title: Cavotricuspid-Dependent Atrial Flutter in Patients With Prior Atriotomy: 12-Lead ECG Interpretation and Electroanatomical Characteristics.
abstract: BACKGROUND
  The aim of this study was to describe the electrocardiogram (ECG) morphology and electroanatomical characteristics of counterclockwise tricuspid annular atrial flutter (CCWTA-AFL) in the patients with prior atriotomy.
  
  
  RESULTS
  This retrospective study included 34 patients with CCWTA-AFL after cardiac surgery and 20 patients with typical CCWTA-AFL without prior surgery. For patients in the postsurgical group, 19 had single-loop CCWTA-AFL and 15 had a double loop CCWTA-AFL. For single loop CCWTA-AFL the F-wave in lead I was very flat in l7 of 19 patients. The F-wave morphology in the inferior leads and V1 were found to be similar to typical AFL in 14 of 19 patients. For double loop CCWTA-AFL, F-waves were positive in lead I in 13 out of 15 patients. A long isoelectric activation was measured between F-waves in most of the patients. The presence of isoelectric segments between F-waves suggested a double loop AFL, which had a sensitivity of 86.7% and a specificity of 100%. Moreover, flat F-waves in lead I suggested a single loop AFL, which had a sensitivity of 89.5% and specificity of 86.7%. All patients in the group without prior cardiac surgery had typical ECGs features of CCWTA-AFL. None of the patients showed isoelectric segments between F-waves in the inferior leads. The amplitudes of most of the leads were higher than those for single loop CCWTA-AFL in patients with prior surgery.
authors.affiliation: Heart Institute, Tianjin Chest Hospital, Tianjin, China.|Tianjin Medical University, Tianjin, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Ma
authors.affiliation: Heart Institute, Tianjin Chest Hospital, Tianjin, China.
authors.forename: Fengmin
authors.initials: F
authors.lastname: Lu
authors.affiliation: Heart Institute, Tianjin Chest Hospital, Tianjin, China.
authors.forename: Dongyan
authors.initials: D
authors.lastname: Wu
authors.affiliation: Heart Institute, Tianjin Chest Hospital, Tianjin, China.
authors.forename: Bingwei
authors.initials: B
authors.lastname: Chen
authors.affiliation: Heart Institute, Tianjin Chest Hospital, Tianjin, China.
authors.forename: Hongliang
authors.initials: H
authors.lastname: Cong
authors.affiliation: Duke-NUS Graduate Medical School, Singapore.
authors.forename: Reginald
authors.initials: R
authors.lastname: Liew
authors.affiliation: Heart Institute, Tianjin Chest Hospital, Tianjin, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Xu
keywords: F-waves; atrial flutter; cardiac surgery; catheter ablation; cavotricuspid atrial flutter; electrocardiogram