Atypical Electrocardiographic Features of Cavotricuspid Isthmus-Dependent Atrial Flutter Occurring during Left Atrial Fibrillation Ablation

作者：Chyou Janice Y; Hickey Kathleen; Diamond Laurence; Whang William; Dizon Jose; Garan Hasan; Biviano Angelo^*

来源：Annals of Noninvasive Electrocardiology, 2010, 15(3): 200-208.

• atrial flutter
• atrial fibrillation
• radiofrequency ablation
• ablation
• electrocardiography
• cavotricuspid isthmus

Methods and Results: Of 223 patients presenting for first AF ablation at our institution between May 2004 and February 2008, 20 patients (9%) developed CTI-dependent AFL during LA ablation for AF. CTI-dependent AFL developed spontaneously in 4 patients (20%) and was induced in 16 patients (80%). Among these 20 patients, 3 (15%) had typical ECG patterns and 17 (85%) had atypical ECG patterns. Flutter waves in the inferior leads were biphasic in 10 patients (50%), downward in 3 patients (15%), positive in 3 patients (15%), and not fitting the above classifications in 4 patients (20%). There was no statistically significant association between AFL pattern and LA size, left ventricular ejection fraction, total ablation time, duration of prior AF, or type of prior AF.
Conclusion: A majority of patients with CTI-dependent AFL occurring during LA ablation have atypical ECG patterns. Biphasic flutter waves in the inferior leads are common ECG features, occurring in one-half of patients. Right atrial CTI-dependent AFL should be suspected even if the ECG appearance is atypical.
Ann Noninvasive Electrocardiol 2010;15(3):200-208.

• 出版日期2010-7