Clinical studyThromboembolic complications after electrical cardioversion in patients with atrial flutter
Section snippets
Study population
This was a retrospective analysis of 615 electrical cardioversions performed electively in 493 patients at the Mayo Clinic, Rochester, Minnesota, from 1990 through 1994. Patients were identified consecutively through a registry of cardioversions performed at our institution. Atrial flutter was defined as an organized atrial tachycardia of 240 beats/min or more. The duration of atrial flutter, defined by documentation of arrhythmias on echocardiographic recordings, was less than 1 month in 439
Results
The mean age of the study patients was 66 ± 15 years. There were 362 men (73%). Associated diseases were hypertension in 218 patients (44%), diabetes mellitus in 87 (18%), coronary artery disease in 214 (43%), valvular heart disease in 126 (26%), and cardiomyopathy in 90 (18%). Previous atrial fibrillation was documented in 283 procedures (46%).
Procedures that were performed without anticoagulation were associated with a shorter duration of atrial flutter, lower left atrial and left ventricular
Discussion
In this study, successful restoration of sinus rhythm after atrial flutter was achieved in 93% of the cardioversion procedures. Failure of cardioversion was significantly associated with older age (P = 0.01) and longer duration of atrial flutter (P = 0.02). Diabetes mellitus, valvular heart disease, cardiomyopathy, and coronary artery disease had no impact on the success of cardioversion, suggesting that cardioversion should not be deferred in patients presenting with atrial flutter on the
References (21)
- et al.
The efficacy of anticoagulant therapy in preventing embolism related to D.C. electrical conversion of atrial fibrillation
Am J Cardiol
(1969) - et al.
Role of prophylactic anticoagulation for direct current cardioversion in patients with atrial fibrillation or atrial flutter
J Am Coll Cardiol
(1992) - et al.
Risk of thromboembolism in chronic atrial flutter
Am J Cardiol
(1997) - et al.
Thromboembolism in chronic atrial flutteris the risk underestimated?
J Am Coll Cardiol
(1997) - et al.
Risk of thromboembolic events in patients with atrial flutter
Am J Cardiol
(1998) - et al.
Thromboembolism following cardioversion of “common” atrial flutter. Risk factors and limitations of transesophageal echocardiography
Chest
(1996) - et al.
Limitations of transesophageal echocardiography in the risk assessment of patients before nonanticoagulated cardioversion from atrial fibrillation and flutteran analysis of pooled trials
Am Heart J
(1995) - et al.
Prevalence of intraatrial thrombus in patients with atrial flutter
Am J Cardiol
(1995) - et al.
Left atrial appendage function and thrombus formation in atrial fibrillation-fluttera transesophageal echocardiographic study
J Am Coll Cardiol
(1994) - et al.
Acute changes in spontaneous echo contrast and atrial function after cardioversion of persistent atrial flutter
Am J Cardiol
(1998)
Cited by (25)
The 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society Comprehensive Guidelines for the Management of Atrial Fibrillation
2020, Canadian Journal of CardiologyPeriprocedural Anticoagulation for Cardioversion of Acute Onset Atrial Fibrillation and Flutter: Evidence Base for Current Guidelines
2019, Canadian Journal of CardiologyCitation Excerpt :Observational studies of patients with nonacute AF/AFL (AF episode durations > 48 hours) have reported a risk of a thromboembolism in the 30 days after CV of 1.76%-2.39% in those who received no or inadequate OAC therapy and 0.20%-0.45% in those who received adequate OAC therapy (defined as therapeutic OACs for at least 3 weeks before the CV; Fig. 1).4,5,17-28
Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report
2018, ChestCitation Excerpt :However, patients with atrial flutter frequently present phases of AF alternated with phases of classical flutter or regular atrial rhythm.392-394 A systematic review on the thromboembolic risk associated with atrial flutter, including 52 articles, found that thromboembolic event rates after cardioversion varied from 0% to 6% with a follow-up from 1 week to 6 years.234,271,274,275,395-405 Echocardiographic studies reported prevalence of intra-atrial thrombi from 0% to 38% and a prevalence of spontaneous echo contrast up to 28%.392,393,403,406-415
Canadian Cardiovascular Society atrial fibrillation guidelines 2010: Prevention of stroke and systemic thromboembolism in atrial fibrillation and flutter
2011, Canadian Journal of CardiologyCitation Excerpt :The potential role of TEE to rule out the presence of atrial thrombi and the avoidance of anticoagulation was studied in several case series. An overview of these studies71 reported that patients with no atrial thrombus who then underwent electrical cardioversion had an unacceptably high incidence of embolization by comparison with anticoagulated patients in separate case series. It is generally accepted that the absence of thrombi on TEE does not eliminate the requirement for a period of 4 weeks of anticoagulation following cardioversion.
Antithrombotic therapy in atrial fibrillation: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition)
2008, ChestCitation Excerpt :Patients at particularly high risk include those with valvular heart disease, prior thromboembolism, congestive heart failure and left ventricular systolic dysfunction. Several other reports have shown no events among patients receiving pre- and post-cardioversion warfarin therapy.189,190,263 As with AF, a transient reduction in atrial mechanical activity (atrial “stunning”) is common after successful cardioversion of atrial flutter although the severity of the depression is less pronounced than for AF.184,187,264,265