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Criteria for the electrocardiographic diagnosis of atrial flutter improve diagnostic accuracy
Kenneth M Weinberg1, Pablo Denes, Alan H Kadish
1Department of Medicine and the Feinberg Cardiovascular Institute, Northwestern University, Chicago, Ill, USA.
Purpose:
We previously developed and validated diagnostic criteria for the differentiation of atrial flutter from atrial fibrillation. In this study we examine if the criteria (F waves in the frontal plane and a partially or completely regular ventricular response) can improve the diagnostic accuracy of internists.
Methods:
Two groups of 10 internists (1 group given the criteria and 1 not) read a set of electrocardiograms (ECGs) selected from the hospital database with cardiologist-confirmed diagnoses of atrial fibrillation, atrial flutter, or "atrial fibrillation-flutter" (100 each). The final diagnoses of all ECGs were provided by a consensus of electrophysiologists. The criteria also were used to establish the criteria-based diagnoses.
Results:
Of the 298 ECGs analyzed, the electrophysiologist diagnosis was atrial fibrillation in 71% and atrial flutter in 29%. The concordance of the internists' diagnoses with the electrophysiologist consensus diagnoses was 66+/-12% for those not given the criteria and 81+/-4% (P <.01) for those given the criteria. The concordance of the internists' diagnoses with the criteria based diagnoses was 66+/-12% for those not given the criteria and 83+/-4% (P <.01) for those given the criteria.
Conclusions:
The simple criteria of F waves in the frontal plane and a partially or completely regular ventricular response can be used to improve the differentiation of atrial flutter from atrial fibrillation based on the ECG.
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