A new electrocardiographic algorithm to differentiate upper loop re-entry from reverse typical atrial flutter.
OBJECTIVE
This study was performed to differentiate upper loop re-entry (ULR) from reverse typical atrial flutter (AFL).


BACKGROUND
Right atrial ULR and reverse typical AFL have different mechanisms and ablation strategies, but similar electrocardiographic characteristics.


METHODS
This study included 26 patients with reverse typical AFL and 20 patients with ULR. The noncontact mapping system (EnSite-3000, Endocardial Solutions, St. Paul, Minnesota) was used to confirm diagnosis and guide successful radiofrequency ablation. Flutter wave polarity and amplitude in the 12-lead surface electrocardiogram were determined by two independent electrophysiologists.


RESULTS
The flutter wave polarity in leads I and aVL was significantly different between the reverse typical AFL and ULR groups (p < or = 0.001). Voltage measurement revealed significant differences between reverse typical AFL and ULR in leads I, II, aVR, aVF, V1, and V2 (p < 0.001). A new diagnostic algorithm based on negative or isoelectric/flat flutter wave polarity and amplitude < or =0.07 mV in lead I was useful for diagnosis of ULR, with an accuracy of 90% to 97%, a sensitivity of 82% to 100%, and a specificity of 95%.


CONCLUSIONS
Polarity and voltage measurement of flutter wave in lead I can differentiate reverse typical AFL from ULR.
Yuniadi
Yoga
Y
Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, and National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.
Tai
Ching-Tai
CT
Lee
Kun-Tai
KT
Huang
Bien-Hsien
BH
Lin
Yenn-Jiang
YJ
Higa
Satoshi
S
Liu
Tu-Ying
TY
Huang
Jin-Long
JL
Lee
Pi-Chang
PC
Chen
Shih-Ann
SA
D000328:Adult; D000368:Aged; D000465:Algorithms; D001282:Atrial Flutter / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D018780:Body Surface Potential Mapping; D017115:Catheter Ablation / Q000379:methods*; D015331:Cohort Studies; D004562:Electrocardiography / Q000379:methods*; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D016896:Treatment Outcome