Variable electrocardiographic characteristics of isthmus-dependent atrial flutter
Paul Milliez, MD ,
Allison W. Richardson, MD*, ,
Ogundu Obioha-Ngwu, MD*,,
Peter J. Zimetbaum, MD, FACC*,,
Panos Papageorgiou, MD, FACC, PhD*, and
Mark E. Josephson, MD, FACC*,*
* Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
Harvard Medical School, Boston, Massachusetts, USA
Dr. Milliez is currently affiliated with the Lariboisiere University Hospital, Paris, France
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Figure 1 Sample F-wave morphologies: F– = negative F-wave; F+(n) = notched positive F-wave; F–/f+ = biphasic predominantly negative F-wave with a small terminal positive component; f–/F+ = biphasic predominantly positive F-wave with a small initial negative component; F+/f– = biphasic predominantly positive F-wave with a small terminal negative component; I = biphasic, isoelectric F-wave with approximately equal positivity and negativity.
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Figure 2 Morphologic variations of counterclockwise isthmus-dependent atrial flutter on 12-lead surface electrocardiogram: (A) Type 1: F– in II, III, aVF, and V6; F+ in V1. (B) Type 2: F–/f+ in II, III, aVF; F– or F–/f+ in V6, F+ in V1. (C) Type 3: f–/F+ in II, III, aVF, and V6; F+/f– in V1. Abbreviations as in Figure 1.
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Figure 3 Morphologic variations of clockwise isthmus-dependent atrial flutter on 12-lead surface electrocardiogram: (A) Type 1: F+(n) or F+ in II, III, aVF, and V6; F– in V1, narrow F-wave/distinct isoelectric segment. (B) Type 2: f–/F+9(n) or F+(n) inferiorly and V6, isoelectric in V1, with a broad F-wave and no distinct isoelectric segment. Abbreviations as in Figure 1.
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