Unexplained atrial flutter: A frequent herald of pulmonary embolism

Abstract

Abstract Of 5,396 consecutive new patients studied in our electrocardiographic laboratory between September 1967 and April 1970, 45 were found to have atrial flutter. In 19 of the 45, esophageal leads were used to confirm the diagnosis of the arrhythmia and 25 of the 45 patients with atrial flutter were thought to have definite evidence of pulmonary embolism. Two facts are of clinical significance: First, the judicious use of esophageal or intraatrial electrograms may enhance the frequency with which rapid atrial arrhythmias with block are clearly identified rather than superficially dismissed as “sinus” or “supraventricular” tachycardia; second, and more important, the occurrence of atrial flutter with no clear etiologic basis should precipitate a careful search for the presence of covert pulmonary embolism.