Atrial flutter echocardiography
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]
Overview
Transthoracic echocardiography (TTE) is used in atrial flutter to evaluate the sizes of left and right atria. Transesophageal echocardiography (TEE) is used to evaluate the presence of thrombus and selection of candidates for cardioversion.
Echocardiography
TTE is the preferred modality for evaluating the sizes of right and left atria in atrial flutter. It can also be used to assist in the diagnosis of valvular heart disease, left ventricular hypertrophy, heart failure and pericardial disease. Consistent echocardiographic findings in atrial flutter include regular undulatory waves of the posterior left atrial wall and upper left interventricular septum coinciding with each flutter wave of the electrocardiogram[1].
TEE is preferred over TTE, which has a low sensitivity, for detecting left atrial thrombus which is unusual in stable atrial flutter.
Transthoracic echocardiography may be helpful in the diagnosis of atrial flutter. Findings on an echocardiography suggestive of atrial flutter include:[1]Manning WJ, Weintraub RM, Waksmonski CA, Haering JM, Rooney PS, Maslow AD, Johnson RG, Douglas PS (December 1995). "Accuracy of transesophageal echocardiography for identifying left atrial thrombi. A prospective, intraoperative study". Ann. Intern. Med. 123 (11): 817–22. doi:10.7326/0003-4819-123-11-199512010-00001.Manning WJ, Silverman DI, Keighley CS, Oettgen P, Douglas PS (May 1995). "Transesophageal echocardiographically facilitated early cardioversion from atrial fibrillation using short-term anticoagulation: final results of a prospective 4.5-year study". J. Am. Coll. Cardiol. 25 (6): 1354–61. doi:10.1016/0735-1097(94)00560-D. PMID 7722133.Santiago D, Warshofsky M, Li Mandri G, Di Tullio M, Coromilas J, Reiffel J, Homma S (July 1994). "Left atrial appendage function and thrombus formation in atrial fibrillation-flutter: a transesophageal echocardiographic study". J. Am. Coll. Cardiol. 24 (1): 159–64. doi:10.1016/0735-1097(94)90557-6. PMID 8006260.de Divitiis M, Omran H, Rabahieh R, Rang B, Illien S, Schimpf R, MacCarter D, Jung W, Becher H, Lüderitz B (November 1999). "Right atrial appendage thrombosis in atrial fibrillation: its frequency and its clinical predictors". Am. J. Cardiol. 84 (9): 1023–8. doi:10.1016/s0002-9149(99)00492-0. PMID 10569657.
- Detection of left atrial appendage and right atrial appendage thrombi
- Estimation of blood flow velocity in the left or right atrium and left and right atrial appendage
- Detection of right atrial and right atrial appendage thrombi
- Regular undulatory waves of the posterior left atrial wall
- Regular undulatory waves of the upper left interventricular septum