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The Natural History of Lone Atrial Flutter

Sean C. Halligan, MD; Bernard J. Gersh, MBChB, DPhil; Robert D. Brown Jr., MD; A. Gabriela Rosales, MS; Thomas M. Munger, MD; Win-Kuang Shen, MD; Stephen C. Hammill, MD; and Paul A. Friedman, MD
[+] Article, Author, and Disclosure Information

From the Mayo Clinic, Rochester, Minnesota.

Grant Support: Through support from the Mayo Foundation.

Potential Financial Conflicts of Interest: None disclosed.

Corresponding Author: Paul A. Friedman, MD, Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.

Current Author Addresses: Drs. Halligan, Brown, Munger, Shen, Hammill, Friedman, and Gersh and Ms. Rosales: Mayo Clinic, 200 First Street SW, Rochester, MN 55905.

Author Contributions: Conception and design: S.C. Halligan, B.J. Gersh, R.D. Brown Jr., T.M. Munger, S.C. Hammill, P.A. Friedman.

Analysis and interpretation of the data: S.C. Halligan, B.J. Gersh, R.D. Brown Jr, A.G. Rosales, T.M. Munger, S.C. Hammill, P.A. Friedman.

Drafting of the article: S.C. Halligan, B.J. Gersh, R.D. Brown Jr., S.C. Hammill,

Critical revision of the article for important intellectual content: S.C. Halligan, B.J. Gersh, R.D. Brown Jr., A.G. Rosales, W.-K. Shen, S.C. Hammill, P.A. Friedman.

Final approval of the article: B.J. Gersh, R.D. Brown Jr., T.M. Munger, W.-K. Shen, S.C. Hammill, P.A. Friedman.

Provision of study materials or patients: S.C. Halligan.

Statistical expertise: A.G. Rosales.

Obtaining of funding: S.C. Halligan.

Administrative, technical, or logistic support: R.D. Brown Jr., S.C. Hammill, P.A. Friedman.

Collection and assembly of data: S.C. Halligan.

Ann Intern Med. 2004;140(4):265-268. doi:10.7326/0003-4819-140-4-200402170-00008
Text Size: A A A

Background: The natural history of atrial flutter is not well defined.

Objective: To report the risk for stroke, conversion to atrial fibrillation, and anticoagulation for lone atrial flutter.

Design: Retrospective cohort analysis.

Setting: A clinically based longitudinal study of inpatients and outpatients with atrial flutter.

Patients: The authors compared the stroke rate in 59 patients with atrial flutter with rates in a sample in which age- and sex-specific ischemic cerebrovascular event rates were determined and in a sample of nonhypertensive patients with lone atrial fibrillation. The risk for developing atrial fibrillation after presenting with atrial flutter is also reported.

Measurements: Electrocardiograms and clinical data were collected and reviewed for each study participant.

Results: After adjustment for age and sex, patients with atrial flutter had a higher incidence of thromboembolic events than the sample control patients and patients with atrial fibrillation. Atrial fibrillation developed in 56% of patients with atrial flutter.

Conclusions: Lone atrial flutter has a stroke risk at least as high as lone atrial fibrillation and carries a higher risk for subsequent development of atrial fibrillation than in the general population. Anticoagulation should be considered for all patients with atrial flutter who are older than 65 years of age.


Grahic Jump Location
Kaplan–Meier curves depict the time without conversion to atrial fibrillation from the initial lone atrial flutter diagnosis.
Grahic Jump Location




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Summary for Patients

Outcomes of Patients with Lone Atrial Flutter

The summary below is from the full report titled “The Natural History of Lone Atrial Flutter.” It is in the 17 February 2004 issue of Annals of Internal Medicine (volume 140, pages 265-268). The authors are S.C. Halligan, B.J. Gersh, R.D. Brown Jr., A.G. Rosales, T.M. Munger, W.-K. Shen, S.C. Hammill, and P.A. Friedman.


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