Related Experiment Videos
Electrocardiographic differentiation of atrial flutter from atrial fibrillation by physicians
B P Knight1, G F Michaud, S A Strickberger
1Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, USA.
Insights
Physicians often misdiagnose atrial fibrillation as atrial flutter on electrocardiograms (ECGs). This confusion is more common when atrial activity is prominent in multiple ECG leads.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Diagnostics
Background:
- Atrial fibrillation and atrial flutter are common arrhythmias.
- Accurate differentiation on surface electrocardiograms (ECGs) is crucial for appropriate management.
- Previous studies indicate potential diagnostic challenges.
Purpose of the Study:
- To assess the diagnostic accuracy of physicians in distinguishing atrial flutter from atrial fibrillation using surface ECGs.
- To identify factors influencing misdiagnosis rates.
Main Methods:
- A questionnaire with three distinct 12-lead ECG examples was distributed to 689 physicians.
- Participants were asked to classify each ECG rhythm as either atrial flutter or atrial fibrillation.
- ECG examples included varying degrees of prominent atrial activity.
Main Results:
- Overall accuracy for identifying atrial fibrillation was 79% (ECG 1) and 31% (ECG 2).
- Accuracy for identifying atrial flutter was 90% (ECG 3).
- Misdiagnosis of atrial fibrillation was more frequent when prominent atrial activity appeared in multiple ECG leads.
Conclusions:
- Atrial fibrillation is frequently misdiagnosed as atrial flutter.
- Prominent atrial activity in more than one ECG lead increases the likelihood of misdiagnosis.
- Enhanced physician training may be needed for accurate arrhythmia differentiation.
Abstract:
The purpose of this study was to determine the ability of physicians to differentiate atrial flutter from atrial fibrillation on a surface electrocardiogram (ECG). A questionnaire containing three 12-lead ECGs was mailed to 689 physicians, with multiple-choice questions asking whether the rhythm on each ECG was atrial flutter or atrial fibrillation. ECG 1 showed atrial fibrillation with prominent atrial activity (>0.2 mV) in lead V1; ECG 2 displayed atrial fibrillation with prominent atrial activity (>0.2 mV) in leads III and V1; and ECG 3 displayed atrial flutter. Overall, ECG1 was correctly identified as atrial fibrillation by 79% of physicians, ECG 2 was correctly identified as atrial fibrillation by 31%, and ECG 3 was correctly identified as atrial flutter by 90%. Cardiology fellows and cardiologists correctly identified ECG 1 more often than house officers and internists (95% vs 63%; P < or = .01). ECG 2 was correctly identified by 26% of cardiology fellows and cardiologists and by 37% of house officers and internists (P = .10). ECG 3 was correctly identified by 91% of cardiology fellows and cardiologists and by 82% of house officers and internists (P = .06). In conclusion, atrial fibrillation is frequently misdiagnosed as atrial flutter. Misdiagnosis of atrial fibrillation occurs more often when atrial activity is prominent on an ECG in more than one lead.