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. 1997 Sep;78(3):250–254. doi: 10.1136/hrt.78.3.250

Left atrial appendage function in patients with atrial flutter.

H Omran 1, W Jung 1, R Rabahieh 1, D MacCarter 1, S Illien 1, B Rang 1, A Hagendorff 1, R Schimpf 1, B Lüderitz 1
PMCID: PMC484926  PMID: 9391286

Abstract

OBJECTIVE: To determine whether echocardiographic markers thromboembolic risk differ between patients with pure atrial flutter and patients with atrial flutter and intermittent atrial fibrillation. DESIGN: Patients with atrial flutter were followed up prospectively for 12 months to identify intermittent atrial fibrillation. After the follow up period, transthoracic and multiplane transoesophageal echocardiography were performed to assess left atrial chamber and appendage size, peak emptying velocities, and emptying fraction of the left atrial appendage. The presence of spontaneous echo contrast was also determined. SETTING: Tertiary cardiac care centre. PATIENTS: 20 consecutive patients with atrial flutter; 11 healthy subjects in sinus rhythm served as controls. RESULTS: Intermittent atrial fibrillation was documented in 11 patients by Holter monitoring or surface ECG; atrial fibrillation was not found in the other nine patients. Compared with the patients with pure atrial flutter, patients with atrial flutter and intermittent atrial fibrillation had larger left atrial chamber (mean (SD) 4.5 (0.6) v 3.8 (0.5) cm; 95% confidence interval 0.2 to 1.2; P = 0.01) and appendage areas (6.7 (2.2) v 4.8 (4.9) cm; 95% CI 0.4 to 3.5; P = 0.02), lower left atrial appendage emptying fractions (33 (11)% v 52 (11)%; 95% CI 8 to 29; P = 0.008), and also lower left atrial appendage emptying velocities (0.44 (0.21) v 0.79 (0.27) m/s; 95% CI 0.13 to 0.56; P = 0.005). In addition, a higher incidence of spontaneous echo contrast (11% v 36%) was observed in patients with atrial flutter and intermittent atrial fibrillation. CONCLUSIONS: Left atrial appendage function is depressed and spontaneous echo contrast more frequent in patients with atrial flutter and intermittent atrial fibrillation, as opposed to patients with pure atrial flutter. These data support the concept that patients with atrial flutter and intermittent atrial fibrillation have an increased risk of thromboembolic events and should therefore receive adequate anticoagulant treatment.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Arnold A. Z., Mick M. J., Mazurek R. P., Loop F. D., Trohman R. G. Role of prophylactic anticoagulation for direct current cardioversion in patients with atrial fibrillation or atrial flutter. J Am Coll Cardiol. 1992 Mar 15;19(4):851–855. doi: 10.1016/0735-1097(92)90530-z. [DOI] [PubMed] [Google Scholar]
  2. Black I. W., Hopkins A. P., Lee L. C., Walsh W. F. Evaluation of transesophageal echocardiography before cardioversion of atrial fibrillation and flutter in nonanticoagulated patients. Am Heart J. 1993 Aug;126(2):375–381. doi: 10.1016/0002-8703(93)91054-i. [DOI] [PubMed] [Google Scholar]
  3. Black I. W., Hopkins A. P., Lee L. C., Walsh W. F. Left atrial spontaneous echo contrast: a clinical and echocardiographic analysis. J Am Coll Cardiol. 1991 Aug;18(2):398–404. doi: 10.1016/0735-1097(91)90592-w. [DOI] [PubMed] [Google Scholar]
  4. Fatkin D., Kelly R. P., Feneley M. P. Relations between left atrial appendage blood flow velocity, spontaneous echocardiographic contrast and thromboembolic risk in vivo. J Am Coll Cardiol. 1994 Mar 15;23(4):961–969. doi: 10.1016/0735-1097(94)90644-0. [DOI] [PubMed] [Google Scholar]
  5. Grimm R. A., Chandra S., Klein A. L., Stewart W. J., Black I. W., Kidwell G. A., Thomas J. D. Characterization of left atrial appendage Doppler flow in atrial fibrillation and flutter by Fourier analysis. Am Heart J. 1996 Aug;132(2 Pt 1):286–296. doi: 10.1016/s0002-8703(96)90424-x. [DOI] [PubMed] [Google Scholar]
  6. Henry W. L., DeMaria A., Gramiak R., King D. L., Kisslo J. A., Popp R. L., Sahn D. J., Schiller N. B., Tajik A., Teichholz L. E. Report of the American Society of Echocardiography Committee on Nomenclature and Standards in Two-dimensional Echocardiography. Circulation. 1980 Aug;62(2):212–217. doi: 10.1161/01.cir.62.2.212. [DOI] [PubMed] [Google Scholar]
  7. Jones E. F., Calafiore P., McNeil J. J., Tonkin A. M., Donnan G. A. Atrial fibrillation with left atrial spontaneous contrast detected by transesophageal echocardiography is a potent risk factor for stroke. Am J Cardiol. 1996 Aug 15;78(4):425–429. doi: 10.1016/s0002-9149(96)00331-1. [DOI] [PubMed] [Google Scholar]
  8. Kinch J. W., Davidoff R. Prevention of embolic events after cardioversion of atrial fibrillation. Current and evolving strategies. Arch Intern Med. 1995 Jul 10;155(13):1353–1360. [PubMed] [Google Scholar]
  9. Kronik G., Stöllberger C., Schuh M., Abzieher F., Slany J., Schneider B. Interobserver variability in the detection of spontaneous echo contrast, left atrial thrombi, and left atrial appendage thrombi by transoesophageal echocardiography. Br Heart J. 1995 Jul;74(1):80–83. doi: 10.1136/hrt.74.1.80. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Leung D. Y., Black I. W., Cranney G. B., Hopkins A. P., Walsh W. F. Prognostic implications of left atrial spontaneous echo contrast in nonvalvular atrial fibrillation. J Am Coll Cardiol. 1994 Sep;24(3):755–762. doi: 10.1016/0735-1097(94)90025-6. [DOI] [PubMed] [Google Scholar]
  11. Omran H., Jung W., Rabahieh R., Schimpf R., Wolpert C., Hagendorff A., Fehske W., Lüderitz B. Left atrial chamber and appendage function after internal atrial defibrillation: a prospective and serial transesophageal echocardiographic study. J Am Coll Cardiol. 1997 Jan;29(1):131–138. doi: 10.1016/s0735-1097(96)00439-1. [DOI] [PubMed] [Google Scholar]
  12. Pollick C., Taylor D. Assessment of left atrial appendage function by transesophageal echocardiography. Implications for the development of thrombus. Circulation. 1991 Jul;84(1):223–231. doi: 10.1161/01.cir.84.1.223. [DOI] [PubMed] [Google Scholar]
  13. Santiago D., Warshofsky M., Li Mandri G., Di Tullio M., Coromilas J., Reiffel J., Homma S. Left atrial appendage function and thrombus formation in atrial fibrillation-flutter: a transesophageal echocardiographic study. J Am Coll Cardiol. 1994 Jul;24(1):159–164. doi: 10.1016/0735-1097(94)90557-6. [DOI] [PubMed] [Google Scholar]

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