JOURNAL ARTICLE

Accuracy of diagnosing atrial flutter and atrial fibrillation from a surface electrocardiogram by hospital physicians: analysis of data from internal medicine departments

Arthur Shiyovich, Arik Wolak, Lital Yacobovich, Aviva Grosbard, Amos Katz
American Journal of the Medical Sciences 2010, 340 (4): 271-5
20881756

INTRODUCTION: Atrial fibrillation (AF) and atrial flutter (AFL) are clinically and electrocardiographically similar. However, considering significant therapeutic differences, differentiation of these 2 arrhythmias is essential. Our aims were to evaluate the misdiagnosis rate among electrocardiograms (ECGs) interpreted as AF or AFL by internists and to describe the factors that could be responsible for the misinterpretation.

METHODS: We evaluated patients discharged with a diagnosis of AF or AFL from internal medicine wards of a tertiary referral center. The reanalysis of the ECGs was performed by 2 senior cardiologists (1 electrophysiologist), blinded to the primary analysis and patient's clinical data.

RESULTS: The ECGs of 44 of 268 (16%) patients were misinterpreted and consisted of: 25 (57%) AFL, 5 (11%) SVT, 7 (16%) sinus rhythm with premature atrial beats and 7 (16%) AF. The baseline diagnosis was correct in 212 of 246 (86%) for AF and 12 of 22 (55%) for AFL, P < 0.001. A significantly higher rate of AFL was misdiagnosed compared with AF [25 of 37 (68%) versus 7 of 219 (3%), respectively; P < 0.001], higher in atypical than typical AFL [16 of 20 (80%) versus 9 of 17 (53%), respectively; P = 0.07]. Reduced quality ECGs was found more often among the incorrectly than the correctly diagnosed ECGs (P < 0.001].

CONCLUSIONS: ECGs, interpreted as AF or AFL by internists, are often misdiagnosed. AFL was misdiagnosed more often than AF, with atypical more often than typical AFL. Consulting with a cardiologist and applying diagnostic criteria may reduce misdiagnosis.

Full Text Links

Find Full Text Links for this Article

Discussion

You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read
20881756
×

Save your favorite articles in one place with a free QxMD account.

×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"