The Study Of Electrocardiographic Predictors Of New Atrial Fibrillation After Typical Atrial Flutter Ablation

Objective:The incidence of new onset atrial fibrillation(AF)after cavotricuspid isthmus(CTI)ablation of typical atrial flutter(AFL)is very high.This study was to identify whether we could determine which is inclined to AF by only electrocardiogram(ECG)patterns.Method:A total of 158 consecutive patients(78.9%males,age 57.2±14.4)with typical AFL received CTI ablation were enrolled in the study.Electrocardiograms during sinus rhythm and atrial flutter were examined in all patients.The duration of negative and positive flutter waves of lead II under atrial flutter condition,amplitude of negative flutter waves of lead II under atrial flutter condition,duration and amplitude of negative P waves of lead v1 in sinus rhythm,duration of P waves of lead II under in sinus rhythm were measured in all patients.The primary endpoint was occurrence of new onset AF during the postablation follow-up.Result:22(14%)of 158 patients developed new onset AF during a follow-up period of 26.9±11.8 months.The duration of flutter wave of lead II in AFL was 82.69±12.76 ms in patients without AF and 114.61±30.47 ms in patients with new-onset AF(P<0.0001).The amplitude of Lead II flutter negative wave in AFL was 0.17±0.051 mv in patients without AF and 0.115±0.032 mv with AF(P<0.0001).lead II P wave duration in sinus rhythm in patients with and without AF were 145.89±28.84 ms and 111.46±14.18ms(P<0.0001).Conclusion:Flutter waves' morphology during atrial flutter and P waves' morphology during sinus rhythm in lead II and v1 is useful in identifying the incidence of new onset atrial fibrillation after cavotricuspid isthmus ablation of typical atrial flutter.Objective:There are several electrocardiographic factors that can predict new onset atrial fibrillation after typical atrial flutter ablation,and the predictive factors mainly reflect the left atrial lesions.The purpose of this study was to identify which patients with ECG changes were more likely to develop atrial fibrillation by using electrocardiographic score system.Method:158 consecutive patients with typical atrial flutter undergoing tricuspid isthmus ablation were enrolled in this study.The duration of negative flutter wave in ? leads under atrial flutter,positive flutter wave in ? leads under atrial flutter,negative flutter wave amplitude in ? leads under atrial flutter,negative P wave duration in V1 leads under sinus rhythm and P wave duration in ? leads under sinus rhythm were used as predictors of the electrocardiographic score system.Each item was with one point.Result: The duration of negative flutter wave in lead ? more than 89.8 ms was set score as 1 point,the duration of positive flutter wave in lead ? more than 113.4ms was set as 1 point,the amplitude of negative flutter wave in lead? less than 0.13 mv was set as 1 point,the duration of negative P wave in lead V1 more than 70.7 ms was set as 1 point,the duration of negative P wave in lead ? more than 121.3ms was set as 1 point.There were 14 patients with score more than 3,including 12 patients with new-onset atrial fibrillation.For patients with new-onset atrial fibrillation,the average score was 2.45,while that of patients without new atrial fibrillation was only 0.5.For the prediction of atrial fibrillation with score more than 3,the sensitivity,specificity,positive predictive value and negative predictive value were 54.5%,98.5%,85.7% and 93.1% respectively.Conclusion:Electrocardiographic score system can be used to predict the occurrence of new-onset atrial fibrillation after ablation of atrial flutter and to guide the follow-up treatment.