Article    Table of Contents                    Full Text of this article    PDF of this article (PDFs free after 6 months)    Summary for Patients    Summary for Patients (PDF)    Figures/Tables List    Related articles in Annals  Services    Send comment/rapid response letter    Notify a friend about this article    Alert me when this article is cited    Add to Personal Archive    Download to Citation Manager    ACP Search                            Get Permissions  Google Scholar    Search for Related Content  PubMed Articles in PubMed by Author:    Halligan, S. C.    Friedman, P. A.    Related Articles in PubMed    PubMed Citation    PubMed

BRIEF COMMUNICATION

The Natural History of Lone Atrial Flutter

Sean C. Halligan, MD; Bernard J. Gersh, MBChB, DPhil; Robert D. Brown, Jr., MD; A. Gabriela Rosales, MS; Thomas M. Munger, MD; Win-Kuang Shen, MD; Stephen C. Hammill, MD; and Paul A. Friedman, MD

17 February 2004 | Volume 140 Issue 4 | Pages 265-268

Background: The natural history of atrial flutter is not well defined.

Objective: To report the risk for stroke, conversion to atrial fibrillation, and anticoagulation for lone atrial flutter.

Design: Retrospective cohort analysis.

Setting: A clinically based longitudinal study of inpatients and outpatients with atrial flutter.

Patients: The authors compared the stroke rate in 59 patients with atrial flutter with rates in a sample in which age- and sex-specific ischemic cerebrovascular event rates were determined and in a sample of nonhypertensive patients with lone atrial fibrillation. The risk for developing atrial fibrillation after presenting with atrial flutter is also reported.

Measurements: Electrocardiograms and clinical data were collected and reviewed for each study participant.

Results: After adjustment for age and sex, patients with atrial flutter had a higher incidence of thromboembolic events than the sample control patients and patients with atrial fibrillation. Atrial fibrillation developed in 56% of patients with atrial flutter.

Conclusions: Lone atrial flutter has a stroke risk at least as high as lone atrial fibrillation and carries a higher risk for subsequent development of atrial fibrillation than in the general population. Anticoagulation should be considered for all patients with atrial flutter who are older than 65 years of age.

Editors' Notes Context While the adverse consequences of atrial fibrillation have received much attention, we know little about the outcomes of people with lone atrial flutter. Contribution Among 59 patients with lone atrial flutter cared for at the Mayo Clinic between 1965 and 1995, 33 developed atrial fibrillation and 19 sustained a cerebrovascular event over an average follow-up of 10 years. The rate of thromboembolic events observed in this sample of patients with lone atrial flutter was at least as high as that observed in patients with atrial fibrillation. Cautions This observational study cannot tell us whether treatment for atrial flutter and anticoagulation would improve outcomes for people with lone atrial flutter. –The Editors

 

Author and Article Information

From the Mayo Clinic, Rochester, Minnesota.

Grant Support: Through support from the Mayo Foundation.

Potential Financial Conflicts of Interest: None disclosed.

Corresponding Author: Paul A. Friedman, MD, Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.

Current Author Addresses: Drs. Halligan, Brown, Munger, Shen, Hammill, Friedman, and Gersh and Ms. Rosales: Mayo Clinic, 200 First Street SW, Rochester, MN 55905.

Author Contributions: Conception and design: S.C. Halligan, B.J. Gersh, R.D. Brown Jr., T.M. Munger, S.C. Hammill, P.A. Friedman.

Analysis and interpretation of the data: S.C. Halligan, B.J. Gersh, R.D. Brown Jr, A.G. Rosales, T.M. Munger, S.C. Hammill, P.A. Friedman.

Drafting of the article: S.C. Halligan, B.J. Gersh, R.D. Brown Jr., S.C. Hammill,

Critical revision of the article for important intellectual content: S.C. Halligan, B.J. Gersh, R.D. Brown Jr., A.G. Rosales, W.-K. Shen, S.C. Hammill, P.A. Friedman.

Final approval of the article: B.J. Gersh, R.D. Brown Jr., T.M. Munger, W.-K. Shen, S.C. Hammill, P.A. Friedman.

Provision of study materials or patients: S.C. Halligan.

Statistical expertise: A.G. Rosales.

Obtaining of funding: S.C. Halligan.

Administrative, technical, or logistic support: R.D. Brown Jr., S.C. Hammill, P.A. Friedman.

Collection and assembly of data: S.C. Halligan.

Related articles in Annals:

Summaries for Patients
Outcomes of Patients with Lone Atrial Flutter

Annals 2004 140: I-55. [Full Text]  

This article has been cited by other articles:

				J. J. Blanc, J. Almendral, M. Brignole, M. Fatemi, K. Gjesdal, E. Gonzalez-Torrecilla, P. Kulakowski, G. Y.H. Lip, D. Shah, C. Wolpert, et al. Consensus document on antithrombotic therapy in the setting of electrophysiological procedures Europace, May 1, 2008; 10(5): 513 - 527. [Full Text] [PDF]

				E. Doufekias, A. Z. Segal, and J. R. Kizer Cardiogenic and aortogenic brain embolism. J. Am. Coll. Cardiol., March 18, 2008; 51(11): 1049 - 1059. [Abstract] [Full Text] [PDF]

				W. Rosamond, K. Flegal, K. Furie, A. Go, K. Greenlund, N. Haase, S. M. Hailpern, M. Ho, V. Howard, B. Kissela, et al. Heart Disease and Stroke Statistics--2008 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Circulation, January 29, 2008; 117(4): e25 - e146. [Full Text] [PDF]

				A. Y.-J. Shen, J. F. Yao, S. S. Brar, M. B. Jorgensen, and W. Chen Racial/Ethnic Differences in the Risk of Intracranial Hemorrhage Among Patients With Atrial Fibrillation J. Am. Coll. Cardiol., July 24, 2007; 50(4): 309 - 315. [Abstract] [Full Text] [PDF]

				L. Frost Lone Atrial Fibrillation: Good, Bad, or Ugly? Circulation, June 19, 2007; 115(24): 3040 - 3041. [Full Text] [PDF]

				J. Heeringa, D. A. M. van der Kuip, A. Hofman, J. A. Kors, F. J. A. van Rooij, G. Y. H. Lip, and J. C. M. Witteman Subclinical Atherosclerosis and Risk of Atrial Fibrillation: The Rotterdam Study Arch Intern Med, February 26, 2007; 167(4): 382 - 387. [Abstract] [Full Text] [PDF]

				W. Rosamond, K. Flegal, G. Friday, K. Furie, A. Go, K. Greenlund, N. Haase, M. Ho, V. Howard, B. Kissela, et al. Heart Disease and Stroke Statistics--2007 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Circulation, February 6, 2007; 115(5): e69 - e171. [Full Text] [PDF]

				D J H McCabe and R D Rakhit Antithrombotic and interventional treatment options in cardioembolic transient ischaemic attack and ischaemic stroke J. Neurol. Neurosurg. Psychiatry, January 1, 2007; 78(1): 14 - 24. [Abstract] [Full Text] [PDF]

				A. Da Costa, J. Thevenin, F. Roche, C. Romeyer-Bouchard, L. Abdellaoui, M. Messier, L. Denis, E. Faure, R. Gonthier, G. Kruszynski, et al. Results From the Loire-Ardeche-Drome-Isere-Puy-de-Dome (LADIP) Trial on Atrial Flutter, a Multicentric Prospective Randomized Study Comparing Amiodarone and Radiofrequency Ablation After the First Episode of Symptomatic Atrial Flutter Circulation, October 17, 2006; 114(16): 1676 - 1681. [Abstract] [Full Text] [PDF]

				J. Heeringa, D. A.M. van der Kuip, A. Hofman, J. A. Kors, G. van Herpen, B. H.Ch. Stricker, T. Stijnen, G. Y.H. Lip, and J. C.M. Witteman Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study Eur. Heart J., April 2, 2006; 27(8): 949 - 953. [Abstract] [Full Text] [PDF]

				A. A. Elesber, A. G. Rosales, R. M. Herges, W.-K. Shen, B. S. Moon, J. F. Malouf, N. M. Ammash, V. Somers, D. O. Hodge, B. J. Gersh, et al. Relapse and mortality following cardioversion of new-onset vs. recurrent atrial fibrillation and atrial flutter in the elderly Eur. Heart J., April 1, 2006; 27(7): 854 - 860. [Abstract] [Full Text] [PDF]

				Drugs to prevent vascular events after stroke DTB, July 1, 2005; 43(7): 53 - 56. [Abstract] [Full Text] [PDF]

				M. F. Scholten, A. S. Thornton, J. M. Mekel, P. J. Koudstaal, and L. J. Jordaens Anticoagulation in atrial fibrillation and flutter Europace, January 1, 2005; 7(5): 492 - 499. [Abstract] [Full Text] [PDF]

				T. J. Wang, H. Parise, D. Levy, R. B. D'Agostino Sr, P. A. Wolf, R. S. Vasan, and E. J. Benjamin Obesity and the Risk of New-Onset Atrial Fibrillation JAMA, November 24, 2004; 292(20): 2471 - 2477. [Abstract] [Full Text] [PDF]

				Natural History of Lone Atrial Flutter Journal Watch Cardiology, April 9, 2004; 2004(409): 2 - 2. [Full Text]