Journal
JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY
Volume 25, Issue 7, Pages 747-753Publisher
WILEY-BLACKWELL
DOI: 10.1111/jce.12392
Keywords
catheter ablation; electrocardiogram; premature ventricular contraction; ventricular outflow tract; ventricular tachycardia
Categories
Funding
- Banyu Life Science Foundation International
- Banyu Fellowship Program
- Biosense-Webster
- Irvine Biomedical
- Boston Scientific
- St. Jude Medical
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V2S/V3R Index Distinguishes LVOT from RVOT Origins. Introduction: Although several ECG criteria have been proposed for differentiating between left and right origins of idiopathic ventricular arrhythmias (VA) originating fromthe outflow tract (OT-VA), their accuracy and usefulness remain limited. This study was undertaken to develop a more accurate and useful ECG criterion for differentiating between left and right OT-VA origins. Methods and Results: We studied OT-VAs with a left bundle branch block pattern and inferior axis QRS morphology in 207 patients who underwent successful catheter ablation in the right (RVOT; n = 154) or left ventricular outflow tract (LVOT; n = 53). The surface ECGs during the OT-VAs and during sinus beats were analyzed with an electronic caliper. The V2S/V3R index was defined as the S-wave amplitude in lead V2 divided by the R-wave amplitude in lead V3 during the OT-VA. The V2S/V3R index was significantly smaller for LVOT origins than RVOT origins (P < 0.001). The area under the curve (AUC) for the V2S/V3R index by a receiver operating characteristic analysis was 0.964, with a cut-off value of <= 1.5 predicting an LVOT origin with an 89% sensitivity and 94% specificity. In the AUC and accuracy, the V2S/V3R index was superior to any previously proposed ECG criteria in an analysis of all OT-VAs. This advantage of the V2S/V3R index over the V2 transition ratio and other indices also held true for a subanalysis of 77 OT-VAs with a lead V3 precordial transition. Conclusion: The V2S/V3R index outperformed other ECG criteria to differentiate left from right OT-VA origins independent of the site of the precordial transition.
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