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Introduction: Most current evidence suggests the risk of left atrial and or auricular thrombi(LA &LAA) in patients with atrial flutter rhythm is similar to patients with atrial fibrillation, but there is still uncertainty in the risk level and the patient's need to receive anticoagulant therapy. Different studies report various frequencies for atrial thrombi and left atrial spontaneous echo-contrast. This is important to identify patients with LA or LAA clot before applying electrical or medical cardioversion. At present, there is not absolute agreement about the best strategy in patients with AFL before cardioversion. The present study focuses on assessing the risk. Methods: This research was a case series on patients referred to Shahid Rajaee Heart Center(Tehran-Iran) in a 2 year period. We performed TEE for all of the patients with AFL rhythm and duration of more than 48h, without any contraindication for TEE. Then, presence or absence of LA and LAA thrombi was evaluated. Results: Among total cases of about 110 individuals, 40 patients fulfilled the inclusion criteria and entered to our evaluation. Average age of patients was 48.4 years. Forty percent of them were females and 60% were males. Four patients(10%) had LA or LAA thrombi. In respect to underlying diseases, all positive cases had a history of rheumatic heart disease(100%). Among these patients, severe MS was the most prevalent disease(71%). Prevalence of LA or LAA clot among patients with severe MS was 40%. Conclusion: Although, we found10% prevalence in LA or LAA clot in patients With AFL, this prevalence was prominent in patients with rheumatic heart disease as the underlying disease. This rate was significant in patients with severe MS. Indeed we didn't find any LA or LLA clot in patients with AFL and other underlying disorders. We advise paying attention only to this group of patients before electrical or medical cardioversion and exclude other underlying diseases for evaluation of LA or LAA clot by TEE before cardioversion.

Keywords: Atrial Flutter, Left Atrial and Auricular Clot, Trans-Esophageal Echocardiography(TEE), Cardioversion

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