O.S. Sychov, A.O. BorodaiDistinctions in a detection of thrombi formation markers in patients with typical atrial flutter compared to atrial fibrillation

The aim – to evaluate prevalence of thrombi formation markers (low left atrial appendage velocity (LAAV), severe spontaneous echo contrast (SEC), left atrial appendage thrombus, left ventricle thrombus) and to determine whether transthoracic echocardiography or clinical score may predict it in patients with typical atrial flutter.
Material and methods. Consecutive 406 patients (299 with atrial fibrillation and 107 with atrial flutter underwent transesophageal and transthoracic echocardiography before cardioversion. Mean age was 59.3 years, mean CHA2DS2-VASc score – 1.86 and mean LAAV – 37.02 cm/s.
Results. Patients with atrial flutter had lower incidence of thrombi formation markers in the LAA compared to those with atrial fibrillation (Р<0.05); severe SEC 4+ was defined in 1.85 % of cases, low LAAV ≤ 25 cm/s in 7.41 % and left atrial appendage thrombus in 2.78 % vs. 8.14 % patients with atrial fibrillation. But the prevalence of thrombi in the left ventricle cavity was significantly higher in patients with atrial flutter – 3.13 % vs. 0.34 % in atrial fibrillation patients (Р=0.02). In patients with atrial flutter systolic dysfunction was found to be most significantly associated with severe left atrial appendage dysfunction and appearance of left ventricle thrombus. In summary, atrial flutter may impose to the higher risk of embolic events primarily due to its adverse effect on left ventricle function. Conclusions. Transoesophageal and transthoracic echocardiography are useful tools for evaluation of embolic risk in patients with typical atrial flutter. Left ventricular systolic dysfunction was a most significant predictor of left atrial appendage dysfunction and cavity thrombi in patients with typical atrial flutter.

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