 0.01, respectively). These findings suggest that some patients with atrial flutter have impaired atrial contraction and that prolonged impairment after cardioversion is also possible. Atrial enlargement and low flow velocity in the atrial appendage were predictive factors for such patients.

Left atrial appendage thrombus in patients referred to electrical cardioversion for typical atrial flutter

“…AFL is associated with increased risk of heart failure (HF), stroke, systemic thromboembolism, and mortality [1,[4][5][6][7][8]. Stroke risk stratification in patients with AFL remains a complicated issue [1,[9][10][11][12]. Left atrial appendage thrombus (LAAT) is regarded as a risk factor for stroke in these patients; however, the actual LAATrelated health risk in patients with AFL on chronic anticoagulation remains unknown [13].…”

“…cardioversion, conservative management) or left atrial appendage morphology [13]. Although the restoration of sinus rhythm in patients with AFL increases the stroke risk [11,[14][15][16][17], the stroke mechanism can be difficult to establish [13]. The proper anticoagulation reduces stroke risk following the sinus rhythm restoration [1,13].…”