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Europace Advance Access originally published online on July 1, 2009
Europace 2009 11(8):1071-1076; doi:10.1093/europace/eup166
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

Electrophysiology and Ablation

Is electrocardiography a reliable tool for identifying patients with isthmus-dependent atrial flutter?

Gaetano Barbato1, Valeria Carinci1,*, Corrado Tomasi2, Valeria Frassineti2, Massimo Margheri2 and Giuseppe Di Pasquale1

1 Cardiology Department, Maggiore Hospital, Largo Nigrisoli 2, Bologna, Italy; 2 Cardiology Department, S. Maria delle Croci Hospital, Viale Randi 5, Ravenna, Italy

Aims: To verify the reliability of the surface ECG to discriminate between cavotricuspid isthmus-dependent atrial flutter (CTI-AFL) and non-CTI-AFL.

Methods and results: We reviewed the ECGs of 186 consecutive patients who underwent catheter ablation of AFL between January 2004 and January 2008. The ECG pattern was defined typical for CTI-AFL, if F-waves were: (i) dominantly negative in the inferior leads and positive in V1 (CCW) or (ii) dominantly positive in the inferior leads and negative in V1 (CW). At the electrophysiological study (EPS), 138 patients (74.2%) had a CTI-AFL and 48 patients (25.8%) had a non-CTI-AFL. A CTI-AFL was found not only in 90.5% of patients having a typical ECG, but also in 40% of patients having an atypical ECG. Thus, a typical AFL ECG showed a sensitivity of 0.83 and a specificity of 0.75 to predict a CTI-AFL, with a positive predictive value of 90.5% and a negative predictive value of 60%.

Conclusion: Typical AFL ECG is a good predictor of CTI-AFL, and in this case, an ablation procedure can be recommended. On the contrary, an atypical AFL ECG does not rule out a CTI-AFL; so, even in this group of patients, an EPS should not be denied when indicated by the clinical circumstances.

Key Words: Atrial flutter, ECG, Isthmus-dependent, Ablation, Atypical

* Corresponding author: Cardiology Department, Maggiore Hospital, Largo Nigrisoli 2, 40133 Bologna, Italy. Tel: +39 0328 6864603, Fax: +39 051 6478635, Email: valeria.carinci{at}ausl.bologna.it, vcarinci{at}htomail.com

Manuscript submitted 27 January 2009. Accepted after revision 2 June 2009.


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