PREVALENCE OF THROMBUS, SPONTANEOUS ECHO CONTRAST, AND ATRIAL STUNNING IN PATIENTS UNDERGOING CARDIOVERSION OF ATRIAL-FLUTTER - A PROSPECTIVE-STUDY USING TRANSESOPHAGEAL ECHOCARDIOGRAPHY

Background Several studies have shown that patients undergoing cardiov ersion of atrial fibrillation have a high prevalence of of atrial thro mbus and spontaneous echo contrast and frequently develop atrial stunn ing after restoration of sinus rhythm. These findings are strongly ass ociated with increased risk of embolism in these patients. However, li ttle is known about the prevalence of these markers of thromboembolism in patients undergoing cardioversion of atrial flutter. Methods and R esults We performed transesophageal echocardiography in 47 consecutive , nonanticoagulated patients scheduled for elective cardioversion of a trial flutter. In patients who underwent successful cardioversion, mit ral inflow velocity was recorded by transthoracic pulsed Doppler exami nation immediately after restoration of sinus rhythm. All patients wer e men (mean age, 65+/-10 years). Mean duration of flutter was 4+/-9 we eks. Atrial thrombus and/or spontaneous echo contrast were found in 16 patients (34%). Left atrial thrombus was seen in 5 patients (11%), ei ther with (n=4) or without spontaneous contrast. Of 40 patients with s uccessful cardioversion, strial mechanical activity was absent in 28% immediately after restoration of sinus rhythm. Conclusions Our finding s suggest that contrary to traditional teaching, atrial thrombus and s pontaneous contrast are not uncommon in patients with atrial flutter a nd cardioversion may be associated with increased risk of thromboembol ism.