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Volume 15
Issue 9
10.3390/diagnostics15091095
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

Clinical and Electrophysiological Predictors of Isthmus Dependency in Atrial Flutter

by
Lyuboslav Katov
,
Sonja Reiländer
,
Alyssa Schlarb
,
Federica Diofano
,
Deniz Aktolga
,
Yannick Teumer
,
Carlo Bothner
,
Wolfgang Rottbauer
and
Karolina Weinmann-Emhardt
*
Department of Cardiology, Ulm University Heart Center, Albert-Einstein-Allee 23, 89081 Ulm, Germany
*
Author to whom correspondence should be addressed.
Diagnostics 2025, 15(9), 1095; https://doi.org/10.3390/diagnostics15091095
Submission received: 10 February 2025 / Revised: 13 April 2025 / Accepted: 25 April 2025 / Published: 25 April 2025
(This article belongs to the Section Clinical Diagnosis and Prognosis)
Versions Notes

Abstract

Background: Atrial flutter (AFL) is a macro-reentrant tachycardia classified as cavotricuspid isthmus (CTI)-dependent or non-CTI-dependent based on its reliance on the CTI for conduction. CTI dependence can present as type I ECG (sawtooth flutter waves in inferior leads and positive P-waves in V1) or type II ECG (absence of these characteristics). This study aimed to identify clinical and electrophysiological parameters to improve CTI dependence prediction in AFL. Methods: Patients at the Ulm University Heart Center between 2010 and 2019 with AFL undergoing electrophysiological studies and ablation were enrolled. Clinical and electrophysiological parameters such as age, gender, prior comorbidities, interventions, and medication use were analyzed. Results: The study included 383 patients, with 70% presenting with type I ECG AFL. CTI dependence was observed in 242 (90.3%) type I ECG patients and 52 (45.2%) type II ECG patients. CTI-dependent AFL patients were younger and had fewer comorbidities. Predictors for CTI dependence in type I ECG included male gender (p = 0.006), absence of beta-blocker use (p = 0.031), no prior atrial fibrillation (p = 0.035), and no prior pulmonary vein isolation (p < 0.001). In type II ECG, predictors for CTI dependence included younger age (p = 0.016), male gender (p = 0.007), absence of arterial hypertension (p = 0.036), and longer atrial cycle length (p < 0.001). Conclusions: Identifying clinical and electrophysiological parameters enhances the ability to predict CTI dependence in AFL, offering valuable insights for tailored diagnostic and therapeutic approaches. Coupling these parameters with ECG findings holds promise for refining prediction accuracy and optimizing patient care.
Keywords: cavotricuspid isthmus-dependent atrial flutter; typical atrial flutter; atypical atrial flutter; type I ECG; type II ECG; predictors cavotricuspid isthmus-dependent atrial flutter; typical atrial flutter; atypical atrial flutter; type I ECG; type II ECG; predictors

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MDPI and ACS Style

Katov, L.; Reiländer, S.; Schlarb, A.; Diofano, F.; Aktolga, D.; Teumer, Y.; Bothner, C.; Rottbauer, W.; Weinmann-Emhardt, K. Clinical and Electrophysiological Predictors of Isthmus Dependency in Atrial Flutter. Diagnostics 2025, 15, 1095. https://doi.org/10.3390/diagnostics15091095

AMA Style

Katov L, Reiländer S, Schlarb A, Diofano F, Aktolga D, Teumer Y, Bothner C, Rottbauer W, Weinmann-Emhardt K. Clinical and Electrophysiological Predictors of Isthmus Dependency in Atrial Flutter. Diagnostics. 2025; 15(9):1095. https://doi.org/10.3390/diagnostics15091095

Chicago/Turabian Style

Katov, Lyuboslav, Sonja Reiländer, Alyssa Schlarb, Federica Diofano, Deniz Aktolga, Yannick Teumer, Carlo Bothner, Wolfgang Rottbauer, and Karolina Weinmann-Emhardt. 2025. "Clinical and Electrophysiological Predictors of Isthmus Dependency in Atrial Flutter" Diagnostics 15, no. 9: 1095. https://doi.org/10.3390/diagnostics15091095

APA Style

Katov, L., Reiländer, S., Schlarb, A., Diofano, F., Aktolga, D., Teumer, Y., Bothner, C., Rottbauer, W., & Weinmann-Emhardt, K. (2025). Clinical and Electrophysiological Predictors of Isthmus Dependency in Atrial Flutter. Diagnostics, 15(9), 1095. https://doi.org/10.3390/diagnostics15091095

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