Document Detail

Twelve-lead ECG features to identify ventricular tachycardia arising from the epicardial right ventricle.
MedLine Citation:
PMID:  17018339     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Usefulness of 12-lead ECG for predicting an epicardial origin for ventricular tachycardia (VT) arising from the right ventricle (RV) has not been assessed. An epicardial approach is sometimes warranted to eliminate RV VT. OBJECTIVES: The purpose of this study was investigate the hypothesis that specific ECG features identify an epicardial origin for RV VT. METHODS: To mimic an endocardial or epicardial origin, we paced representative sites in 13 patients undergoing RV endocardial/epicardial mapping (134/180 pace map sites). RESULTS: QRS duration from epicardial vs endocardial sites was not different (183 +/- 27 ms vs 185 +/- 28 ms, P = .3). Reported cut-off values for identifying epicardial left ventricular origin, pseudo-delta wave (> or =34 ms), intrinsicoid deflection time (> or =85 ms), and RS complex (> or =121 ms) did not apply to the RV. A Q wave in lead II, III, or aVF was more likely noted from inferior epicardial vs endocardial sites (53/73 vs 16/43, P <.01). A Q wave in lead I was more frequently present from epicardial vs endocardial anterior RV sites (30/82 vs 5/52, P <.001). QS in lead V(2) was noted from anatomically matched epicardial anterior RV sites (22/33 vs 13/33, P <.05). In the RV outflow tract, no ECG feature distinguishing epicardial/endocardial origin reached statistical significance. CONCLUSION: A Q wave or QS in leads that best reflect local activation suggest an epicardial origin for RV depolarization and may help in identifying a probable epicardial site of origin for RV VT. QRS duration and reported criteria for epicardial origin of VT in the left ventricle do not identify a probable epicardial origin in the RV.
Victor Bazan; Rupa Bala; Fermin C Garcia; Jonathan S Sussman; Edward P Gerstenfeld; Sanjay Dixit; David J Callans; Erica Zado; Francis E Marchlinski
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2006-07-08
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 Oct 
Date Detail:
Created Date:  2006-10-04     Completed Date:  2006-11-07     Revised Date:  2009-10-27    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1132-9     Citation Subset:  IM    
Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
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MeSH Terms
Catheter Ablation
Diagnosis, Differential
Electrocardiography / methods*
Heart Ventricles / physiopathology*
Middle Aged
Pericardium / physiopathology*
Tachycardia, Ventricular / diagnosis*,  physiopathology,  surgery

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