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Atrial flutter and embolic risk: The relationship between atrial flutter cycle length and left atrial appendage
Ana Paula Susin Osório1, Luciana Eder Martins Barros Simoni1, Antonio Lessa Gaudie Ley2
1Institute of Cardiology, University Foundation of Cardiology, Porto Alegre, Brazil.
Journal of Electrocardiology
|November 27, 2018
Summary
Atrial flutter cycle length (AFL-CL) is linked to reduced left atrial appendage emptying velocity (LAEV), increasing clot risk. A new index combining atrial rate and left atrial size predicts thrombus formation.
Area of Science:
- Cardiology
- Electrophysiology
- Thrombosis Research
Background:
- Atrial flutter (AFL) poses a distinct thromboembolic risk compared to atrial fibrillation.
- Rapid AFL cycle length (AFL-CL) can impair left atrial appendage (LAA) function, reducing emptying velocity (LAEV) and increasing clot formation risk.
Purpose of the Study:
- To investigate the relationship between AFL-CL and LAEV.
- To identify predictors of reduced LAEV and its role in thrombogenesis within AFL patients.
Main Methods:
- Cross-sectional study involving 123 patients with AFL undergoing transesophageal echocardiography (TEE).
- AFL-CL measured via EKG or intracardiac recordings; LAEV assessed by TEE.
- Multivariate analysis used to identify predictors of low LAEV.
Main Results:
- A significant correlation was found between AFL-CL and LAEV in typical AFL (r=0.34, p=0.003).
- AFL-CL, left atrial size, and flutter type predicted low LAEV.
- A novel index (atrial rate × left atrial size) effectively identified spontaneous echogenic contrast and/or left atrial thrombus (C-statistic=0.71).
Conclusions:
- AFL-CL is significantly related to LAEV, with LA size and flutter type also influencing LAEV.
- A new index combining atrial rate and left atrial size can identify patients at higher risk for thrombus formation in AFL.
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