Key result
A clockwise atrial activation pattern (OR 15.3; 95% CI 4.0-59.4; P<0.005) and decreased systolic function (OR 3.5; 95% CI 1.1-11.5) predicted unusual ECG patterns in CTI-dependent atrial flutter.
Why the study?
What are the clinical and echocardiographic predictors of unusual ECG characteristics in patients with CTI-dependent atrial flutter?
Cohort (n=147)
Yes
What are the clinical and echocardiographic predictors of unusual ECG characteristics in patients with CTI-dependent atrial flutter?
Odds Ratio: 15.3 (95% CI 4–59.4)
p-value: p=<0.005
In patients with CTI-dependent atrial flutter, clockwise atrial activation and left ventricular dysfunction strongly predict the presence of unusual surface ECG patterns.
May prompt EPS confirmation over ECG alone in select CTI flutter cases; leaves open prospective validation for diagnostic algorithms.
BACKGROUND: An unusual 12-lead electrocardiographic pattern may be present in patients with cavotricuspid isthmus (CTI)-dependent flutter. OBJECTIVE: Using baseline patient characteristics and echocardiography, we sought to study predictors of unusual electrocardiogram (ECG) characteristics in patients with CTI-dependent atrial flutter. METHODS: This was a dual-center, retrospective cohort study of 147 patients undergoing electrophysiology study and ablation for CTI-dependent atrial flutter. RESULTS: Among this cohort, 23 patients (16%) had unusual 12-lead ECG characteristics. Using multivariate logistic regression, we found two clinical predictors for having an unusual ECG pattern. A clockwise (CW) pattern at time of electrophysiology study was the strongest predictor of an unusual ECG pattern (odds ratio 15.3, 95% confidence interval [CI] 4.0-59.4, P < 0.005). In addition, patients with decreased systolic function had a 3.5 greater odds (95% CI 1.1-11.5, P = 0.037) of having an unusual ECG pattern. CONCLUSIONS: Our data demonstrate that among patients suffering from CTI-dependent atrial flutter who are referred for ablation, 16% will have unusual ECG patterns. Patients with CW atrial activation and left ventricle dysfunction have greater odds of manifesting unusual patterns by surface electrocardiogram.
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Hoffmayer et al. (2011) conducted a cohort in Cavotricuspid isthmus (CTI)-dependent atrial flutter (n=147). Clockwise atrial activation pattern and decreased systolic function was evaluated on Unusual 12-lead ECG characteristics (OR 15.3, 95% CI 4.0-59.4, p=<0.005). A clockwise atrial activation pattern (OR 15.3; 95% CI 4.0-59.4; P<0.005) and decreased systolic function (OR 3.5; 95% CI 1.1-11.5) predicted unusual ECG patterns in CTI-dependent atrial flutter.
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