Barbato Gaetano, Carinci Valeria, Tomasi Corrado, Frassineti Valeria, Margheri Massimo, Di Pasquale Giuseppe
Cardiology Department, Maggiore Hospital, Largo Nigrisoli 2, Bologna, Italy.
Europace. 2009 Aug;11(8):1071-6. doi: 10.1093/europace/eup166. Epub 2009 Jul 1.
To verify the reliability of the surface ECG to discriminate between cavotricuspid isthmus-dependent atrial flutter (CTI-AFL) and non-CTI-AFL.
We reviewed the ECGs of 186 consecutive patients who underwent catheter ablation of AFL between January 2004 and January 2008. The ECG pattern was defined typical for CTI-AFL, if F-waves were: (i) dominantly negative in the inferior leads and positive in V1 (CCW) or (ii) dominantly positive in the inferior leads and negative in V1 (CW). At the electrophysiological study (EPS), 138 patients (74.2%) had a CTI-AFL and 48 patients (25.8%) had a non-CTI-AFL. A CTI-AFL was found not only in 90.5% of patients having a typical ECG, but also in 40% of patients having an atypical ECG. Thus, a typical AFL ECG showed a sensitivity of 0.83 and a specificity of 0.75 to predict a CTI-AFL, with a positive predictive value of 90.5% and a negative predictive value of 60%.
Typical AFL ECG is a good predictor of CTI-AFL, and in this case, an ablation procedure can be recommended. On the contrary, an atypical AFL ECG does not rule out a CTI-AFL; so, even in this group of patients, an EPS should not be denied when indicated by the clinical circumstances.
验证体表心电图鉴别三尖瓣峡部依赖性房扑（CTI-AFL）和非CTI-AFL的可靠性。
我们回顾了2004年1月至2008年1月期间连续186例行房扑导管消融术患者的心电图。如果F波满足以下条件，则心电图模式定义为CTI-AFL典型模式：（i）下壁导联主要为负向，V1导联为正向（逆时针方向）；或（ii）下壁导联主要为正向，V1导联为负向（顺时针方向）。在电生理研究（EPS）中，138例患者（74.2%）为CTI-AFL，48例患者（25.8%）为非CTI-AFL。不仅90.5%具有典型心电图的患者被发现为CTI-AFL，而且40%具有非典型心电图的患者也被发现为CTI-AFL。因此，典型的房扑心电图预测CTI-AFL的敏感性为0.83，特异性为0.75，阳性预测值为90.5%，阴性预测值为60%。
典型的房扑心电图是CTI-AFL的良好预测指标，在这种情况下，可以推荐进行消融手术。相反，非典型的房扑心电图不能排除CTI-AFL；因此，即使在这组患者中，当临床情况表明需要时，也不应拒绝进行电生理研究。
