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Am J Med. 2005 Feb;118(2):101-7.

Atrial flutter and the risk of thromboembolism: a systematic review and meta-analysis.

Author information

1
Department of Medicine, University of Calgary, Alberta, Canada. wghali@ucalgary.ca

Abstract

PURPOSE:

We conducted a systematic review and meta-analysis of observational studies to assess the risk of thromboembolism associated with atrial flutter.

METHODS:

MEDLINE, EMBASE, bibliographies, and consultation with clinical experts were used to identify studies that report the risk of thromboembolism associated with attempted cardioversion and longer-term risk in chronic atrial flutter. The review process and data extraction were performed by two reviewers. Study event rates were assessed graphically, and a chi-squared test was used to assess heterogeneity across studies. Meta-regression with weighted logistic regression was used to assess the association between study-level clinical factors and reported thromboembolic event rates.

RESULTS:

We found 13 studies that reported the risk of thromboembolism associated with cardioversion of atrial flutter. Short-term event rates ranged from 0% to 7.3%. A chi-squared test for heterogeneity was significant (P < 0.001), so results were not pooled. Instead, a meta-regression analysis was performed, which partly explained the heterogeneity across studies. Studies were more likely to report high event rates when they included patients with a prior history of thromboembolism, and to report lower event rates when at least some patients were anticoagulated or if patients underwent echocardiography before cardioversion. Four studies reported the longer-term risk of thromboembolism, and these suggest a yearly event rate of approximately 3% with sustained atrial flutter.

CONCLUSION:

These findings suggest that atrial flutter is indeed associated with an increased risk of thromboembolism, and that clinical factors account for the low event rates reported in some studies.

PMID:
15694889
DOI:
10.1016/j.amjmed.2004.06.048
[Indexed for MEDLINE]

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