Related Experiment Videos
Risk of thromboembolic events in patients with atrial flutter
K Seidl1, B Hauer, N G Schwick
1Herzzentrum Ludwigshafen, Cardiology, Germany.
Insights
Patients with atrial flutter face a higher thromboembolic risk than previously thought. This study highlights hypertension as a key predictor, suggesting anticoagulation therapy may reduce embolic events.
Area of Science:
- Cardiology
- Thrombosis Research
Background:
- Anticoagulation is standard for atrial fibrillation but less defined for atrial flutter.
- The incidence of thromboembolism in atrial flutter patients requires further investigation.
Purpose of the Study:
- To evaluate the risk of thromboembolism in patients with atrial flutter.
- To identify predictors of embolic events in this population.
Main Methods:
- Prospective evaluation of 191 consecutive patients with atrial flutter.
- Assessment of acute embolism and thromboembolic events during a mean follow-up of 26 months.
- Univariate and multivariate analyses to identify risk factors.
Main Results:
- An overall embolic event rate of 7% was observed.
- Risk indicators included organic heart disease, depressed left ventricular function, hypertension, and diabetes.
- Hypertension emerged as the sole independent predictor of elevated embolic risk (OR=6.5).
Conclusions:
- The thromboembolic risk in atrial flutter patients is higher than previously recognized.
- Hypertension is a significant independent predictor of embolic events.
- Anticoagulation therapy warrants consideration to mitigate this risk.
Abstract:
Based on multiple studies, clear, guided anticoagulation therapy is recommended for patients with atrial fibrillation. The value of anticoagulation therapy in patients with atrial flutter, however, is less well established. Little is known about the incidence of thromboembolism in patients with atrial flutter. We evaluated the risk of thromboembolism in 191 consecutive unselected patients referred for treatment of atrial flutter. A history of embolic events was noted in 11 patients. Acute embolism (<48 hours) occurred in 4 patients (3 after direct current cardioversion, 1 after catheter ablation). During follow-up of 26+/-18 months, 9 patients experienced thromboembolic events. During the follow-up, the overall embolic event rate (including acute embolism and thromboembolic events during follow-up) was 7 % in this patient population. Risk indicators for an embolic event in an univariate analysis were organic heart disease (p = 0.037), depressed left ventricular function (p = 0.02), history of systemic hypertension (p = 0.004), and diabetes mellitus (p = 0.0038). Using multivariate analysis, a history of hypertension was the only independent predictor for elevated embolic risk in this patient population (odds ratio = 6.5; 95% confidence intervals 1.5 to 45). Thus, the thromboembolic risk is higher than previously recognized for patients with atrial flutter. Anticoagulation therapy may decrease this risk.