Document Detail


Localization of precise origin of idiopathic ventricular tachycardia from the right ventricular outflow tract by a 12-lead ECG: a study of pace mapping using a multielectrode "basket" catheter.
MedLine Citation:
PMID:  10642129     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Radiofrequency catheter ablation guided by pace-mapping techniques has proven effective in eliminating idiopathic ventricular tachycardia (VT) originating from the right ventricular outflow tract (RVOT). A method for rapidly identifying the origin of VT from 12-lead electrocardiogram (ECG) findings would be helpful for the catheter ablation procedure. The purpose of this study is to precisely localize the origin of idiopathic VT from the RVOT by a 12-lead ECG from a study of multipoint pace mapping. In one patient with premature ventricular complex (PVC) and 3 with VT, a "basket" catheter was deployed in the RVOT for bipolar pacing from 56 sites in the endocardium of RVOT. Under fluoroscopy the pacing sites were classified into the septum and free wall. We investigated the QRS morphology in leads, I, II, and III; the depth of the QS wave in leads aVR and aVL; and the height of the initial r wave in leads V1 and V2. Pacing was captured in 30-47 of 56 sites (54%-84%). As the pacing sites changed from the anterior to posterior of the septum, the QS notch (-) type in lead I shifted through rs to R, while a shift from R type to rR' or Rr' was noted in leads II and III. As the pacing sites changed from the anterior to posterior of the free wall, lead I showed a shift from the QS notch (+) type to R, while a shift from rR' to Rr' (or rR' unchanged) was found in leads II and III. The depth of the QS wave in leads aVR and aVL showed a tendency for aVR to be deeper than aVL toward the posterolateral attachment of both the septum and free wall, whereas aVL tended to be deeper than aVR toward the anterior attachment. The initial r waves in V1 and V2 became greater as the pacing site was positioned at a higher or more posterior location. These findings may provide more precise and clinically useful diagnostic information on the site of the origin of idiopathic VT originating from the RVOT by a 12-lead ECG.
Authors:
Y Yoshida; M Hirai; Y Murakami; T Kondo; Y Inden; M Akahoshi; M Tsuda; M Okamoto; T Yamada; N Tsuboi; H Hirayama; T Ito; J Toyama; H Saito
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pacing and clinical electrophysiology : PACE     Volume:  22     ISSN:  0147-8389     ISO Abbreviation:  Pacing Clin Electrophysiol     Publication Date:  1999 Dec 
Date Detail:
Created Date:  2000-02-03     Completed Date:  2000-02-03     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7803944     Medline TA:  Pacing Clin Electrophysiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1760-8     Citation Subset:  IM    
Affiliation:
First Department of Internal Medicine, University of Nagoya School of Medicine, Japan.
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MeSH Terms
Descriptor/Qualifier:
Adult
Body Surface Potential Mapping / instrumentation*
Cardiac Pacing, Artificial*
Catheter Ablation
Electrocardiography* / instrumentation
Electrodes*
Endocardium / innervation
Equipment Design
Female
Heart Catheterization / instrumentation*
Heart Conduction System / pathology*,  physiopathology
Heart Septum / innervation
Heart Ventricles / innervation*,  physiopathology
Humans
Male
Middle Aged
Predictive Value of Tests
Sensitivity and Specificity
Tachycardia, Ventricular / diagnosis*,  pathology,  physiopathology
Ventricular Premature Complexes / diagnosis,  pathology,  physiopathology

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


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