Weinberg Kenneth M, Denes Pablo, Kadish Alan H, Goldberger Jeffrey J
Department of Medicine and the Feinberg Cardiovascular Institute, Northwestern University, Chicago, Ill, USA.
Am J Med. 2007 Sep;120(9):814-8. doi: 10.1016/j.amjmed.2006.06.013. Epub 2007 Aug 2.
We previously developed and validated diagnostic criteria for the differentiation of atrial flutter from atrial fibrillation. In this study we examine if the criteria (F waves in the frontal plane and a partially or completely regular ventricular response) can improve the diagnostic accuracy of internists.
Two groups of 10 internists (1 group given the criteria and 1 not) read a set of electrocardiograms (ECGs) selected from the hospital database with cardiologist-confirmed diagnoses of atrial fibrillation, atrial flutter, or "atrial fibrillation-flutter" (100 each). The final diagnoses of all ECGs were provided by a consensus of electrophysiologists. The criteria also were used to establish the criteria-based diagnoses.
Of the 298 ECGs analyzed, the electrophysiologist diagnosis was atrial fibrillation in 71% and atrial flutter in 29%. The concordance of the internists' diagnoses with the electrophysiologist consensus diagnoses was 66+/-12% for those not given the criteria and 81+/-4% (P <.01) for those given the criteria. The concordance of the internists' diagnoses with the criteria based diagnoses was 66+/-12% for those not given the criteria and 83+/-4% (P <.01) for those given the criteria.
The simple criteria of F waves in the frontal plane and a partially or completely regular ventricular response can be used to improve the differentiation of atrial flutter from atrial fibrillation based on the ECG.
我们之前制定并验证了区分心房扑动与心房颤动的诊断标准。在本研究中，我们检验这些标准（额面F波以及部分或完全规则的心室反应）能否提高内科医生的诊断准确性。
两组各10名内科医生（一组给予标准，另一组未给予）阅读从医院数据库中选取的一组心电图（ECG），这些心电图经心脏病专家确诊为心房颤动、心房扑动或“心房颤动 - 扑动”（各100份）。所有心电图的最终诊断由电生理学家达成共识后给出。这些标准也用于确立基于标准的诊断。
在分析的298份心电图中，电生理学家诊断为心房颤动的占71%，心房扑动的占29%。未给予标准的内科医生诊断与电生理学家共识诊断的一致性为66±12%，给予标准的内科医生诊断与电生理学家共识诊断的一致性为81±4%（P<.01）。未给予标准的内科医生诊断与基于标准的诊断的一致性为66±12%，给予标准的内科医生诊断与基于标准的诊断的一致性为83±4%（P<.01）。
额面F波以及部分或完全规则的心室反应这一简单标准可用于提高基于心电图区分心房扑动与心房颤动的能力。
