| Differentiating arrhythmogenic right ventricular cardiomyopathy from right ventricular outflow tract ventricular tachycardia using multilead QRS duration and axis. | |
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MedLine Citation:
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PMID: 16567288 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Ventricular tachycardia (VT) resulting from arrhythmogenic right ventricular cardiomyopathy (ARVC) may be difficult to differentiate from idiopathic right ventricular outflow tract (RVOT) VT. OBJECTIVES: The purpose of this study was to investigate the hypothesis that QRS characteristics would be different in ARVC because of altered conduction through abnormal myocardium. METHODS: In 24 RVOT VT patients (18 women and 6 men; age 42 +/- 10 years) and 20 ARVC patients (12 women and 8 men; age 38 +/- 14 years), mean QRS duration, frontal plane axis, and precordial R-wave transition were measured in 12-lead ECGs recorded during VT. RESULTS: Mean QRS duration was longer in all 12 leads in ARVC patients. A significant difference was noted in leads I, III, aVL, aVF, V(1), V(2), and V(3) (P <.05). Leads I and aVL had the largest mean difference between ARVC and RVOT VT patients of 17.6 +/- 4.7 ms and 15.8 +/- 7.5 ms, respectively (P <.0001). Lead I QRS duration > or =120 ms had a sensitivity of 100%, specificity 46%, positive predictive value 61%, and negative predictive value 100% for ARVC. The area under the receiver operating characteristic (ROC) curve was 0.89. The addition of mean QRS axis <30 degrees (R<S in lead III) to the above criterion increased specificity for ARVC to 100%. QRS duration remained sensitive and specific in the subgroup of nine ARVC ECGs with an inferior axis (ROC area 0.82). R-wave transition was not different between groups. CONCLUSION: QRS duration is longer in ARVC compared with RVOT VT. An algorithm combining lead I QRS duration for sensitivity and axis for specificity is useful for differentiating the two tachycardia substrates. |
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Authors:
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Craig D Ainsworth; Allan C Skanes; George J Klein; Lorne J Gula; Raymond Yee; Andrew D Krahn |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Heart rhythm : the official journal of the Heart Rhythm Society Volume: 3 ISSN: 1547-5271 ISO Abbreviation: Heart Rhythm Publication Date: 2006 Apr |
Date Detail:
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Created Date: 2006-03-28 Completed Date: 2006-09-21 Revised Date: 2009-10-27 |
Medline Journal Info:
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Nlm Unique ID: 101200317 Medline TA: Heart Rhythm Country: United States |
Other Details:
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Languages: eng Pagination: 416-23 Citation Subset: IM |
Affiliation:
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Division of Cardiology, University of Western Ontario, London, Canada. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Analysis of Variance Arrhythmogenic Right Ventricular Dysplasia / diagnosis*, physiopathology* Diagnosis, Differential Electrocardiography Female Heart Conduction System / physiopathology* Humans Male Middle Aged Myocardium / pathology Predictive Value of Tests ROC Curve Research Design Tachycardia, Ventricular / diagnosis*, physiopathology* Ventricular Outflow Obstruction / diagnosis*, physiopathology* |
| Grant Support | |
ID/Acronym/Agency:
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U01-HL65594/HL/NHLBI NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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