What is the prevalence of thrombosis in pediatric atrial flutter and how is it treated?

Updated: Feb 04, 2019
  • Author: M Silvana Horenstein, MD; Chief Editor: Syamasundar Rao Patnana, MD  more...
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Thrombosis and thromboembolic events are recognized complications in patients with atrial flutter, particularly in the setting of repaired congenital heart disease, such as the Fontan procedure. [15] Patients who have thrombi identified on transesophageal echocardiography or have a history of chronic atrial flutter (>2 wk duration) should be treated with a period of anticoagulation (2-4 wk), if hemodynamically and symptomatically tolerated, before undergoing direct current (DC) cardioversion or other conversion of their rhythm.

A systematic review that analyzed data from 52 articles suggested that atrial flutter indeed confers a thromboembolic risk; a 0% to 38% prevalence of thrombus was seen, and a 21% to 28% prevalence of spontaneous echocardiographic contrast was observed. [16] In another study, there was a high incidence of thrombus/thromboembolism with atrial flutter or fibrillation in patients who underwent the Fontan surgery, but it was low in this population in the setting of electrical cardioversion and anticoagulation therapy. [15]

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