Abstract 11027: Interlead Differences in the Timing of Atrial Flutter Waves: A New Electrocardiographic Index to Predict whick Atrium Supports the Reentrant Circuit
Introduction: No electrocardiographic index (ECGI) is available to confidently predict the location of the reentrant circuit of atrial flutter (AFL). We examined the reliability of a new ECGI reflecting the interlead difference (ILD) in the timing of the peak of AFL wave between limb and precordial leads, in predicting the atrium supporting the reentrant circuit.
Methods: In 37 men and 5 women, 66.0±11.5 years of age, who underwent successful ablation, we divided 46 AFL among 1) Group A, which comprised 24 typical counterclockwise (CCW) AFL, 2 lower/upper loop reentries and 1 incisional reentry originating from the right atrium, 2) Group B, which comprised 9 clockwise (CW) typical right AFL, and 3) Group C, which comprised 10 AFL originating from the left atrium, including 6 CW perimitral, 2 roof-dependent, 1 CCW perimitral, and 1 gap reentrant AFL. Choosing the highest amplitude of the AFL wave regardless of polarity in lead II as Point A, and the peak of the positive AFL wave in lead V1 as Point B, ILD, the interval between Point A and next Point B (Interval Y) divided by the FL cycle length (Interval X) (Figure) was compared among the 3 groups. The results are shown in the table. An ILD <0.26 predicted AFL originating from the RA (except in the cases of CW typical right AFL) with 90.2 % accuracy, while an ILD >0.76 predicted AFL originating from the LA with 94.7% accuracy.
Conclusions: ILD is a new ECGI that reliably predicts the atrium supporting the reentrant circuit of AFL. This index might help for counseling patients and planning AFL ablation procedures.
- © 2012 by American Heart Association, Inc.