Electrocardiographic differentiation of atrial flutter from atrial fibrillation by physicians

Bradley P. Knight*, Gregory F. Michaud, S. Adam Strickberger, Fred Morady

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

35 Scopus citations

Abstract

The purpose of this study was to determine the ability of physicians to differentiate atrial flutter from atrial fibrillation on a surface electrocardiogram (ECG). A questionnaire containing three 12-lead ECGs was mailed to 689 physicians, with multiple-choice questions asking whether the rhythm on each ECG was atrial flutter or atrial fibrillation. ECG 1 showed atrial fibrillation with prominent atrial activity (>0.2 mV) in lead V1; ECG 2 displayed atrial fibrillation with prominent atrial activity (>0.2 mV) in leads III and V1; and ECG 3 displayed atrial flutter. Overall, ECG 1 was correctly identified as atrial fibrillation by 79% of physicians, ECG 2 was correctly identified as atrial fibrillation by 31%, and ECG 3 was correctly identified as atrial flutter by 90%. Cardiology fellows and cardiologists correctly identified ECG 1 more often than house officers and internists (95% vs 63%; P ≤ .01). ECG 2 was correctly identified by 26% of cardiology fellows and cardiologists and by 37% of house officers and internists (P = .10). ECG 3 was correctly identified by 91% of cardiology fellows and cardiologists and by 82% of house officers and internists (P = .06). In conclusion, atrial fibrillation is frequently misdiagnosed as atrial flutter. Misdiagnosis of atrial fibrillation occurs more often when atrial activity is prominent on an ECG in more than one lead.

Original languageEnglish (US)
Pages (from-to)315-319
Number of pages5
JournalJournal of Electrocardiology
Volume32
Issue number4
DOIs
StatePublished - Oct 1999

Keywords

  • Atrial fibrillation
  • Atrial flutter
  • Electrocardiology

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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