{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,25]],"date-time":"2025-07-25T10:44:10Z","timestamp":1753440250198,"version":"3.37.3"},"reference-count":17,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2021,2,21]],"date-time":"2021-02-21T00:00:00Z","timestamp":1613865600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,8,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>Long-term mortality after ablation of typical atrial flutter has been found to be increased two-fold in comparison to atrial fibrillation ablations through a period of 5 years with unclear mechanism.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>We analysed 189 consecutive patients who underwent ablation for typical atrial flutter (AFL), in which the incidence of AF was the first manifestation of cardiac disease. According to the clinical standards of our centre, the routine recommendation was to evaluate for coronary artery disease (CAD) by invasive angiogram or computed tomography scan. We compared the AFL patients to 141 patients with paroxysmal atrial fibrillation (AFIB) without known structural heart disease who underwent ablation in the same period and who had routine coronary angiograms performed. Out of 189 patients who presented with AFL, coronary status was available in 152 patients (80.4%). Both groups were balanced for mean age (64.9\u2009years in AFL vs. 63.2\u2009years in AFIB; P\u2009=\u20090.15), body mass index (BMI; 28.8 vs. 28.5\u2009kg\/m2; P\u2009=\u20090.15), CHA2DS2-VASc-Score (2.20 vs. 2.04; P\u2009=\u20090.35), smoking status (22.2% smokers vs. 28.4%; P\u2009=\u20090.23), and renal function (GFR &amp;gt;60\u2009mL\/min in 96.7% of all patients vs. 95.7%; P\u2009=\u20090.76). There were significantly lower values for left ventricular ejection fraction (52.5% vs. 59.7%; P\u2009&amp;lt;\u20090.001), female sex (17.0% vs. 47.5%; P\u2009&amp;lt;\u20090.001), hyperlipidaemia (37.9% vs. 58.9%; P\u2009&amp;lt;\u20090.001), and family history of cardiovascular disease (CVD) (15.0 vs. 31.9%; P\u2009=\u20090.001) in the AFL vs. AFIB cohorts. Coronary artery disease with stenoses &amp;gt;50% was found in 26.3% of all patients with available coronary status in AFL and in 7.0% in AFIB (P\u2009&amp;lt;\u20090.001). Coronary artery disease with stenoses &amp;gt;75% in 16.4% in AFL whereas only in 1.4% in AFIB (P\u2009&amp;lt;\u20090.001). Multivessel disease was detected in 10.5% in AFL and 0.7% in AFIB (P\u2009&amp;lt;\u20090.001). After correction for age, left ventricular ejection fraction, BMI, CHA2DS2-VASc-Score and its individual components, smoking status, hyperlipidaemia, and family history of CVD, there was a more than five-fold increase in the likelihood of CAD with stenosis &amp;gt;50% in AFL as compared to AFIB [odds ratio (OR 5.26)]. A multivariate analysis was performed in the AFL group. Patients with clinically relevant stenoses (&amp;gt;75%) were older (70.6\u2009years vs. 63.8\u2009years; P\u2009=\u20090.001), had a higher number of risk factors (3.08 vs. 2.24; P \u2264 0.0016) and a higher CHA2DS2-VASc-Score (3.20 vs. 2.00; P\u2009&amp;lt;\u20090.0001). With logistic regression, significant CAD could be predicted by higher values for CHA2DS2-VASc-Score with an exponential rise to a pretest-probability of 42.1% at a value of 4 points.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>These data suggest that typical atrial flutter constitutes a manifestation of previously asymptomatic CAD. Due to the inclusion criteria, CAD has to be considered silent and chronic in most of the patients. Therefore, the presence of typical atrial flutter in formerly healthy patients should raise suspicion of otherwise silent CAD and initiate further investigations and risk stratification with particular emphasis on the individual CHA2DS2-VASc-Scores.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/europace\/euab002","type":"journal-article","created":{"date-parts":[[2021,1,6]],"date-time":"2021-01-06T18:33:31Z","timestamp":1609958011000},"page":"1227-1236","source":"Crossref","is-referenced-by-count":4,"title":["Typical atrial flutter but not fibrillation predicts coronary artery disease in formerly healthy patients"],"prefix":"10.1093","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6012-9293","authenticated-orcid":false,"given":"Leon","family":"Iden","sequence":"first","affiliation":[{"name":"Department of Cardiology, Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, L\u00fcbeck and Hamburg), Am Kurpark 1, Bad Segeberg, Schleswig-Holstein, 23795, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gert","family":"Richardt","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, L\u00fcbeck and Hamburg), Am Kurpark 1, Bad Segeberg, Schleswig-Holstein, 23795, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rolf","family":"Weinert","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, L\u00fcbeck and Hamburg), Am Kurpark 1, Bad Segeberg, Schleswig-Holstein, 23795, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susann","family":"Groschke","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, L\u00fcbeck and Hamburg), Am Kurpark 1, Bad Segeberg, Schleswig-Holstein, 23795, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ralph","family":"Toelg","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, L\u00fcbeck and Hamburg), Am Kurpark 1, Bad Segeberg, Schleswig-Holstein, 23795, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Borlich","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, L\u00fcbeck and Hamburg), Am Kurpark 1, Bad Segeberg, Schleswig-Holstein, 23795, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,2,21]]},"reference":[{"key":"2021080909030666800_euab002-B1","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1016\/j.acvd.2011.07.003","article-title":"Characteristics of isolated atrial flutter versus atrial flutter combined with atrial fibrillation","volume":"104","author":"Peyrol","year":"2011","journal-title":"Arch Cardiovasc Dis"},{"key":"2021080909030666800_euab002-B2","doi-asserted-by":"crossref","first-page":"1774","DOI":"10.1093\/europace\/euq334","article-title":"Cavotricuspid isthmus dependent flutter is associated with an increased incidence of occult coronary artery disease","volume":"12","author":"de Bono","year":"2010","journal-title":"Europace"},{"key":"2021080909030666800_euab002-B3","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.hrthm.2015.07.031","article-title":"Atrial flutter: clinical risk factors and adverse outcomes in the Framingham Heart Study","volume":"13","author":"Rahman","year":"2016","journal-title":"Heart Rhythm"},{"key":"2021080909030666800_euab002-B4","first-page":"838","article-title":"Death and thrombo-embolic risk after ablation of atrial flutter compared with atrial fibrillation: a nationwide cohort study","volume":"19","author":"Vadmann","year":"2017","journal-title":"Europace"},{"key":"2021080909030666800_euab002-B5","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.ejrad.2007.07.014","article-title":"Diagnostic value of 64-slice CT angiography in coronary artery disease: a systematic review","volume":"67","author":"Sun","year":"2008","journal-title":"Eur J Radiol"},{"key":"2021080909030666800_euab002-B6","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1016\/j.hfc.2013.10.002","article-title":"The role of coronary artery disease in heart failure","volume":"10","author":"Lala","year":"2014","journal-title":"Heart Fail Clin"},{"key":"2021080909030666800_euab002-B7","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1016\/j.ahj.2005.12.001","article-title":"Predicting significant coronary artery disease in patients with left ventricular dysfunction","volume":"152","author":"Whellan","year":"2006","journal-title":"Am Heart J"},{"key":"2021080909030666800_euab002-B8","doi-asserted-by":"crossref","first-page":"1609","DOI":"10.1093\/europace\/euw295","article-title":"2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS","volume":"18","author":"Kirchhof","year":"2016","journal-title":"Europace"},{"key":"2021080909030666800_euab002-B9","doi-asserted-by":"crossref","first-page":"e27","DOI":"10.1016\/j.jacc.2015.08.856","article-title":"2015 ACC\/AHA\/HRS guideline for the management of adult patients with supraventricular tachycardia: a report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society","volume":"67","author":"Page","year":"2016","journal-title":"J Am Coll Cardiol"},{"key":"2021080909030666800_euab002-B10","first-page":"5837","article-title":"Relationship between coronary artery disease and pulmonary arterial pressure in patients with chronic obstructive pulmonary disease","volume":"7","author":"Asker","year":"2014","journal-title":"Int J Clin Exp Med"},{"key":"2021080909030666800_euab002-B11","doi-asserted-by":"crossref","first-page":"2374","DOI":"10.1161\/01.STR.0000088643.07108.19","article-title":"Risk factors for progression of atherosclerosis measured at multiple sites in the arterial tree: the Rotterdam Study","volume":"34","author":"van der Meer","year":"2003","journal-title":"Stroke"},{"key":"2021080909030666800_euab002-B12","doi-asserted-by":"crossref","first-page":"2242","DOI":"10.1016\/S0735-1097(00)00982-7","article-title":"Incidence and predictors of atrial flutter in the general population","volume":"36","author":"Granada","year":"2000","journal-title":"J Am Coll Cardiol"},{"key":"2021080909030666800_euab002-B13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1161\/CIRCULATIONAHA.117.028981","article-title":"Sex differences and similarities in atrial fibrillation epidemiology, risk factors, and mortality in community cohorts: results from the BiomarCaRE Consortium (Biomarker for Cardiovascular Risk Assessment in Europe)","volume":"136","author":"Magnussen","year":"2017","journal-title":"Circulation"},{"key":"2021080909030666800_euab002-B14","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1053\/euhj.2001.2842","article-title":"Coronary heart disease risk factors ranked by importance for the individual and community. A 21 year follow-up of 12 000 men and women from The Copenhagen City Heart Study","volume":"23","author":"Schnohr","year":"2002","journal-title":"Eur Heart J"},{"key":"2021080909030666800_euab002-B15","doi-asserted-by":"crossref","first-page":"2949","DOI":"10.1093\/eurheartj\/eht296","article-title":"2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology","volume":"34","author":"Montalescot","year":"2013","journal-title":"Eur Heart J"},{"key":"2021080909030666800_euab002-B16","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1093\/eurheartj\/ehz425","article-title":"2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes","volume":"41","author":"Knuuti","year":"2020","journal-title":"Eur Heart J"},{"key":"2021080909030666800_euab002-B17","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1016\/j.hrthm.2007.10.007","article-title":"Markers of inflammation before and after curative ablation of atrial flutter","volume":"5","author":"Marcus","year":"2008","journal-title":"Heart Rhythm"}],"container-title":["EP Europace"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/europace\/article-pdf\/23\/8\/1227\/39606300\/euab002.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/europace\/article-pdf\/23\/8\/1227\/39606300\/euab002.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,9]],"date-time":"2021-08-09T10:25:39Z","timestamp":1628504739000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/europace\/article\/23\/8\/1227\/6145860"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,21]]},"references-count":17,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2021,2,21]]},"published-print":{"date-parts":[[2021,8,6]]}},"URL":"https:\/\/doi.org\/10.1093\/europace\/euab002","relation":{},"ISSN":["1099-5129","1532-2092"],"issn-type":[{"type":"print","value":"1099-5129"},{"type":"electronic","value":"1532-2092"}],"subject":[],"published-other":{"date-parts":[[2021,8,1]]},"published":{"date-parts":[[2021,2,21]]}}}