Embolic risk and the role of anticoagulation in atrial flutter
- Warren J Manning, MD
Warren J Manning, MD
- Section Editor — Noninvasive Cardiac Imaging and Stress Testing
- Professor of Medicine and Radiology
- Harvard Medical School
- Jordan M Prutkin, MD, MHS, FHRS
Jordan M Prutkin, MD, MHS, FHRS
- Associate Professor of Medicine, Division of Cardiology, Electrophysiology Section
- University of Washington
- Section Editors
- Bradley P Knight, MD, FACC
Bradley P Knight, MD, FACC
- Section Editor — Cardiac Arrhythmias
- Professor of Medicine
- Feinberg School of Medicine, Northwestern University
- Scott E Kasner, MD
Scott E Kasner, MD
- Section Editor — Stroke
- Professor of Neurology
- University of Pennsylvania School of Medicine
Most patients with atrial flutter should be considered for long-term anticoagulation in a manner similar to those with atrial fibrillation (AF). This recommendation is based not only on the fact atrial flutter carries a risk for systemic embolization but also that these patients usually have episodes of AF. (See "Atrial fibrillation: Anticoagulant therapy to prevent embolization", section on 'Summary and recommendations'.)
Our approach to anticoagulation applies to all types of atrial flutter, whether it is typical or atypical, or whether it is type I or type II. (See "Electrocardiographic and electrophysiologic features of atrial flutter".)
PREVALENCE OF THROMBUS
Many patients with atrial flutter have alternating periods of atrial fibrillation (AF) making it difficult to know the exact risk of thrombus formation (and subsequent embolization) attributable to atrial flutter .
Atrial mechanical function is not normal in patients with atrial flutter. However, Doppler echocardiography demonstrates more organized atrial mechanical function with sustained atrial flutter, as opposed to AF, in which organized atrial contraction is absent. One study performed transesophageal echocardiography (TEE) immediately before and after cardioversion in 19 patients with atrial flutter and 44 patients with AF with the following findings :
●Prior to cardioversion, patients with atrial flutter had greater left atrial appendage ejection velocities and shear rates compared to those with AF.
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