Predictors of unusual ECG characteristics in cavotricuspid isthmus-dependent atrial flutter ablation

Pacing Clin Electrophysiol. 2011 Oct;34(10):1251-7. doi: 10.1111/j.1540-8159.2011.03137.x. Epub 2011 May 23.


Background: An unusual 12-lead electrocardiographic pattern may be present in patients with cavotricuspid isthmus (CTI)-dependent flutter.

Objective: Using baseline patient characteristics and echocardiography, we sought to study predictors of unusual electrocardiogram (ECG) characteristics in patients with CTI-dependent atrial flutter.

Methods: This was a dual-center, retrospective cohort study of 147 patients undergoing electrophysiology study and ablation for CTI-dependent atrial flutter.

Results: Among this cohort, 23 patients (16%) had unusual 12-lead ECG characteristics. Using multivariate logistic regression, we found two clinical predictors for having an unusual ECG pattern. A clockwise (CW) pattern at time of electrophysiology study was the strongest predictor of an unusual ECG pattern (odds ratio 15.3, 95% confidence interval [CI] 4.0-59.4, P < 0.005). In addition, patients with decreased systolic function had a 3.5 greater odds (95% CI 1.1-11.5, P = 0.037) of having an unusual ECG pattern.

Conclusions: Our data demonstrate that among patients suffering from CTI-dependent atrial flutter who are referred for ablation, 16% will have unusual ECG patterns. Patients with CW atrial activation and left ventricle dysfunction have greater odds of manifesting unusual patterns by surface electrocardiogram.

MeSH terms

  • Aged
  • Atrial Flutter / diagnostic imaging
  • Atrial Flutter / physiopathology*
  • Atrial Flutter / surgery*
  • Catheter Ablation*
  • Electrocardiography*
  • Female
  • Heart Atria / diagnostic imaging
  • Heart Atria / physiopathology
  • Heart Atria / surgery
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Stroke Volume
  • Ultrasonography