BACKGROUND: There are no universally accepted ECG diagnostic criteria for atrial flutter (AFL), making its differentiation from "coarse" atrial fibrillation (AF) difficult. METHODS: To develop diagnostic criteria for AFL, we examined two sets of ECGs. Set 1 consisted of 100 ECGs (50 AF, AFL) with diagnoses confirmed by intracardiac recordings. Criteria evaluated were presence of F waves in the frontal plane leads, F waves in V(1), sawtooth F waves, rate, and regularity of ventricular response. Set 2 included 200 ECGs taken from the hospital database each of which had already been interpreted by a cardiologist as either AF (n = 100) or AFL (n = 100). Set 2 was blindly read by electrophysiologists whose consensus-diagnoses were compared to the diagnoses made by using the best criteria identified from the Set 1 data. RESULTS: The criteria of frontal plane F waves, regular or partially regular ventricular response, and their combination had sensitivities of 92%, 98%, and 90% and specificities of 100%, 78%, and 100% in Set 1 for the diagnosis of AFL. In Set 2, concordance of electrophysiologist and cardiologist diagnoses was only 84%. The criteria of frontal plane Fwaves, regular or partially regular ventricular response, and their combination resulted in concordances with the cardiologist diagnoses of 85%, 85%, and 82% and with the electrophysiologist-consensus diagnoses of 90%, 89%, and 94% (P < 0.001). CONCLUSIONS: The criteria of frontal plane F waves and regular or partially regular ventricular response aid in the proper diagnosis of AFL. Because management strategies may differ for AF and AFL, it is important to adopt a more rigorous diagnostic approach.
BACKGROUND: There are no universally accepted ECG diagnostic criteria for atrial flutter (AFL), making its differentiation from "coarse" atrial fibrillation (AF) difficult. METHODS: To develop diagnostic criteria for AFL, we examined two sets of ECGs. Set 1 consisted of 100 ECGs (50 AF, AFL) with diagnoses confirmed by intracardiac recordings. Criteria evaluated were presence of F waves in the frontal plane leads, F waves in V(1), sawtooth F waves, rate, and regularity of ventricular response. Set 2 included 200 ECGs taken from the hospital database each of which had already been interpreted by a cardiologist as either AF (n = 100) or AFL (n = 100). Set 2 was blindly read by electrophysiologists whose consensus-diagnoses were compared to the diagnoses made by using the best criteria identified from the Set 1 data. RESULTS: The criteria of frontal plane F waves, regular or partially regular ventricular response, and their combination had sensitivities of 92%, 98%, and 90% and specificities of 100%, 78%, and 100% in Set 1 for the diagnosis of AFL. In Set 2, concordance of electrophysiologist and cardiologist diagnoses was only 84%. The criteria of frontal plane Fwaves, regular or partially regular ventricular response, and their combination resulted in concordances with the cardiologist diagnoses of 85%, 85%, and 82% and with the electrophysiologist-consensus diagnoses of 90%, 89%, and 94% (P < 0.001). CONCLUSIONS: The criteria of frontal plane F waves and regular or partially regular ventricular response aid in the proper diagnosis of AFL. Because management strategies may differ for AF and AFL, it is important to adopt a more rigorous diagnostic approach.
Authors: D G Wyse; A L Waldo; J P DiMarco; M J Domanski; Y Rosenberg; E B Schron; J C Kellen; H L Greene; M C Mickel; J E Dalquist; S D Corley Journal: N Engl J Med Date: 2002-12-05 Impact factor: 91.245
Authors: Frank Bogun; Daejoon Anh; Gautham Kalahasty; Erik Wissner; Chadi Bou Serhal; Rabih Bazzi; W Douglas Weaver; Claudio Schuger Journal: Am J Med Date: 2004-11-01 Impact factor: 4.965
Authors: C T Tai; S A Chen; C E Chiang; S H Lee; Z C Wen; J L Huang; Y J Chen; W C Yu; A N Feng; Y J Lin; Y A Ding; M S Chang Journal: J Cardiovasc Electrophysiol Date: 1998-02
Authors: A Natale; K H Newby; E Pisanó; F Leonelli; R Fanelli; D Potenza; S Beheiry; G Tomassoni Journal: J Am Coll Cardiol Date: 2000-06 Impact factor: 24.094
Authors: J Granada; W Uribe; P H Chyou; K Maassen; R Vierkant; P N Smith; J Hayes; E Eaker; H Vidaillet Journal: J Am Coll Cardiol Date: 2000-12 Impact factor: 24.094
Authors: David E Krummen; Mitul Patel; Hong Nguyen; Gordon Ho; Dhruv S Kazi; Paul Clopton; Marian C Holland; Scott L Greenberg; Gregory K Feld; Mitchell N Faddis; Sanjiv M Narayan Journal: J Cardiovasc Electrophysiol Date: 2010-11
Authors: Jason D Roberts; Jonathan C Hsu; Bradley E Aouizerat; Clive R Pullinger; Mary J Malloy; John P Kane; Jeffrey E Olgin; Gregory M Marcus Journal: J Cardiovasc Electrophysiol Date: 2013-12-13