Wood K A, Eisenberg S J, Kalman J M, Drew B J, Saxon L A, Lee R J, Lesh M D, Scheinman M M
Department of Physiological Nursing, School of Nursing, University of California, San Francisco 94143-1354, USA.
Am J Cardiol. 1997 Apr 15;79(8):1043-7. doi: 10.1016/s0002-9149(97)00044-1.
Anticoagulant therapy is not conventionally used in the treatment of patients with atrial flutter. This recommendation has been based on sparse clinical experience, and recent preliminary reports suggest a significant risk of thromboembolism for these patients. A retrospective study was undertaken to assess the frequency of thromboembolic events as well as potential risk factors for these events in a cohort of patients with atrial flutter referred for radiofrequency ablation treatment. Eighty-six consecutive patients with a primary diagnosis of atrial flutter were evaluated. A history of embolic events was noted in 12 of 86 patients (14%) with atrial flutter, with an annual risk of approximately 3%. There were no differences in the prevalence of coronary artery disease, cardiomyopathy, valvular disease, or atrial fibrillation between the 2 groups of patients having an embolic event and those of patients without embolic events. Left ventricular function and left atrial size were also similar between the 2 groups. The only significant risk factor was hypertension (p < 0.05). However, in a regression model with other clinical variables (i.e., age, gender, left atrial size, presence or absence of any cardiac disease, length of time in flutter, left ventricular function, type of flutter, flutter cycle length, type of secondary arrhythmias) no significant predictors were found. Patients with transient ischemic attacks or pulmonary emboli were then excluded from the analysis in order to compare the thromboembolic risk in the present study to that reported in major atrial fibrillation trials. The overall risk becomes 7% (6 of 86), which over a mean follow-up period of 4.5 years yields an annual risk of approximately 1.6%. Although this risk is only 1/3 of that for patients with atrial fibrillation, this risk is higher than previously recognized for patients with chronic atrial flutter. Anticoagulant therapy should be seriously considered for these patients.
抗凝治疗传统上并不用于心房扑动患者的治疗。这一推荐基于稀少的临床经验，且近期的初步报告提示这些患者存在显著的血栓栓塞风险。开展了一项回顾性研究，以评估一组因射频消融治疗而转诊的心房扑动患者中血栓栓塞事件的发生频率以及这些事件的潜在风险因素。对86例初步诊断为心房扑动的连续患者进行了评估。86例心房扑动患者中有12例（14%）有栓塞事件史，年风险约为3%。有栓塞事件的患者组与无栓塞事件的患者组在冠状动脉疾病、心肌病、瓣膜病或心房颤动的患病率方面无差异。两组患者的左心室功能和左心房大小也相似。唯一显著的风险因素是高血压（p<0.05）。然而，在包含其他临床变量（即年龄、性别、左心房大小、有无任何心脏病、心房扑动持续时间、左心室功能、心房扑动类型、心房扑动周期长度、继发性心律失常类型）的回归模型中，未发现显著的预测因素。为了将本研究中的血栓栓塞风险与主要心房颤动试验中报告的风险进行比较，随后将短暂性脑缺血发作或肺栓塞患者排除在分析之外。总体风险变为7%（86例中的6例），在平均4.5年的随访期内，年风险约为1.6%。尽管这一风险仅为心房颤动患者风险的1/3，但对于慢性心房扑动患者而言，这一风险高于先前的认识。对于这些患者应认真考虑抗凝治疗。
