![]() A 64 pole basket catheter (Constellation, Boston Scientific™) was used to record atrial electrograms (EGMs). Left sided access was obtained by crossing the intra-atrial septum under intra cardiac echocardiogram (ICE) and fluoroscopic guidance using a SL0 sheath and a BRK-1 (St Jude Medical) needle. A 5 Fr sheath was placed in the femoral artery for continuous arterial pressure monitoring. Percutaneous femoral venous access was obtained bilaterally. Animals were sedated using Propofol and then intubated for general anesthesia using Isoflurane (1–3%). We provide a spectral analysis where dominant frequency (DF) of the ECG leads can differentiate between the two distinct arrhythmias, even when it is not evident by the presence of flutter \fibrillation waves or beat-to-beat regularity.Īll animals underwent an electrophysiology (EP) study to record atrial electrograms along with surface ECG signals. We hypothesized that some of these induced atrial arrhythmias in control animals can be atrial flutter (AFL), even though it might appear as AF on the body-surface ECG. While there is no structural or electrical remodeling in healthy animals, lone-AF induction that is sustained can be questionable leading to mischaracterization of the underlying mechanism of these arrhythmias. Most of these animals are healthy and undergo arrhythmia induction by rapid pacing with or without pharmacological intervention. The same problem arises in animal models of AF, which are routinely used to study arrhythmia mechanisms or test drugs. Coarse fibrillation waves during AF can be mistaken for AFL or rapid focal AT. ![]() Atrial flutter can represent itself with variable RR intervals. As a result the differentiation between AF and AFL/AT can be a persistent challenge in ECG based diagnosis of atrial arrhythmias, especially when looking at brief periods of surface ECG. At times, despite the regular atrial activity in AFL and AT due to block in the AV node, specially, at high rates the ventricular activity is not regular and the surface ECG can mimic AF. As a result, in both AFL and AT ventricular activation can be regular and in AFL saw-tooth flutter waves is commonly seen on the surface ECG. Unlike AF, in AT and AF there is organized activity with a single focal or re-entrant driver, respectively. This chaotic activation presents itself on electrocardiogram (ECG) with absence of regular P wave, irregular RR intervals and fibrillatory waves. Multiple micro-reentrant and focal activation can be simultaneously present in AF. Atrial fibrillation is characterized by a more disorganized electrical activity in the atrium as compared to atrial flutter (AFL) or atrial tachycardia (AT). Accurate ECG interpretation of the atrial tachyarrhythmia facilitates optimal management. Sometimes other atrial arrhythmias like atrial flutter (AFL) or atrial tachycardia (AF) can mimic AF on surface ECG. Atrial Fibrillation (AF) is the most common cardiac arrhythmia and a major cause of stroke.
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