Different implication in dementia between patients with atrial flutter and atrial fibrillation: a national cohort study

Abstract Funding Acknowledgements Type of funding sources: None. Importance Atrial fibrillation (AF) has been reported with increasing the risk of stroke and dementia. Atrial flutter (AFL) is also a risk of stroke with different discrepancies in clinical outcome. Little is known about the difference in the risk of dementia between AF and AFL. Objective To investigate if the risk of dementia is difference between AF and AFL. Methods The patients with newly diagnosed AF and AFL during 2001–2013 was retrieved from Taiwan’s National Health Insurance Research Database. Patients with missing information, aged <20 years, history of valvular surgery, rheumatic heart disease, hyperthyroidism, and history of dementia were excluded. Propensity score matching (PSM) between AF and AFL was performed, which included patient comorbidities, past medical history, medications, and index date stratified by age. Primary outcome was defined as dementia at follow-up. Results A total of 232,425 AF and 7,569 AFL were eligible for analysis. After 4:1 PSM, we included 30,276 AF (aged 67.3 ± 15.7 years) and 100,065 AFL (aged 67.4 ± 16.0 years) for analysis. The risk of dementia was higher in AF patients compared with AFL patients (subdistribution HR (SHR)=1.52, 95% CI 1.39 - 1.66; p <0.0001) before PSM and still higher in AF patients (SHR = 1.14, 95% CI 1.04 to 1.25; p = 0.0064). The risk was higher in AF patients without previous stroke after PSM and there was no difference between AF and AFL patients with previous stroke history. Conclusions and relevance Our finding supports that risk of dementia is higher in AF patients than AFL patients. However, the risk of dementia between patients with AF and AFL varies depending on whether there is a previous stroke history.

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Differential Risk of Dementia Between Patients With Atrial Flutter and Atrial Fibrillation: A National Cohort Study

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.787866 ◽

2021 ◽

Vol 8 ◽

Author(s):

Hui-Ting Wang ◽

Yung-Lung Chen ◽

Yu-Sheng Lin ◽

Huang-Chung Chen ◽

Shaur-Zheng Chong ◽

...

Keyword(s):

Atrial Fibrillation ◽

Atrial Flutter ◽

Oral Anticoagulants ◽

Demographic Data ◽

Previous History ◽

Research Database ◽

Subdistribution Hazard ◽

Valvular Surgery ◽

Increased Risk ◽

History Of

Objectives: Atrial fibrillation (AF) is linked to an increased risk of stroke and dementia. Atrial flutter (AFL) is also linked to an increased risk of stroke but at a different level of risk as compared to AF. Little is known about the difference in the risk of dementia between AF and AFL. This study aims to investigate whether the risk of dementia is different between AF and AFL.Methods: Patients with newly diagnosed AF and AFL during 2001–2013 were retrieved from Taiwan's National Health Insurance Research Database. Patients with incomplete demographic data, aged <20 years, history of valvular surgery, rheumatic heart disease, hyperthyroidism, and history of dementia were excluded. The incidence of new-onset dementia was set as the primary outcome and analyzed in patients with AF and AFL after propensity score matching (PSM).Results: A total of 232,425 and 7,569 patients with AF and AFL, respectively, were eligible for analysis. After 4:1 PSM, we included 30,276 and 7,569 patients with AF and AFL, respectively, for analysis. Additionally, patients with AF (n = 29,187) and AFL (n = 451) who received oral anticoagulants were enrolled for comparison. The risk of dementia was higher in patients with AF compared with patients with AFL (subdistribution hazard ratio (SHR) = 1.52, 95% CI 1.39–1.66; p < 0.0001) before PSM and remained higher in patients with AF (SHR = 1.14, 95% CI 1.04–1.25; p = 0.0064) after PSM. The risk of dementia was higher in patients with AF without previous history of stroke after PSM but the risk did not differ between patients with AF and AFL with previous history of stroke. Among patients who received oral anticoagulants, the cumulative incidences of dementia were significantly higher in patients with AF than in patients with AFL before and after PSM (all P < 0.05).Conclusions: This study found that, among patients without history of stroke, the risk of dementia was higher in patients with AF than in patients with AFL, and CHA2DS2-VASc score might be useful for risk stratification of dementia between patients with AF and AFL.

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Female sex as a risk factor for ischaemic stroke varies with age in patients with atrial fibrillation

Heart ◽

10.1136/heartjnl-2019-315065 ◽

2019 ◽

Vol 106 (7) ◽

pp. 534-540 ◽

Cited By ~ 6

Author(s):

Victor Chien-Chia Wu ◽

Michael Wu ◽

Victor Aboyans ◽

Shang-Hung Chang ◽

Shao-Wei Chen ◽

...

Keyword(s):

Atrial Fibrillation ◽

Risk Factor ◽

Heart Disease ◽

Ischaemic Stroke ◽

Stroke Risk ◽

Research Database ◽

Stroke Risk Factor ◽

Female Sex ◽

Included Patient ◽

History Of

ObjectivesFemale sex is an inconsistent ischaemic stroke risk factor in patients with atrial fibrillation (AF). We hypothesised that the ischaemic stroke risk varies with age among women compared with men.MethodsWe retrieved the patients with newly diagnosed AF during 2001–2013 from Taiwan’s National Health Insurance Research Database. Patients with missing information, age <20 years, history of valvular heart disease and surgery, rheumatic heart disease, hyperthyroidism or anticoagulation and/or antiplatelet use were excluded. Propensity score matching (PSM) included patient comorbidities, medications and index date stratified by age and sex groups. Primary outcome was defined as ischaemic stroke at follow-up.ResultsAfter exclusion criteria, 87 369 men and 71 853 women remained for analysis (aged 73.1±14.4 years). After 1:1 PSM, we included 59 583 men (aged 73.5±13.7 years) and 59 583 women (aged 73.4±13.8 years) for analysis. We also stratified patients by age. The ischaemic stroke risk varied with age in women compared with men: lower in the ≤55 years (subdistribution HR (SHR)=0.75, 95% CI 0.62 to 0.90) and 56–65 years (SHR=0.87, 95% CI 0.78 to 0.98) groups, neutral in the 66–75 years group (SHR=1.01, 95% CI 0.94 to 1.08) and adverse in the >75 years group (SHR=1.14, 95% CI 1.09 to 1.19).ConclusionsThe female/male ischaemic stroke risk ratio varied with age. Only women aged >75 years had a higher risk, whereas women aged <65 years had a lower risk compared with men. These findings challenge the ‘sex category’ component of the CHA2DS2-VASc score, used to make decision regarding anticoagulation treatment in AF patients.

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766 Detection of atrial flutter in pacemaker patients with a history of atrial fibrillation: incidence and clinical relevance

EP Europace ◽

10.1016/s1099-5129(05)80510-0 ◽

2005 ◽

Vol 7 ◽

pp. 173-173

Keyword(s):

Atrial Fibrillation ◽

Atrial Flutter ◽

Clinical Relevance ◽

History Of

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Subacute postoperative atrial fibrillation after heart surgery: incidence and predictive factors in cardiac rehabilitation

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.326 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

V Rizza ◽

F Maranta ◽

L Cianfanelli ◽

R Grippo ◽

C Meloni ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cardiac Surgery ◽

Hospital Stay ◽

Heart Surgery ◽

Troponin T ◽

Management Strategies ◽

Inpatient Rehabilitation ◽

Postoperative Atrial Fibrillation ◽

Funding Sources ◽

Valvular Surgery

Abstract Funding Acknowledgements Type of funding sources: None. Background. Postoperative atrial fibrillation (POAF) is the most common arrhythmic complication following cardiac surgery. It may occur between the second and fourth postoperative days as acute POAF, or within 30 days as subacute POAF (sPOAF). The incidence varies from 15% to 60%, with the highest rates observed in patients undergoing valvular surgery. POAF is associated with longer hospital stay and higher thromboembolic risk, which consistently increase patients’ morbidity and mortality. Identification of high-risk categories may allow optimization of in-hospital prevention and treatment, possibly improving clinical outcomes. Aim of the study. The aim of this study was to assess the incidence of sPOAF and to identify possible predictors in patients performing Cardiovascular Rehabilitation (CR) after Cardiac Surgery (CS). Methods. A single-centre retrospective study was performed on 383 post-cardiac surgery patients hospitalised in our CR Unit for inpatient rehabilitation. The entire population was on sinus rhythm at the admission in CR and continuous monitoring with 12-lead ECG telemetry was performed during the hospital stay. We calculated the incidence of sPOAF and then evaluated the predictive value of the following variables: anamnestic data, type of cardiac intervention, clinical course in both CS and CR Unit, laboratory parameters including baseline neutrophil-to-lymphocyte ratio (NLR). Results. Median age was 65 years (63% male). sPOAF was documented in 122 cases (31.9%). Patients developing sPOAF were older [median age 69 (63-76) vs. 61 (51-70); p < 0.001)], more frequently underwent complex surgical procedures (50% vs. 36%; p = 0.009) and were known for previous episodes of atrial fibrillation (27.9% vs. 11.2%; p < 0.001). On the first day after surgery (T1), sPOAF group showed higher values of glycemia [median 155 (126.5–186.8) vs. 129 (106.5–164); p < 0.001] and troponin T [median 721.5 (470.1–1084.3) vs. 488 (301.6-776.2); p < 0.001]. The multivariate analysis identified advanced age (OR 1.04, 95% CI 1.01-1.08; p = 0.023), acute POAF in the Cardiac Surgery Unit (OR 3.51, 95% CI 1.62-7.59; p = 0.001), baseline NLR (OR 1.46, 95% CI 1.10-1.93; p = 0.008) and T1-troponin > 552 ng/L (OR 4.16 95% CI 1.50-11.53; p = 0.006) as independent risk predictors of sPOAF during the CR period. Conclusions. sPOAF is common after cardiac surgery occurring in 31.9% of patients during CR. Age, acute POAF, baseline NLR and elevated troponin T on the first postoperative day were shown predictors of increased sPOAF risk. Recognition of new predictors of POAF could be helpful to better stratify patients, improving management strategies and outcomes.

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Abstract 84: Atrial Fibrillation Causes a Progressive, Time-Dependent Reduction in Myocardial Neuronal NOS in Humans and Goats: Implications for AF-Induced Electrical Remodeling

Circulation Research ◽

10.1161/res.111.suppl_1.a84 ◽

2012 ◽

Vol 111 (suppl_1) ◽

Author(s):

Svetlana Reilly ◽

Xing Liu ◽

Raja Jayaram ◽

Sunder Verheule ◽

Uli Schotten ◽

...

Keyword(s):

Atrial Fibrillation ◽

Electrical Properties ◽

Tissue Concentration ◽

Specific Effect ◽

Right Atrial ◽

Early Event ◽

Atrial Myocytes ◽

History Of ◽

Neuronal Nos ◽

The Difference

Rationale: Nitric oxide (NO) plays a key role in the regulation of cardiac and endothelial function and thrombogenesis. Atrial fibrillation (AF) has been associated with reduced NO availability but the mechanisms and implications of this finding remain to be fully investigated. Methods and Results: We evaluated NO synthase (NOS) activity and localization in right atrial (RA) tissue from 30 patients with permanent AF (vs. 65 controls in sinus rhythm, SR), and in the RA and left atrial (LA) tissue of 48 goats after 2 weeks (2W) and 6 months (6M) of pacing-induced AF. NOS activity was uncoupled in RA tissue from patients and goats in 6M-AF, and was caused by a reduction in BH4 tissue concentration and by an increase in arginase activity (HPLC). Although BH4 and arginine supplementation re-coupled NOS, it did not abolish the difference in NOS activity between AF and SR. Immunoblotting and immunolocalization revealed a progressive reduction in bi-atrial neuronal NOS (nNOS) protein with the duration of AF (by 65% at 2W, 86% at 6M in goats and by 62% in patients with AF) and a reduction in eNOS in long-standing AF. nNOS was reduced in atrial myocytes but not in neuronal tissue. The mRNA expression of NOS (qRT-PCR) was unaltered; however, the reduction in nNOS protein in AF was associated with an increase in nNOS ubiquitination which was partially reversed by inhibition of proteosomal activity with MG132; inhibition of the autophagy-lysosomal pathway with bafilomycin A1 did not restore nNOS protein. To investigate the electrophysiological consequences of a reduced nNOS in LA and RA myocytes, we compared electrical properties of the isolated atrial myocytes from nNOS-/- mice (n=18) and their wild type (WT) littermates after nNOS inhibition with SMTC. Both nNOS gene deletion and inhibition impaired myocytes' relaxation in both RA and LA, and result in a slower rate of decay of [Ca2+]i transient in the LA myocytes only. Conclusions: A reduction in bi-atrial nNOS activity and protein level is an early event in the natural history of AF that results in a chamber-specific effect on electrical properties of the myocytes.

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Abstract TP138: Chronic Kidney Disease in Heart Failure Patients is Associated with Increased Prevalence of Atrial Fibrillation or Atrial Flutter as well as CVA/TIA

Stroke ◽

10.1161/str.51.suppl_1.tp138 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Christopher Lu ◽

Jack Chan ◽

Zejia Yu ◽

Paula Anzenberg ◽

Mikhail Torosoff

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Risk Assessment ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Atrial Flutter ◽

Stroke Risk ◽

Multivariate Logistic Regression Analysis ◽

History Of ◽

Get With The Guidelines

Background: The CHADS-VASC score does not incorporate renal dysfunction in stroke risk assessment in patients with atrial fibrillation and the prevalence of atrial fibrillation, atrial flutter, and cerebrovascular accidents (CVA) in patients with concurrent CHF and CKD is not well investigated. Objective: Evaluate the prevalence of history of stroke, atrial fibrillation, atrial flutter in patients with CHF and CKD. Methods: Data from the single institution Get With The Guidelines- Heart Failure (GWG-HF) cohort of 2938 consecutive inpatients with known GFR was utilized. CHADS-VASC score was calculated from the GWG-HF variables. Chronic kidney disease (CKD) was defined as GFR <60 ml/min. Results: An overwhelming majority (95%) of GWG-HF patients had elevated >1 CHADS-VASC score, which was also significantly more common in patients with CKD (97.6% vs. 91.7% in patients without CKD, p<0.0001). Average CHADS-VASC score was also significantly increased in patients with CKD (4+/-1.3 vs. 3.3+/-1.4, p<0.0001). Furthermore, CKD was associated with increased prevalence of atrial fibrillation and/or flutter (45.6% vs. 35.3%, p<0.0001) and stroke history (17.5% vs. 12.3%, p=0.002). When stroke and TIA histories were removed from the CHADS-VASC score ("CHAD-VASC score"), the remaining variables were strongly predictive of stroke or TIA (14.2% vs. 3.8%, p<0.0001). In multivariate logistic regression analysis, both CHAD-VASC score (OR 2.6, 95%CI 1.3-5.4, p=0.009) and CKD (OR 1.5, 95%CI 1.2-1.8, p=0.001) were associated significantly increased odds of prior stroke or TIA. Conclusions: In patients admitted with heart failure, CKD is associated with increased prevalence of atrial fibrillation or atrial flutter as well as increased prevalence of CVA/TIA. Further prospective studies are warranted to examine whether CKD history should be included in stroke risk assessment in patients with atrial fibrillation or atrial flutter, in conjunction with existing risk assessment frameworks.

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Abstract 240: Assessing the Lack of Appropriate Anticoagulation in Patients With Atrial Fibrillation - Implications for Cardiology Registry-Based Care

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/hcq.13.suppl_1.240 ◽

2020 ◽

Vol 13 (Suppl_1) ◽

Author(s):

Danielle Daly ◽

Jennifer Searl Como ◽

Jason H Wasfy

Keyword(s):

Atrial Fibrillation ◽

Atrial Flutter ◽

Administrative Data ◽

Persistent Atrial Fibrillation ◽

Chronic Atrial Fibrillation ◽

Administrative Claims ◽

Quality Problem ◽

History Of ◽

Problem Lists ◽

Lost To Follow Up

Intro: Anticoagulation is indicated for many patients with atrial fibrillation (AF) for prevention of cardioembolic stroke, although national proportions of eligible patients receiving anticoagulation remain suboptimal. Automated and semi-automated quality improvement techniques including registries and population health coordinators may help identify and increase eligible patients to receive anticoagulation. Methods: We queried our electronic health record to identify patients without anticoagulation but with atrial fibrillation (as identified as either paroxysmal atrial fibrillation, persistent atrial fibrillation, chronic atrial fibrillation, typical atrial flutter, atypical atrial flutter, or unspecified atrial flutter) either on the problem list or as billed administrative claims between September 2016 - September 2019 in MGH outpatient cardiology clinics. All patients were participating in MGH cardiology, with their primary care based either within MGH or outside of MGH. Then, we conducted detailed chart review to calculate thromboembolic risk with respective CHADS-VASC score and confirmed that the patient was not receiving anticoagulation. A typology was developed as charts were reviewed to categorize reasons for lacking anticoagulation. These categories were grouped into broader categories representing a (1) potential quality problem or (2) appropriate lack of anticoagulation. Results: Of 100 patients, 59 were deemed to have a potential quality problem and 41 were deemed to have appropriate lack of anticoagulation. Of the patients with a potential quality problem, 11 have a CHADS VASC score of 1, 18 have a CHADS VASC score of 2, 6 have a CHADS VASC score of 3, 10 have a CHADS VASC score of 4, and 8 have a CHADS of 5, and 6 have a CHADS VASC of 6 or above. Additionally, 3 patients have been lost to follow up, 12 patients had presented with current symptoms of AF within the last year, and 44 patients exhibited acute history of AF symptoms. 41 patients did not present concern for multiple reasons including: CHADS VASC=0, deceased, patients declined medication, followed by outside cardiologist, technology and medication discrepancies, inaccurate administrative data for AF, and prior major bleeding. Conclusions: We found that most un-anticoagulated AF patients identified by administrative claims and EHR problem lists are likely eligible for anticoagulation. Of those, most have a history of paroxysmal AF. As such, registry-based strategies based on queries of past AF may improve rates of anticoagulation in this population. Since automated queries still detect many patients with contraindications such as bleeding or inaccurate administrative data, manual review of administrative queries is likely to be important in quality efforts for AF.

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Incidence of atrial fibrillation in different major cancer subtypes: a Nationwide population-based 12 year follow up study

BMC Cancer ◽

10.1186/s12885-019-6314-9 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 6

Author(s):

Christina Boegh Jakobsen ◽

Morten Lamberts ◽

Nicholas Carlson ◽

Morten Lock-Hansen ◽

Christian Torp-Pedersen ◽

...

Keyword(s):

Atrial Fibrillation ◽

General Population ◽

The Elderly ◽

Population Based ◽

Incidence Rates ◽

Cancer Subtypes ◽

History Of ◽

The Difference ◽

Rate Ratios ◽

New Onset

Abstract Background The prevalence of both atrial fibrillation (AF) and malignancies are increasing in the elderly, but incidences of new onset AF in different cancer subtypes are not well described.The objectives of this study were therefore to determine the incidence of AF in different cancer subtypes and to examine the association of cancer and future AF. Methods Using national databases, the Danish general population was followed from 2000 until 2012. Every individual aged > 18 years and with no history of cancer or AF prior to study start was included. Incidence rates of new onset AF were identified and incidence rate ratios (IRRs) of AF in cancer patients were calculated in an adjusted Poisson regression model. Results A total of 4,324,545 individuals were included in the study. Cancer was diagnosed in 316,040 patients. The median age of the cancer population was 67.0 year and 51.5% were females. Incidences of AF were increased in all subtypes of cancer. For overall cancer, the incidence was 17.4 per 1000 person years (PY) vs 3.7 per 1000 PY in the general population and the difference increased with age. The covariate adjusted IRR for AF in overall cancer was 1.46 (95% confidence interval (CI) 1.44–1.48). The strength of the association declined with time from cancer diagnosis (IRR0-90days = 3.41 (3.29–3.54), (IRR-180 days-1 year = 1.57 (CI 1.50–1.64) and (IRR2–5 years = 1.12 (CI 1.09–1.15). Conclusions In this nationwide cohort study we observed that all major cancer subtypes were associated with an increased incidence of AF. Further, cancer and AF might be independently associated.

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1203Typical atrial flutter is a manifestation of previously silent coronary artery disease

European Heart Journal ◽

10.1093/eurheartj/ehz748.0033 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

L Iden ◽

S Groschke ◽

R Weinert ◽

R Toelg ◽

G Richardt ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cardiovascular Disease ◽

Family History ◽

Atrial Flutter ◽

Smoking Status ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Typical Atrial Flutter ◽

Silent Coronary Artery Disease ◽

History Of

Abstract Background 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 five years with unclear mechanism. Methods We analysed 189 consecutive patients who underwent ablation for typical atrial flutter (AFL), in which the incidence of atrial flutter was the first manifestation of cardiac disease. According to clinical standards of our center, the routine recommendation was to evaluate for CAD by invasive angiogram or CT-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. Results 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 years in AFL vs. 63.2 years in AFIB; p=0.15), body-mass-index (BMI; 28.8 vs. 28.5 kg/m2; p=0.15), CHA2DS2-VASc-Score (2.20 vs. 2.04; p=0.35), smoking status (22.2% smokers vs. 28.4%; p=0.23) and renal function (GFR >60 ml/min in 96.7% of all patients vs. 95.7%; p=0.76). There were significantly lower values for left-ventricular ejection fraction (52.5% vs. 59.7%; p<0.001), female sex (17.0% vs. 47.5%; p<0.001), hyperlipidemia (37.9% vs. 58.9%; p<0.001) and family history of cardiovascular disease (15.0 vs. 31.9%; p=0.001) in the AFL vs. AFIB cohorts. CAD with stenoses >50% was found in 26.3% of all patients with available coronary status in AFL and in 7.0% in AFIB (p<0.001). CAD with stenoses >75% in 16.4% in AFL whereas only in 1.4% in AFIB (p<0.001). Multivessel disease was detected in 10.5% in AFL and 0.7% in AFIB (p<0.001). After correction for age, LVEF, BMI, CHA2DS2-VASc-Score and it's individual components, smoking status, hyperlipidemia and family history of cardiovascular disease, there was a more than five-fold increase in the likelihood of CAD with stenosis >50% in AFL as compared to AFIB (OR 5.26). A multivariate analysis was performed in the AFL group. Patients with clinically relevant stenoses (>75%) were older (70.6 years vs. 63.8 years; p=0.001), had a higher number of risk factors (3.08 vs. 2.24; p≤0.0016) and a higher CHA2DS2-VASc-Score (3.20 vs 2.00; p<0.0001). 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. Odds ratios of CAD with AFL vs AFIB Discussion This data suggests that typical atrial flutter constitutes a manifestation for previously asymptomatic CAD. Due to the inclusion criteria, CAD has to be considered silent and stable 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.

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