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

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

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: The risk of stroke and thromboembolism in atrial fibrillation is established. However, the evidence surrounding the risk of thromboembolism in patients with atrial flutter is not as clear. We hypothesized that atrial flutter would have indicators of less risk for thromboembolism compared with atrial fibrillation on transesophageal echocardiography, thereby possibly leading to a lower stroke risk. Methods: A retrospective review of 2225 patients undergoing transesophageal echocardiography was performed. Those with atrial fibrillation or atrial flutter were screened. Exclusion criteria were patients being treated with chronic anticoagulation, the presence of a prosthetic valve, moderate to severe mitral regurgitation or stenosis, congenital heart disease, or a history of heart transplantation. A total of 114 patients with atrial fibrillation and 55 patients with atrial flutter met the criteria and were included in the analysis. Results: Twelve patients (11%) in the atrial fibrillation group had left atrial appendage thrombus versus zero patients in the atrial flutter group (P < .05). The prevalence of spontaneous echocardiography contrast was significantly higher and left atrial appendage emptying velocity was significantly lower in the atrial fibrillation group compared with the atrial flutter group (P < .001). No spontaneous contrast was seen when the left atrial appendage emptying velocity was >60 cm/sec. Conclusions: Patients with atrial flutter have a lower incidence of left atrial appendage thrombi, higher left atrial appendage emptying velocity, and less left atrial spontaneous contrast compared with patients with atrial fibrillation, suggesting a lower risk for potential arterial thromboembolism.

Original languageEnglish (US)
JournalAmerican Journal of Medicine
DOIs
StateAccepted/In press - Jan 1 2017
Externally publishedYes

Fingerprint

Atrial Appendage
Atrial Flutter
Atrial Fibrillation
Thrombosis
Thromboembolism
Transesophageal Echocardiography
Stroke
Mitral Valve Stenosis
Mitral Valve Insufficiency
Heart Transplantation
Heart Diseases

Keywords

  • Atrial fibrillation
  • Atrial flutter
  • Left atrial appendage emptying velocity
  • Left atrial spontaneous contrast

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Atrial Appendage Thrombosis Risk Is Lower for Atrial Flutter Compared with Atrial Fibrillation. / Huang, Jennifer J.; Reddy, Sridhar; Truong, Tam H.; Suryanarayana, Prakash; Alpert, Joseph S.

In: American Journal of Medicine, 01.01.2017.

Research output: Contribution to journalArticle

Huang, Jennifer J. ; Reddy, Sridhar ; Truong, Tam H. ; Suryanarayana, Prakash ; Alpert, Joseph S. / Atrial Appendage Thrombosis Risk Is Lower for Atrial Flutter Compared with Atrial Fibrillation. In: American Journal of Medicine. 2017.
@article{124fbaa52dad4c51b02d0b032e986380,
title = "Atrial Appendage Thrombosis Risk Is Lower for Atrial Flutter Compared with Atrial Fibrillation",
abstract = "Background: The risk of stroke and thromboembolism in atrial fibrillation is established. However, the evidence surrounding the risk of thromboembolism in patients with atrial flutter is not as clear. We hypothesized that atrial flutter would have indicators of less risk for thromboembolism compared with atrial fibrillation on transesophageal echocardiography, thereby possibly leading to a lower stroke risk. Methods: A retrospective review of 2225 patients undergoing transesophageal echocardiography was performed. Those with atrial fibrillation or atrial flutter were screened. Exclusion criteria were patients being treated with chronic anticoagulation, the presence of a prosthetic valve, moderate to severe mitral regurgitation or stenosis, congenital heart disease, or a history of heart transplantation. A total of 114 patients with atrial fibrillation and 55 patients with atrial flutter met the criteria and were included in the analysis. Results: Twelve patients (11{\%}) in the atrial fibrillation group had left atrial appendage thrombus versus zero patients in the atrial flutter group (P < .05). The prevalence of spontaneous echocardiography contrast was significantly higher and left atrial appendage emptying velocity was significantly lower in the atrial fibrillation group compared with the atrial flutter group (P < .001). No spontaneous contrast was seen when the left atrial appendage emptying velocity was >60 cm/sec. Conclusions: Patients with atrial flutter have a lower incidence of left atrial appendage thrombi, higher left atrial appendage emptying velocity, and less left atrial spontaneous contrast compared with patients with atrial fibrillation, suggesting a lower risk for potential arterial thromboembolism.",
keywords = "Atrial fibrillation, Atrial flutter, Left atrial appendage emptying velocity, Left atrial spontaneous contrast",
author = "Huang, {Jennifer J.} and Sridhar Reddy and Truong, {Tam H.} and Prakash Suryanarayana and Alpert, {Joseph S}",
year = "2017",
month = "1",
day = "1",
doi = "10.1016/j.amjmed.2017.10.041",
language = "English (US)",
journal = "American Journal of Medicine",
issn = "0002-9343",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Atrial Appendage Thrombosis Risk Is Lower for Atrial Flutter Compared with Atrial Fibrillation

AU - Huang, Jennifer J.

AU - Reddy, Sridhar

AU - Truong, Tam H.

AU - Suryanarayana, Prakash

AU - Alpert, Joseph S

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Background: The risk of stroke and thromboembolism in atrial fibrillation is established. However, the evidence surrounding the risk of thromboembolism in patients with atrial flutter is not as clear. We hypothesized that atrial flutter would have indicators of less risk for thromboembolism compared with atrial fibrillation on transesophageal echocardiography, thereby possibly leading to a lower stroke risk. Methods: A retrospective review of 2225 patients undergoing transesophageal echocardiography was performed. Those with atrial fibrillation or atrial flutter were screened. Exclusion criteria were patients being treated with chronic anticoagulation, the presence of a prosthetic valve, moderate to severe mitral regurgitation or stenosis, congenital heart disease, or a history of heart transplantation. A total of 114 patients with atrial fibrillation and 55 patients with atrial flutter met the criteria and were included in the analysis. Results: Twelve patients (11%) in the atrial fibrillation group had left atrial appendage thrombus versus zero patients in the atrial flutter group (P < .05). The prevalence of spontaneous echocardiography contrast was significantly higher and left atrial appendage emptying velocity was significantly lower in the atrial fibrillation group compared with the atrial flutter group (P < .001). No spontaneous contrast was seen when the left atrial appendage emptying velocity was >60 cm/sec. Conclusions: Patients with atrial flutter have a lower incidence of left atrial appendage thrombi, higher left atrial appendage emptying velocity, and less left atrial spontaneous contrast compared with patients with atrial fibrillation, suggesting a lower risk for potential arterial thromboembolism.

AB - Background: The risk of stroke and thromboembolism in atrial fibrillation is established. However, the evidence surrounding the risk of thromboembolism in patients with atrial flutter is not as clear. We hypothesized that atrial flutter would have indicators of less risk for thromboembolism compared with atrial fibrillation on transesophageal echocardiography, thereby possibly leading to a lower stroke risk. Methods: A retrospective review of 2225 patients undergoing transesophageal echocardiography was performed. Those with atrial fibrillation or atrial flutter were screened. Exclusion criteria were patients being treated with chronic anticoagulation, the presence of a prosthetic valve, moderate to severe mitral regurgitation or stenosis, congenital heart disease, or a history of heart transplantation. A total of 114 patients with atrial fibrillation and 55 patients with atrial flutter met the criteria and were included in the analysis. Results: Twelve patients (11%) in the atrial fibrillation group had left atrial appendage thrombus versus zero patients in the atrial flutter group (P < .05). The prevalence of spontaneous echocardiography contrast was significantly higher and left atrial appendage emptying velocity was significantly lower in the atrial fibrillation group compared with the atrial flutter group (P < .001). No spontaneous contrast was seen when the left atrial appendage emptying velocity was >60 cm/sec. Conclusions: Patients with atrial flutter have a lower incidence of left atrial appendage thrombi, higher left atrial appendage emptying velocity, and less left atrial spontaneous contrast compared with patients with atrial fibrillation, suggesting a lower risk for potential arterial thromboembolism.

KW - Atrial fibrillation

KW - Atrial flutter

KW - Left atrial appendage emptying velocity

KW - Left atrial spontaneous contrast

UR - http://www.scopus.com/inward/record.url?scp=85038380255&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85038380255&partnerID=8YFLogxK

U2 - 10.1016/j.amjmed.2017.10.041

DO - 10.1016/j.amjmed.2017.10.041

M3 - Article

C2 - 29128265

AN - SCOPUS:85038380255

JO - American Journal of Medicine

JF - American Journal of Medicine

SN - 0002-9343

ER -