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1998 Presentations for the Poster and Vignette Sessions
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STROKE IN ATRIAL FLUTTER: FREQUENCY AND OUTCOMES IN THE GENERAL POPULATION. Juan Granada M.D., Humberto Vidaillet M.D., Armando Falcon M.D., John Hayes M.D., Peter Smith M.D., Elaine Eaker ScD, Percy Karanjia M.D., Marshfield Clinic, St. Joseph's Hospital and the Marshfield Medical Research and Education Fdn, Marshfield, Wisconsin.

Background: The Framingham Heart Study, the first epidemiologic investigation to show an increased Stroke risk in "Atrial Fibrillation" (AFIB), defined that condition electrocardiographically to include subjects with either AFIB or Atrial Flutter (AFLTR). Grouped initially with published reports describing the "clinical course of pts. With AFIB:, the long outcome of pts. With AFLTR remains unknown.

Objective: To determine the frequency and significance of TIA or Stroke in AFLTR pts.

Methods: We used the resources of the Marshfield Epidemiologic study Area (MESA), a region covering practically all medical care received by its 55,000 residents. We reviewed the medical records of ÿ2,000 potential cases. Incident cases of AFLTR were defined as those in whom the first episode of AFLTR (defined by standard ECG criteria) was documented from 7/1/91 to 6/30/95. All cerebrovascular events occurring during follow­up were classified according to 1998 AHA Stroke Outcome Classification (AHA SOC) System. Our results remained significant after adjustment for the ÿ40% of pts with concurrent AFIB.

Results: During ÿ230,000 patient/years of enrollment, new­onset AFLTR was diagnosed in 181 patients. Follow up (mean duration, 4 years) was available in all 181 (100%) pts. Although ÿ40% had concurrent AFIB, ÿDuring follow­up, 29 (16% of all pts) had one or more Stroke or TIA. The diagnosis of Stroke or TIA was confirmed in all 29 patients; 90% had formal Neurology consultation and 72% had Head CT Scan or MRI. At the time of the acute cerebral event; 37% were on Aspirin and 24% were on Warfarin (mean INR, 1.4). Stroke or TIA was the initial clinical manifestation of the newly diagnosed AFLTR in 6% (11 of 181) of pts. In the group as a whole and in 34% (11 of 29) of those with an acute cerebrovascular event.

Pts. With AFLTR in the general population are at an increased risk of suffering large and incapacitating cerebrovascular events. Strokes occurred 4 times more commonly than TIAs (70% versus 21%). In 27 of 29 (93%) pts., an AHA SOC score was determined following their first acute cerebrovascular events. Using the "Severity of Impairment" Criteria, 59% of pts. Had a "B or C Level" disability (more than "mild" impairment). In a "Function Level" or Death Scale analysis, 44% experienced Death or a Score of >III (partial disability or worse).

Conclusions: 1) This report is the first investigation on the neurologic complications of AFLTR in the general population. 2) Our findings challenge prevailing thoughts regarding the "benign" prognosis currently associated with AFLTR. In the general population, pts. With AFLTR experience acute cerebrovascular events with a frequency and severity similar to that reported for pts. With AFIB by the Framingham investigators and other workers. 3) Our data showed the need for more clinical and epidemiologic research on common arrhythmias

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