Determinants ofrecurrentatrial flutterafter cardioversion

summARYEighteen malepatients (meanage 59years) who were electrically cardioverted forpure atrial flutter were retrospectively studied todetermine thosefactors influencing themaintenanceof regular sinus rhythm or reversiontoatrial flutter.Sixmonthsafter successful cardioversion, 10 patients (55%) hadrecurrentatrial flutter andeight patients (45%)were still insinusrhythm.The twogroupswerenotsignificantly different withrespectto age, symptomatology, abnormalities on the12lead electrocardiogram (during sinus rhythm), or theadministration ofdigoxin anda class Ia antiarrhydtmic agent(after cardioversion). There was atrendforthose patients withrecurrent atrial flutter tohave ahigher incidence ofunderlying heart disease andprevious episodes ofatrial flutter than the non-recurrent group.There were statistically significant differences betweentherecurrent andnon-recurrent groupswith respecttoechocardiographically determined left atrial sizeandleft ventricular ejection fraction. Patients with a left atrial size greaterthan45mm or withan ejection fraction less than 45%wereall athighrisk for recurrentatrial flutter after successful cardioversion. Previous studies inpatients with atrialfibriUatio