Document Detail

Variable electrocardiographic characteristics of isthmus-dependent atrial flutter.
MedLine Citation:
PMID:  12354439     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The purpose of this study was to characterize variations in flutter-wave (F-wave) morphology among patients with clockwise isthmus-dependent (CWID) and counterclockwise isthmus-dependent (CCWID) right atrial flutter (AFL) and to attempt to correlate F-wave morphology with echocardiographic data and clinical patient characteristics. BACKGROUND: Variations in F-wave morphology on surface electrocardiogram (ECG) during CCWID and CWID flutter have been reported but never systematically characterized. METHODS: Over a four-year period, 139 patients with AFL on ECG underwent electrophysiologic study and echocardiography at our institution. Electrocardiographic data, intracardiac recordings, echocardiographic data, and patient characteristics were reviewed retrospectively. RESULTS: Of 156 AFLs evaluated, 130 were CCWID, 26 were CWID. Three types of CCWID flutter were observed: type 1 had purely negative F-waves inferiorly, types 2 and 3 had F-waves inferiorly with small (type 2) or broad (type 3) positive terminal deflections; CCWID flutter types 2 and 3 were associated with higher incidence of left atrial (LA) enlargement, heart disease, and atrial fibrillation (Afib) than type 1. Two types of CWID flutter were observed: type 1 had notched positive F-waves with a distinct isoelectric segment inferiorly. Type 2 had broader F-waves inferiorly with positive and negative components and a short isoelectric segment. CONCLUSIONS: Variable ECG patterns for CCWID and CWID AFL exist. A positive component of the F-wave in the inferior leads during CCWID flutter is associated with an increased likelihood of heart disease, Afib, and LA enlargement.
Paul Milliez; Allison W Richardson; Ogundu Obioha-Ngwu; Peter J Zimetbaum; Panos Papageorgiou; Mark E Josephson
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  40     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2002 Sep 
Date Detail:
Created Date:  2002-09-30     Completed Date:  2002-10-16     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1125-32     Citation Subset:  AIM; IM    
Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Beth Israel Deacones Medical Center, Boston, Massashusetts 02215, USA.
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MeSH Terms
Aged, 80 and over
Atrial Flutter / physiopathology*,  ultrasonography
Atrial Function, Right / physiology*
Heart Atria / physiopathology*,  ultrasonography
Middle Aged
Retrospective Studies
Sensitivity and Specificity

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