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492–501. [3] Dunn MI. Thromboembolism with atrial flutter. Am J Cardiol 1998; 82: 638. [4] Seidl K, Hauer B, Schwick NG, Zellner D, Zahn R, Senges J. Risk of thromboembolic events in patients with atrial flutter. Am J Cardiol 1998; 82: 580–3. [5] Lanzarotti CJ, Olshansky B. Thromboembolism in chronic atrial flutter: is the risk underestimated? J Am Coll Cardiol 1997; 30: 1506–11. [6] Wood KA, Eisenberg SJ, Kalman JM et al. Risk of thromboembolism in chronic atrial flutter. Am J Cardiol 1997; 79: 1043–7. [7] Irani WN, Grayburn PA, Afridi I. Prevalence of thrombus, spontaneous echo contrast, and atrial stunning in patients undergoing cardioversion of atrial flutter. A prospective study using transesophageal echocardiography. Circulation 1997; 95: 962–6. [8] Weiss R, Marcovitz P, Knight BP et al. Acute changes in spontaneous echo contrast and atrial function after cardioversion of persistent atrial flutter. Am J Cardiol 1998; 82: 1052–5. [9] Feltes TF, Friedman RA. Transesophageal echocardiographic detection of atrial thrombi in patients with nonfibrillation atrial tachyarrhythmias and congenital heart disease. J Am Coll Cardiol 1994; 24: 1365–70. [10] Bikkina M, Alpert MA, Mulekar M, Shakoor A, Massey CV, Covin FA. Prevalence of intraatrial thrombus in patients with atrial flutter. Am J Cardiol 1995; 76: 186–9. [11] Grimm RA, Stewart WJ, Arheart K, Thomas JD, Klein AL. Left atrial appendage ‘‘stunning’’ after electrical cardioversion of atrial flutter: an attenuated response compared with atrial fibrillation as the mechanism for lower susceptibility to thromboembolic events. J Am Coll Cardiol 1997; 29: 582–9. [12] Densem CG. Patients undergoing cardioversion of atrial flutter should be routinely anticoagulated. Am J Cardiol 1999; 83: 140–1. [13] Pagadala P, Gummadi SS, Olshansky B. Thromboembolic risk of chronic atrial flutter: is the risk underestimated? Circulation 1994; 90(Suppl I): I–398. [14] Arnold AZ, Mick MJ, Mazurek RP, Loop FD, Trohman RG. Role of prophylactic anticoagulation for direct current cardioversion in patients with atrial fibrillation of atrial flutter. J Am Coll Cardiol 1992; 19: 851–5. [15] Bertaglia E, D’Este D, Franceschi M, Pascotto P. Cardioversion of persistent atrial flutter in non-anticoagulated patients at low risk for thromboembolism. Ital Heart J 2000; 1: 349–53. [16] Roijer A, Eskilsson J, Olsson B. Transoesophageal echocardiography-guided cardioversion of atrial fibrillation or flutter. Selection of a low-risk group for immediate cardioversion. Eur Heart J 2000; 21: 837–47. [17] Lip GYH. Does atrial fibrillation confer a hypercoagulable state? Lancet 1995; 346: 13113–14. [18] Omran H, Jung W, Rabahieh R et al. Left atrial appendage function in patients with atrial flutter. Heart 1997; 78: 250–4. [19] Santiago D, Warshofsky M, Li Mandri G et al. Left atrial appendage function and thrombus formation in atrial fibrillation-flutter: a transesophageal echocardiographic study. J Am Coll Cardiol 1994; 24: 159–64. [20] Lip GYH, Lowe GDO, Rumley A, Dunn FG. Fibrinogen and fibrin D-dimer levels in paroxysmal atrial fibrillation: evidence for intermediate elevated levels of intravascular thrombogenesis. Am Heart J 1996; 131: 724–30. [21] Shirani J, Alaeddini J. Structural remodelling of the left atrial appendage in patients with chronic non-valvular atrial fibrillation: Implications for thrombus formation, systemic embolism, and assessment by transesophageal echocardiography. Cardiovasc Pathol 2000; 9: 95–101. [22] Frustaci A, Chimenti C, Bellocci F, Morgante E, Russo MA, Maseri A. Histological substrate of atrial biopsies in patients with lone atrial fibrillation. Circulation 1997; 96: 1180–4. [23] Goldsmith I, Kumar P, Carter P, Blann AD, Patel RL, Lip GYH. Atrial endocardial changes in mitral valve disease: a scanning electron microscopy study. Am Heart J 2000; 140: 777–84. [24] Corrado G, Sgalambro A, Mantero A et al. Thromboembolic risk in atrial flutter: The FLASIEC (Flutter Atriale Societa Italiana di Ecografia Cardiovascolare) multicenter study. Eur Heart J 2001; 22: 1042–51. [25] Kamath S, Lip GYH. Mitral regurgitation and atrial fibrillation: milder the disease, higher the risk? Int J Cardiol 2000; 72: 235–7. Editorials 987

european heart journal

D-transposition of the great arteries: post-operative evaluation by breath-by-breath analysis of ventilation and pulmonary gas exchange during exercise