The catheter was used to obtain simultaneous bipolar recordings from the right atrium (lateral tricuspid annulus and cavotricuspid isthmus) and the left atrium. In patients requiring an electrophysiologic study for ablation of atrial fibrillation, typical atrial flutter, or atypical atrial flutter (focal tachycardias were excluded), a 24-pole mapping catheter (Orbiter ®, Bard Electrophysiology) was introduced over the coronary sinus and the lateral tricuspid annulus. The aim of this study was to identify an electrophysiologic parameter that is easily identified with a single catheter electrode in the right atrium and that allows discrimination between atrial flutter and organized atrial fibrillation. This is especially true when recordings are obtained with a single catheter electrode in the right atrium, as occurs, for example, with devices used for treatment of supraventricular tachyarrhythmia, since some episodes of atrial fibrillation can present with an organized electrical pattern in that chamber. 3,4ĭifferential diagnosis between atrial fibrillation and atrial flutter sometimes presents problems that are difficult to resolve, even with the use of endocardial electrograms. Since these arrhythmias differ in their underlying physiologic mechanisms and the currently available therapeutic options for their treatment, it is essential to clearly differentiate between them. Patients who primarily present atrial fibrillation generally also experience atrial flutter over the course of their lives, and vice versa. Cycle length was better than the variation in cycle length for differentiating atrial flutter from organized atrial fibrillation.Ītrial fibrillation and atrial flutter are 2 common arrhythmias. A cycle length variation ≤18 ms discriminated atrial flutter from atrial fibrillation with a sensitivity of 70% and a specificity of 80%. A cycle length ≥203 ms discriminated atrial flutter from atrial fibrillation with a sensitivity of 97% and a specificity of 87%. The mean variation in cycle length was less in Groups I and II than in Group III (16 ms and 13 ms, respectively, versus 22 ms P<.01). The mean cycle length was longer in Groups I and II than in Group III (232 ms and 234 ms, respectively, versus 183 ms P<.001). The mean cycle length and the mean variation in cycle length observed over 15 seconds in electrograms of the right atrium were recorded. Simultaneous bipolar electrograms of the right and left atria were obtained in 45 patients: Group I comprised 15 patients with atypical flutter, Group II comprised 15 with typical flutter, and Group III, 15 with organized atrial fibrillation in the right atrium. We assessed criteria for discriminating between atrial flutter and organized atrial fibrillation when using a bipolar electrode in the right atrium. Because atrial fibrillation in the right atrium can exhibit an organized pattern, it can be difficult to differentiate from atrial flutter. Contemporary atrial pacemakers incorporate pacing modes for treating atrial arrhythmias. La longitud de ciclo fue mejor parámetro diferenciador que la variación del ciclo para distinguir un aleteo auricular de una fibrilación auricular organizada.
Una variación de la longitud de ciclo ≤18 ms permitió discriminar un aleteo auricular de una fibrilación auricular con una sensibilidad del 70% y una especificidad del 80%. Una longitud de ciclo ≥203 ms permitió discriminar un aleteo de una fibrilación auricular con una sensibilidad del 97% y una especificidad del 87%. La variación media de la longitud de ciclo fue menor en los grupos I y II respecto al grupo III (16 ± 7 y 13 ± 4 frente a 22 ± 7 ms, respectivamente p < 0,01). La longitud de ciclo fue mayor en los grupos I y II respecto al grupo III (232 ± 21 y 234 ± 24 frente a 183 ± 16 ms, respectivamente p < 0,001).
Se midieron la longitud de ciclo media y la variación media de la longitud de ciclo en los electrogramas de aurícula derecha durante 15 s. Se obtuvieron electrogramas bipolares simultáneos de aurícula derecha e izquierda en 45 pacientes (grupo I: 15 pacientes con aleteo atípico grupo II: 15 pacientes con aleteo típico, y grupo III: 15 pacientes con fibrilación auricular organizada en la aurícula derecha). Estudiamos los criterios para discriminar un aleteo de una fibrilación auricular organizada utilizando un electrodo bipolar en la aurícula derecha. La fibrilación auricular puede tener un patrón organizado en la aurícula derecha, lo que dificulta el diagnóstico diferencial con el aleteo auricular. Los modernos dispositivos auriculares incorporan estimulación para tratar arritmias auriculares.
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