Key result
A typical atrial flutter ECG pattern predicted CTI-AFL with 83% sensitivity, 75% specificity, and 90.5% positive predictive value, but an atypical ECG did not reliably rule out CTI-AFL.
Why the study?
Does surface ECG reliably discriminate between cavotricuspid isthmus-dependent atrial flutter (CTI-AFL) and non-CTI-AFL in patients undergoing catheter ablation?
Observational (n=186)
Does surface ECG reliably discriminate between cavotricuspid isthmus-dependent atrial flutter (CTI-AFL) and non-CTI-AFL in patients undergoing catheter ablation?
Answers are grounded in this paper and cite their sources.
A typical AFL ECG is a strong predictor of CTI-AFL, but an atypical ECG does not reliably rule it out, indicating that an electrophysiological study should still be considered when clinically appropriate.
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.
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Barbato et al. (2009) conducted an observational in Atrial flutter (n=186). Surface ECG (typical pattern) vs. Surface ECG (atypical pattern) was evaluated on Presence of cavotricuspid isthmus-dependent atrial flutter (CTI-AFL) confirmed by electrophysiological study (Sensitivity 0.83, Specificity 0.75). A typical atrial flutter ECG pattern predicted CTI-AFL with 83% sensitivity, 75% specificity, and 90.5% positive predictive value, but an atypical ECG did not reliably rule out CTI-AFL.
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