Body surface mapping of counterclockwise and clockwise typical atrial flutter: a comparative analysis with...

Area of Science:

• Cardiology
• Electrophysiology
• Medical Imaging

Background:

• 12-lead ECG analysis for atrial flutter (Fl) classification is often inaccurate.
• Distinguishing counterclockwise (CCW) and clockwise (CW) typical atrial Fl is challenging.
• A need exists for more precise diagnostic tools for atrial flutter.

Purpose of the Study:

• To develop spatial 62-lead electrocardiogram (ECG) criteria for classifying CCW and CW typical atrial flutter.
• To establish diagnostic criteria applicable to patients with and without structural heart disease.
• To improve the accuracy of atrial flutter diagnosis using advanced ECG mapping.

Main Methods:

• Acquired 62-lead ECG signals and endocardial recordings during various atrial flutter types.
• Computed integral maps from stable potential distributions during flutter wave episodes.
• Developed quantitative interpatient integral map pattern correspondence for CCW and CW flutter.

Main Results:

• Identified distinct spatial voltage distribution patterns for CCW and CW atrial flutter.
• CCW flutter maps showed sequential activation patterns (caudocranial, craniocaudal, lateral isthmus).
• CW flutter maps revealed different sequential activation patterns (craniocaudal, isthmus, caudocranial).

Conclusions:

• 62-lead ECG reveals stereotypical spatial voltage distributions specific to atrial flutter rotation direction.
• Mean integral maps provide a reference for enhanced clinical detection and classification of typical atrial flutter.
• Spatial ECG mapping offers superior diagnostic capability compared to traditional 12-lead analysis.