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Prevalence of left atrial thrombus in patients with atrial flutter in comparison to atrial fibrillation

Maciej T Wybraniec1, Fabian Wesołek2, Przemysław Szyszka2

  • 1"Club 30," Polish Cardiac Society, Poland; First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland; Upper-Silesian Medical Center, Katowice, Poland; Member of the European Reference Network on Heart diseases, ERN GUARD-Heart, Warsaw, Poland.

Heart Rhythm
|March 27, 2025
PubMed

Insights

The risk of left atrial thrombus in atrial flutter (AFL) is similar to that in atrial fibrillation (AF). This finding supports similar oral anticoagulation (OAC) recommendations for both conditions.

Area of Science:

  • Cardiology
  • Electrophysiology

Background:

  • Atrial flutter (AFL) and atrial fibrillation (AF) are arrhythmias often considered to have similar risks of systemic thromboembolism.
  • However, robust data comparing the risk of left atrial thrombus (LAT) specifically between AFL and AF is limited.

Purpose of the Study:

  • To evaluate and compare the prevalence of left atrial thrombus (LAT) in patients with AFL versus AF.
  • To assess this prevalence in relation to oral anticoagulation (OAC) status.

Main Methods:

  • A subanalysis of the multicenter, prospective Left Atrial Thrombus on Transesophageal Echocardiography (LATTEE) registry.
  • Included patients with AF or AFL undergoing transesophageal echocardiography for ablation or cardioversion, irrespective of OAC use.
  • Assessed the primary endpoint of LAT presence.

Main Results:

  • 3109 patients (2577 AF, 532 AFL) were analyzed.
  • LAT prevalence was 8.3% in AF and 6.8% in AFL (P = .235), with no significant difference regardless of therapeutic OAC use.
  • Prevalence of LAT in patients on therapeutic OAC was 7.6% for AF and 5.7% for AFL (P = .167).

Conclusions:

  • The risk of thrombus formation in AFL appears comparable to that observed in AF.
  • These findings suggest that current recommendations for oral anticoagulation (OAC) use may be similarly applicable to both AFL and AF patients.
Abstract

Keywords:
Atrial fibrillationAtrial flutterLeft atrial thrombusOral anticoagulationTransesophageal echocardiography

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