Atrial fibrillation originating from superior vena cava with atrial flutter-electrocardiogram pattern

Hung Kai Huang, Shih Lin Chang, Yenn Jiang Lin, Li Wei Lo, Yu Feng Hu, Fa Po Chung, Yen Chang Huang, Chung-Hsing Lin, Chao Shun Chan, Hung Yu Chang, Chin Yu Lin, Yao Ting Chang, Ching Hui Huang, Shih Ann Chen

Research output: Contribution to journalArticle

Abstract

Backgrounds: Substrate property is related to the genesis and maintenance of atrial fibrillation (AF). The aim of the study was to investigate the impact of substrate property on the electrocardiogram (ECG) in patients with AF originating from the superior vena cava (SVC). Methods and Results: Seventy-six patients with AF originating from SVC who underwent catheter ablation were included from 2004 to 2013. Of these patients, 16 had a presentation of atrial flutter (AFL)-pattern ECG during AF (group 1), and 60 patients did not (group 2). There was no significant difference in clinical characteristics between the groups. The percentage of low voltage zone (LVZ) in SVC below the level of pulmonary artery in group 1 was significantly larger than that in group 2. The polarities of the flutter wave in 12-lead ECG were compared with another 26 subjects with reverse typical AFL. The ECG morphology was characterized by negative or biphasic P waves in lead V1 in most of the patients in group 1 (62.5%), which was analogous to that in reverse typical AFL. The negative polarity of flutter waves in aVL might distinguish SVC AF with an AFL-pattern from reverse typical AFL. Conclusion: The ECG characteristics of AF originating from SVC can mimic atypical AFL. LVZ in the SVC may be associated with the presentation of AFL-pattern ECG.

Original languageEnglish
Pages (from-to)754-761
Number of pages8
JournalPACE - Pacing and Clinical Electrophysiology
Volume40
Issue number7
DOIs
Publication statusPublished - Jul 1 2017
Externally publishedYes

Fingerprint

Atrial Flutter
Superior Vena Cava
Atrial Fibrillation
Electrocardiography
Catheter Ablation
Pulmonary Artery
Maintenance

Keywords

  • atrial fibrillation
  • mimicking atrial flutter pattern
  • superior vena cava

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Huang, H. K., Chang, S. L., Lin, Y. J., Lo, L. W., Hu, Y. F., Chung, F. P., ... Chen, S. A. (2017). Atrial fibrillation originating from superior vena cava with atrial flutter-electrocardiogram pattern. PACE - Pacing and Clinical Electrophysiology, 40(7), 754-761. https://doi.org/10.1111/pace.13092

Atrial fibrillation originating from superior vena cava with atrial flutter-electrocardiogram pattern. / Huang, Hung Kai; Chang, Shih Lin; Lin, Yenn Jiang; Lo, Li Wei; Hu, Yu Feng; Chung, Fa Po; Huang, Yen Chang; Lin, Chung-Hsing; Chan, Chao Shun; Chang, Hung Yu; Lin, Chin Yu; Chang, Yao Ting; Huang, Ching Hui; Chen, Shih Ann.

In: PACE - Pacing and Clinical Electrophysiology, Vol. 40, No. 7, 01.07.2017, p. 754-761.

Research output: Contribution to journalArticle

Huang, HK, Chang, SL, Lin, YJ, Lo, LW, Hu, YF, Chung, FP, Huang, YC, Lin, C-H, Chan, CS, Chang, HY, Lin, CY, Chang, YT, Huang, CH & Chen, SA 2017, 'Atrial fibrillation originating from superior vena cava with atrial flutter-electrocardiogram pattern', PACE - Pacing and Clinical Electrophysiology, vol. 40, no. 7, pp. 754-761. https://doi.org/10.1111/pace.13092
Huang, Hung Kai ; Chang, Shih Lin ; Lin, Yenn Jiang ; Lo, Li Wei ; Hu, Yu Feng ; Chung, Fa Po ; Huang, Yen Chang ; Lin, Chung-Hsing ; Chan, Chao Shun ; Chang, Hung Yu ; Lin, Chin Yu ; Chang, Yao Ting ; Huang, Ching Hui ; Chen, Shih Ann. / Atrial fibrillation originating from superior vena cava with atrial flutter-electrocardiogram pattern. In: PACE - Pacing and Clinical Electrophysiology. 2017 ; Vol. 40, No. 7. pp. 754-761.
@article{4f2c0ef1f8d044fdb96d5274aae37639,
title = "Atrial fibrillation originating from superior vena cava with atrial flutter-electrocardiogram pattern",
abstract = "Backgrounds: Substrate property is related to the genesis and maintenance of atrial fibrillation (AF). The aim of the study was to investigate the impact of substrate property on the electrocardiogram (ECG) in patients with AF originating from the superior vena cava (SVC). Methods and Results: Seventy-six patients with AF originating from SVC who underwent catheter ablation were included from 2004 to 2013. Of these patients, 16 had a presentation of atrial flutter (AFL)-pattern ECG during AF (group 1), and 60 patients did not (group 2). There was no significant difference in clinical characteristics between the groups. The percentage of low voltage zone (LVZ) in SVC below the level of pulmonary artery in group 1 was significantly larger than that in group 2. The polarities of the flutter wave in 12-lead ECG were compared with another 26 subjects with reverse typical AFL. The ECG morphology was characterized by negative or biphasic P waves in lead V1 in most of the patients in group 1 (62.5{\%}), which was analogous to that in reverse typical AFL. The negative polarity of flutter waves in aVL might distinguish SVC AF with an AFL-pattern from reverse typical AFL. Conclusion: The ECG characteristics of AF originating from SVC can mimic atypical AFL. LVZ in the SVC may be associated with the presentation of AFL-pattern ECG.",
keywords = "atrial fibrillation, mimicking atrial flutter pattern, superior vena cava",
author = "Huang, {Hung Kai} and Chang, {Shih Lin} and Lin, {Yenn Jiang} and Lo, {Li Wei} and Hu, {Yu Feng} and Chung, {Fa Po} and Huang, {Yen Chang} and Chung-Hsing Lin and Chan, {Chao Shun} and Chang, {Hung Yu} and Lin, {Chin Yu} and Chang, {Yao Ting} and Huang, {Ching Hui} and Chen, {Shih Ann}",
year = "2017",
month = "7",
day = "1",
doi = "10.1111/pace.13092",
language = "English",
volume = "40",
pages = "754--761",
journal = "PACE - Pacing and Clinical Electrophysiology",
issn = "0147-8389",
publisher = "Wiley-Blackwell",
number = "7",

}

TY - JOUR

T1 - Atrial fibrillation originating from superior vena cava with atrial flutter-electrocardiogram pattern

AU - Huang, Hung Kai

AU - Chang, Shih Lin

AU - Lin, Yenn Jiang

AU - Lo, Li Wei

AU - Hu, Yu Feng

AU - Chung, Fa Po

AU - Huang, Yen Chang

AU - Lin, Chung-Hsing

AU - Chan, Chao Shun

AU - Chang, Hung Yu

AU - Lin, Chin Yu

AU - Chang, Yao Ting

AU - Huang, Ching Hui

AU - Chen, Shih Ann

PY - 2017/7/1

Y1 - 2017/7/1

N2 - Backgrounds: Substrate property is related to the genesis and maintenance of atrial fibrillation (AF). The aim of the study was to investigate the impact of substrate property on the electrocardiogram (ECG) in patients with AF originating from the superior vena cava (SVC). Methods and Results: Seventy-six patients with AF originating from SVC who underwent catheter ablation were included from 2004 to 2013. Of these patients, 16 had a presentation of atrial flutter (AFL)-pattern ECG during AF (group 1), and 60 patients did not (group 2). There was no significant difference in clinical characteristics between the groups. The percentage of low voltage zone (LVZ) in SVC below the level of pulmonary artery in group 1 was significantly larger than that in group 2. The polarities of the flutter wave in 12-lead ECG were compared with another 26 subjects with reverse typical AFL. The ECG morphology was characterized by negative or biphasic P waves in lead V1 in most of the patients in group 1 (62.5%), which was analogous to that in reverse typical AFL. The negative polarity of flutter waves in aVL might distinguish SVC AF with an AFL-pattern from reverse typical AFL. Conclusion: The ECG characteristics of AF originating from SVC can mimic atypical AFL. LVZ in the SVC may be associated with the presentation of AFL-pattern ECG.

AB - Backgrounds: Substrate property is related to the genesis and maintenance of atrial fibrillation (AF). The aim of the study was to investigate the impact of substrate property on the electrocardiogram (ECG) in patients with AF originating from the superior vena cava (SVC). Methods and Results: Seventy-six patients with AF originating from SVC who underwent catheter ablation were included from 2004 to 2013. Of these patients, 16 had a presentation of atrial flutter (AFL)-pattern ECG during AF (group 1), and 60 patients did not (group 2). There was no significant difference in clinical characteristics between the groups. The percentage of low voltage zone (LVZ) in SVC below the level of pulmonary artery in group 1 was significantly larger than that in group 2. The polarities of the flutter wave in 12-lead ECG were compared with another 26 subjects with reverse typical AFL. The ECG morphology was characterized by negative or biphasic P waves in lead V1 in most of the patients in group 1 (62.5%), which was analogous to that in reverse typical AFL. The negative polarity of flutter waves in aVL might distinguish SVC AF with an AFL-pattern from reverse typical AFL. Conclusion: The ECG characteristics of AF originating from SVC can mimic atypical AFL. LVZ in the SVC may be associated with the presentation of AFL-pattern ECG.

KW - atrial fibrillation

KW - mimicking atrial flutter pattern

KW - superior vena cava

UR - http://www.scopus.com/inward/record.url?scp=85020098961&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85020098961&partnerID=8YFLogxK

U2 - 10.1111/pace.13092

DO - 10.1111/pace.13092

M3 - Article

C2 - 28436566

AN - SCOPUS:85020098961

VL - 40

SP - 754

EP - 761

JO - PACE - Pacing and Clinical Electrophysiology

JF - PACE - Pacing and Clinical Electrophysiology

SN - 0147-8389

IS - 7

ER -