The Risk of Left Atrial Appendage Thrombus in Patients With Atrial Flutter Versus Atrial Fibrillation

Gassan Moady, Gal Rubinstein, Loai Mobarki, Alexander Shturman, Tsafrir Or, Shaul Atar

Research output: Contribution to journalArticlepeer-review


Objective: Patients with atrial fibrillation (AF) are at increased risk of thromboembolic events originating mainly from left atrial appendage thrombus (LAAT). Patients with atrial flutter (AFL) are treated with anticoagulation based on the same criteria as patients with AF. However, whether patients with AFL have similar thromboembolic risk as AF is unclear. In the current study we aimed to estimate the prevalence of LAAT in patients with AFL undergoing trans-esophageal echocardiography (TEE). Methods/results: We included 438 patients (404 with AF and 34 with AFL) scheduled for TEE to rule out LAAT before cardioversion (patients who reported no or inadequate anticoagulation before cardioversion). Demographic and echocardiographic data were compared between patients with and without LAAT. Despite a similar CHA2DS2-VASC score (3.8 ± 1.3 vs 3.4 ± 1.5 in the AF and AFL groups, respectively, P =.09), LAAT was documented in 12 (2.8%) in the AF group and in no patient in the AFL group (P <.0001). Conclusion: Based on our results and previous studies, it seems reasonable to re-evaluate the need for oral anticoagulation in specific populations with AFL such as those with solitary AFL (without a history of AF episodes) undergoing successful ablation and in those with low CHA2DS2-VASC score.

Original languageEnglish
JournalClinical Medicine Insights: Cardiology
StatePublished - 1 Jan 2024

Bibliographical note

Publisher Copyright:
© The Author(s) 2024.


  • Atrial fibrillation
  • anticoagulation
  • atrial appendage
  • atrial flutter
  • thrombus


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