Document Detail


Differentiating arrhythmogenic right ventricular cardiomyopathy from right ventricular outflow tract ventricular tachycardia using multilead QRS duration and axis.
MedLine Citation:
PMID:  16567288     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Craig D Ainsworth; Allan C Skanes; George J Klein; Lorne J Gula; Raymond Yee; Andrew D Krahn
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
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:
Created Date:  2006-03-28     Completed Date:  2006-09-21     Revised Date:  2009-10-27    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  416-23     Citation Subset:  IM    
Affiliation:
Division of Cardiology, University of Western Ontario, London, Canada.
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MeSH Terms
Descriptor/Qualifier:
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:
U01-HL65594/HL/NHLBI NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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