Separating atrial flutter from atrial fibrillation with apparent electrocardiographic organization using dominant and narrow F-wave spectra
Separating atrial flutter from atrial fibrillation with apparent electrocardiographic organization using dominant and narrow F-wave spectra
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DOI：
10.1016/j.jacc.2005.08.048
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发表时间：
2005-12-06
影响因子：
24
通讯作者：
Narayan, SM
中科院分区：
文献类型：
--
作者：
Hoppe, BL;Kahn, AM;Narayan, SM
本研究的目的是区分具有非典型F波的心房扑动（AFL）和具有“明显机化”的房颤（AF）。“背景我们假设F波频谱在AFL中应该显示一个主要的窄峰，反映其单一的宏观折返波前，但在AF中显示宽谱，反映多个波前。AFL 21例（非典型18例，典型3例），AF 18例，均成功消融。通过将F波与连续的ECG时间点交叉相关来创建过滤的心房ECG。从X射线的功率谱中识别出3 - 10 Hz之间的主要峰（导联V-5）、Y（aVF）和Z（V-1）轴，并且对于每个轴，我们计算了高度（相对于两个相邻频谱点）和与带宽为0.625、1.25、2.5、3.75和5 Hz的包络的面积比结果AFL的主导峰的相对高度大于AF（三轴平均值：14.2 +/- 6.4 dB vs. 6.6 +/- 2.1 dB; p < 0.001）。对于所有包膜，AFL的峰面积比也高于AF（p < 0.001）。对于2.5 Hz包络，分离（分别为0.61 +/- 0.14 vs. 0.35 +/- 0.05; p < 0.001）使得比率>= 0.44能够识别所有AFL和AF病例（p < 0.001）。一个由7名心脏病专家组成的小组对临床数据不知情，其诊断准确率较低（82.1%; p < 0.01）。结论：在不明确的ECG中，不典型F波，孤立激动周期的频谱证据将AFL与具有“明显组织性”的AF区分开来。“这种方法可能会改善床旁心电图诊断，并摆脱对心房内组织的两种节奏的斗争。
OBJECTIVES The purpose of this study was to separate atrial flutter (AFL) with atypical F waves from fibrillation (AF) with "apparent organization."BACKGROUND We hypothesized that F-wave spectra should reveal a dominant and narrow peak in AFL, reflecting its single macro-re-entrant wave front, but broad spectra in AF, reflecting multiple wave fronts.METHODS We identified 39 patients with electrocardiograms (ECGs) of "AFL/AF" or "coarse AF" from 134 consecutive patients referred for ablation: 21 had AFL (18 atypical, 3 typical), 18 had AF, and all were successfully ablated. Filtered atrial ECGs were created by cross-correlating F waves to successive ECG time points. Dominant peaks between 3 and 10 Hz were identified from power spectra of X (lead V-5), Y (aVF), and Z (V-1) axes, and for each, we calculated height (relative to two adjacent spectral points) and area ratio to envelopes of bandwidth 0.625, 1.25, 2.5, 3.75, and 5 Hz (range 0 to 1, where higher ratios reflect narrower peaks).RESULTS Dominant peaks had greater relative height for AFL than AF (three-axis mean: 14.2 +/- 6.4 dB vs. 6.6 +/- 2.1 dB; p < 0.001). Peak area ratios were also higher for AFL than AF for all envelopes (p < 0.001). For the 2.5-Hz envelope, the separation (0.61 +/- 0.14 vs. 0.35 +/- 0.05, respectively; p < 0.001) enabled a ratio >= 0.44 to identify all cases of AFL from AF (p < 0.001). A panel of seven cardiologists blinded to clinical data provided lower diagnostic accuracy (82.1%; p < 0.01).CONCLUSIONS In ambiguous ECGs with atypical F waves, spectral evidence for a solitary activation cycle separates AFL from AF with "apparent organization." This approach might improve bedside ECG diagnosis and shed fight on intra-atrial organization of both rhythms.