Document Detail

A Novel Electrocardiographic Criterion for Differentiating a Left from Right Ventricular Outflow Tract Tachycardia Origin: The V2S/V3R Index.
MedLine Citation:
PMID:  24612087     Owner:  NLM     Status:  Publisher    
INTRODUCTION: Although several ECG criteria have been proposed for differentiating between left and right origins of idiopathic ventricular arrhythmias originating from the 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 over the V2 transition ratio and other indices also held true for a sub-analysis 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. This article is protected by copyright. All rights reserved.
Naoki Yoshida; Takumi Yamada; H Thomas McElderry; Yasuya Inden; Masayuki Shimano; Toyoaki Murohara; Vineet Kumar; Harish Doppalapudi; Vance J Plumb; G Neal Kay
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-2-25
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  -     ISSN:  1540-8167     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2014 Feb 
Date Detail:
Created Date:  2014-3-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
This article is protected by copyright. All rights reserved.
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