Algorithm for cavo-tricuspid isthmus flutter on surface ECGs: the ACTIONS study
Objective Cavo-tricuspid isthmus atrial flutter (CTI-AFL) is an important arrhythmia to recognise because there is a highly effective and relatively low-risk ablation strategy. However, clinical experience has demonstrated that providers often have difficulty distinguishing AFL from atrial fibrillat...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2021-02-01
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| Series: | Open Heart |
| Online Access: | https://openheart.bmj.com/content/8/1/e001431.full |
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| author | Daniel R Frisch Eitan Frankel Deanna Gill Jad Al Danaf |
| author_facet | Daniel R Frisch Eitan Frankel Deanna Gill Jad Al Danaf |
| author_sort | Daniel R Frisch |
| collection | DOAJ |
| description | Objective Cavo-tricuspid isthmus atrial flutter (CTI-AFL) is an important arrhythmia to recognise because there is a highly effective and relatively low-risk ablation strategy. However, clinical experience has demonstrated that providers often have difficulty distinguishing AFL from atrial fibrillation.Methods We developed a novel ECG-based three-step algorithm to identify CTI-AFL based on established CTI flutter characteristics and verified on consecutive ablation cases of typical flutter, atypical flutter and atrial fibrillation. The algorithm assesses V1/inferior lead F-wave concordance, consistency of P-wave morphology and the presence of isoelectric intervals in the inferior leads. In this observation study, the algorithm was validated on a cohort of 50 second-year medical students. Students were paired in a control and experimental group, and each pair received 10 randomly selected ECGs (from a pool of 50 intracardiac electrogram-proven CTI-AFL and 50 AF or atypical AFL cases). The experimental group received a cover sheet with the CTI algorithm, and the control group received no additional guidance.Results There was a statistically significant difference in the mean number of correctly identified ECGs among the students in the experimental and control groups (8.12 vs 5.68, p<0.001). Students who used the algorithm correctly identified 2.44 more ECGs as being CTI-AFL or not CTI-AFL. Using the electrophysiology study as the gold standard, the algorithm had an accuracy of 81%, sensitivity of 81%, specificity of 82%, positive predictive value of 78% and negative predictive value of 84% in identifying CTI-AFL.Conclusion We developed a three-step ECG algorithm that provides a simple, sensitive, specific and accurate tool to identify CTI-AFL. |
| format | Article |
| id | doaj-art-c20537e4a98144d88a0fa2c9f58de9f1 |
| institution | Kabale University |
| issn | 2053-3624 |
| language | English |
| publishDate | 2021-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Open Heart |
| spelling | doaj-art-c20537e4a98144d88a0fa2c9f58de9f12024-11-11T13:05:09ZengBMJ Publishing GroupOpen Heart2053-36242021-02-018110.1136/openhrt-2020-001431Algorithm for cavo-tricuspid isthmus flutter on surface ECGs: the ACTIONS studyDaniel R Frisch0Eitan Frankel1Deanna Gill2Jad Al Danaf3Cardiology, Thomas Jefferson University, Philadelphia, PA 19107-5084, USAInternal Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USAInternal Medicine, Emory University Hospital, Atlanta, Georgia, USADivision of Cardiovascular Medicine, University of Utah Health, Salt Lake City, Utah, USAObjective Cavo-tricuspid isthmus atrial flutter (CTI-AFL) is an important arrhythmia to recognise because there is a highly effective and relatively low-risk ablation strategy. However, clinical experience has demonstrated that providers often have difficulty distinguishing AFL from atrial fibrillation.Methods We developed a novel ECG-based three-step algorithm to identify CTI-AFL based on established CTI flutter characteristics and verified on consecutive ablation cases of typical flutter, atypical flutter and atrial fibrillation. The algorithm assesses V1/inferior lead F-wave concordance, consistency of P-wave morphology and the presence of isoelectric intervals in the inferior leads. In this observation study, the algorithm was validated on a cohort of 50 second-year medical students. Students were paired in a control and experimental group, and each pair received 10 randomly selected ECGs (from a pool of 50 intracardiac electrogram-proven CTI-AFL and 50 AF or atypical AFL cases). The experimental group received a cover sheet with the CTI algorithm, and the control group received no additional guidance.Results There was a statistically significant difference in the mean number of correctly identified ECGs among the students in the experimental and control groups (8.12 vs 5.68, p<0.001). Students who used the algorithm correctly identified 2.44 more ECGs as being CTI-AFL or not CTI-AFL. Using the electrophysiology study as the gold standard, the algorithm had an accuracy of 81%, sensitivity of 81%, specificity of 82%, positive predictive value of 78% and negative predictive value of 84% in identifying CTI-AFL.Conclusion We developed a three-step ECG algorithm that provides a simple, sensitive, specific and accurate tool to identify CTI-AFL.https://openheart.bmj.com/content/8/1/e001431.full |
| spellingShingle | Daniel R Frisch Eitan Frankel Deanna Gill Jad Al Danaf Algorithm for cavo-tricuspid isthmus flutter on surface ECGs: the ACTIONS study Open Heart |
| title | Algorithm for cavo-tricuspid isthmus flutter on surface ECGs: the ACTIONS study |
| title_full | Algorithm for cavo-tricuspid isthmus flutter on surface ECGs: the ACTIONS study |
| title_fullStr | Algorithm for cavo-tricuspid isthmus flutter on surface ECGs: the ACTIONS study |
| title_full_unstemmed | Algorithm for cavo-tricuspid isthmus flutter on surface ECGs: the ACTIONS study |
| title_short | Algorithm for cavo-tricuspid isthmus flutter on surface ECGs: the ACTIONS study |
| title_sort | algorithm for cavo tricuspid isthmus flutter on surface ecgs the actions study |
| url | https://openheart.bmj.com/content/8/1/e001431.full |
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