Prevalence of auricular thrombosis before atrial flutter cardioversion: a 17-year transoesophageal echocardiographic study

Europace. 2016 Mar;18(3):450-6. doi: 10.1093/europace/euv128. Epub 2015 May 27.


Aims: Prevalence of left appendage thrombosis ranges from 6 to 18% in persistent atrial fibrillation (AF). Few and low sample size studies have assessed left and right atrial thrombosis in persistent atrial flutter (AFL) and a wide variety of frequencies, from 1 to 21%, has been reported. The aim of this study was to evaluate the prevalence of atrial appendage thrombosis in a large population of patients undergoing transoesophageal echocardiography (TEE)-guided cardioversion (CV) for recent AFL onset and compare it with AF.

Methods and results: From 1999 to September 2014, we collected data of 1081 patients to CV: 877 affected by AF (81.1%) and 204 by AFL (18.9%). The presence of auricular thrombosis was evaluated by TEE in AF or AFL persisting for more than 48 h. The presence of appendage thrombosis, Doppler emptying velocities, and severe spontaneous echo contrast (SEC) was studied. The overall prevalence of atrial thrombosis was 9.62% (104/1081). Frequency of atrial thrombosis in AFL patients was 6.4% (13/204) vs. 10.5% among AF (92/877), P = 0.074. Comparing the two appendages, frequency of left atrial appendage thrombosis was in AFL 5.9% (12/204) vs. 9.9% (87/877) in the AF group, P = 0.07. Right atrial appendage thrombosis was present in 0.5% (1/204) in the AFL group vs. 0.8% (7/877) in the AF group, P = 0.64. Moderate to severe SEC (3+/4+) was present in 28% of AFL patients (57/204) vs. 35% of AF patients (307/877), P = 0.05.

Conclusion: Auricular thrombosis is not an infrequent finding in AFL before CV. Our study suggests the use of TEE screening in AFL, as well as in AF, when patients arrive to clinical attention after more than 48 h from arrhythmia onset.

Keywords: Atrial fibrillation; Atrial flutter; Atrial thrombosis; Cardioversion; Left appendage; Right appendage; Transoesophageal echocardiography.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Atrial Appendage / diagnostic imaging*
  • Atrial Fibrillation / diagnostic imaging*
  • Atrial Fibrillation / epidemiology
  • Atrial Flutter / diagnostic imaging*
  • Atrial Flutter / epidemiology
  • Atrial Flutter / therapy
  • Echocardiography, Doppler*
  • Echocardiography, Transesophageal*
  • Electric Countershock*
  • Female
  • Humans
  • Incidence
  • Italy / epidemiology
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prevalence
  • Severity of Illness Index
  • Thrombosis / diagnostic imaging*
  • Thrombosis / epidemiology
  • Time Factors