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CLINICAL STUDY: ELECTROPHYSIOLOGY

Incidence and predictors of atrial flutter in the general population

Juan Granada, MD^*, William Uribe, MD, Po-Huang Chyou, PhD, Karen Maassen, LPN, Robert Vierkant, MAS, Peter N. Smith, MD, FACC^*, John Hayes, MD, FACC^*, Elaine Eaker, ScD and Humberto Vidaillet, MD, FACC^*

^* Marshfield Clinic and St. Joseph’s Hospital, Marshfield, Wisconsin, USA
Medellin Clinic, Medellin, Colombia
Mayo Clinic, Rochester, Minnesota, USA
Marshfield Medical Research and Education Foundation, Marshfield, Wisconsin, USA

Manuscript received February 2, 2000; revised manuscript received May 25, 2000, accepted July 13, 2000.

Reprint requests and correspondence to: Dr. Humberto Vidaillet, University of Wisconsin School of Medicine, Cardiac Electrophysiology, Marshfield Clinic, 1000 North Oak Avenue, Marshfield, Wisconsin 54449-5777
vidaillh{at}mfldclin.edu

OBJECTIVES

The goal of our study was to determine the incidence and predictors of atrial flutter in the general population.

BACKGROUND

Although atrial flutter can now be cured, there are no reports on its epidemiology in unselected patients.

METHODS

The Marshfield Epidemiological Study Area (MESA), a database that captures nearly all medical care among its 58,820 residents was used to ascertain all new cases of atrial flutter diagnosed from July 1, 1991 to June 30, 1995. To identify predisposing risk factors, we employed an age- and gender-matched case-control study design using eight additional variables.

RESULTS

A total of 181 new cases of atrial flutter were diagnosed for an overall incidence of 88/100,000 person-years. Incidence rates ranged from 5/100,000 in those <50 years old to 587/100,000 in subjects older than 80. Atrial flutter was 2.5 times more common in men (p < 0.001). The risk of developing atrial flutter increased 3.5 times (p < 0.001) in subjects with heart failure and 1.9 times (p < 0.001) for subjects with chronic obstructive pulmonary disease. Among those with atrial flutter 16% were attributable to heart failure and 12% to chronic obstructive lung disease. Three subjects (1.7%) without identifiable predisposing risks were labeled as having "lone atrial flutter."

CONCLUSIONS

This study, the first population-based investigation of atrial flutter, suggests this curable condition is much more common than previously appreciated. If our findings were applicable to the entire U.S. population, we estimate 200,000 new cases of atrial flutter in this country annually. At highest risk of developing atrial flutter are men, the elderly and individuals with preexisting heart failure or chronic obstructive lung disease.

Abbreviations and Acronyms   AA = antiarrhythmic   COPD = chronic obstructive pulmonary disease   DM = diabetes mellitus   ECG = electrocardiogram or electrocardiographic   HF = heart failure   ICD = International Classification of Diseases   MESA = Marshfield Epidemiologic Study Area   PSVT = paroxysmal supraventricular tachycardia

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