Atrial Flutter and Thromboembolic Risk

Vadmann H, Nielsen PB, Hjortshøj SP, et al.
Atrial Flutter and Thromboembolic Risk: A Systematic Review. Heart 2015;Jul 6:[Epub ahead of print].

The following are key points to remember from this review on atrial flutter and thromboembolic risk:

  1. Atrial flutter is associated with a thromboembolic risk, but contrary to atrial fibrillation, the relationship has only been examined in a few studies.
  2. Sharing similar epidemiologic relationships, atrial flutter and fibrillation often coexist, and the thromboembolic risk attributable solely to atrial flutter is difficult to ascertain.
  3. American College of Cardiology/American Heart Association/European Society of Cardiology guidelines from 2006, 2008, 2010, 2011, and 2013 recommend antithrombotic therapy for patients with atrial flutter as for those with atrial fibrillation, with a Level of Evidence C.
  4. The authors of the present study conducted a systematic review of the published literature in MEDLINE and EMBASE prior to October 2014.
  5. Initial screening of titles and abstracts identified 298 articles. Among, those a large majority of articles (242) failed to pass quality screening.
  6. The systematic review identified 52 studies: 6 observational studies, 15 echocardiographic studies, and 14 direct cardioversion studies; the remainder being ablation studies and case reports. There were no randomized controlled trials of antithrombotic therapy in the treatment of atrial flutter.
  7. The authors found a clear increase in thromboembolic risk in atrial flutter, but, due to large heterogeneity of the studies reviewed, believed it was not possible to make an exact estimate of the risk.
  8. The authors of the review agree with the guideline writers that based on extrapolation from atrial fibrillation trials, thromboprophylaxis should be strongly considered in patients with atrial flutter in the presence of one or more additional stroke risk factors.

Clinical Topics: Arrhythmias and Clinical EP, Noninvasive Imaging, Prevention, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Echocardiography/Ultrasound

Keywords: Arrhythmias, Cardiac, Atrial Fibrillation, Atrial Flutter, Echocardiography, Electric Countershock, Fibrinolytic Agents, Risk Factors, Secondary Prevention, Stroke, Thromboembolism, Thrombosis

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