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- Publisher Website: 10.1111/jce.12330
- Scopus: eid_2-s2.0-84897998318
- PMID: 24806530
- WOS: WOS:000334165500011
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Article: Distinguishing ventricular arrhythmia originating from the right coronary cusp, peripulmonic valve area, and the right ventricular outflow tract: Utility of lead I
Title | Distinguishing ventricular arrhythmia originating from the right coronary cusp, peripulmonic valve area, and the right ventricular outflow tract: Utility of lead I |
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Authors | |
Keywords | catheter ablation ventricular tachycardia sinus of Valsalva right coronary cusp premature ventricular contractions outflow tract |
Issue Date | 2014 |
Citation | Journal of Cardiovascular Electrophysiology, 2014, v. 25, n. 4, p. 404-410 How to Cite? |
Abstract | ECG Lead I and Outflow Tract Arrhythmia Introduction Outflow tract ventricular arrhythmia (OTVA) can be complicated to target for ablation when originating from either the periaortic or pulmonary valve (PV) region. Both sites may present with a small R wave in lead V1. However, the utility of lead I in distinguishing these arrhythmia locations is unknown. Methods and Results Thirty-six consecutive patients (mean age 41 ± 14 years, 13 male) underwent catheter ablation for OTVA. OTVA origin was determined from intracardiac electrogram tracings and electroanatomic maps. Observers blinded to results measured QRS waveform amplitude and duration from standard 12-lead ECG tracings. Measurements with highest diagnostic performance were modeled into an algorithm. Sites of successful ablation were anterior right ventricular outflow tract (RVOT; n = 6), posterior RVOT (n = 4), PV (n = 18), and right coronary cusp (RCC; n = 8). Highest performing surface ECG discriminators were from lead I to V1 vectors: RCC, lead I R wave ≥ 1.5 mV, and V1 R wave ≥2.0 mV (sensitivity 87%, specificity 93%); PV, V1 R wave > 0 mV, and lead I R/(R+S) ≤ 0.75 (sensitivity 78%, specificity 72%); anterior RVOT, V1 R wave = 0 mV, and lead I R/(R+S) <0.4 (sensitivity 67%, specificity 97%); posterior RVOT, V1 R wave > 0 mV, and lead I R/(R+S) > 0.75 (sensitivity 75%, specificity 84%). Sequential algorithmic application of these criteria resulted in an overall accuracy of 72% in predicting site of OTVA origin. Conclusions A relatively large R wave in lead I is seen with RCC origin but not PV origin. A sequential algorithm has limited but potentially significant value beyond assessment of lead I in approaching OTVA. © 2013 Wiley Periodicals, Inc. |
Persistent Identifier | http://hdl.handle.net/10722/213393 |
ISSN | 2023 Impact Factor: 2.3 2023 SCImago Journal Rankings: 1.144 |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | Ebrille, Elisa | - |
dc.contributor.author | Chandra, Vishnu M. | - |
dc.contributor.author | Syed, Faisal | - |
dc.contributor.author | Del Carpio Munoz, Freddy | - |
dc.contributor.author | Nanda, Sudip | - |
dc.contributor.author | Hai, Jo Jo | - |
dc.contributor.author | Cha, Yong Mei | - |
dc.contributor.author | Friedman, Paul A. | - |
dc.contributor.author | Hammill, Stephen C. | - |
dc.contributor.author | Munger, Thomas M. | - |
dc.contributor.author | Venkatachalam, K. L. | - |
dc.contributor.author | Packer, Douglas L. | - |
dc.contributor.author | Asirvatham, Samuel J. | - |
dc.date.accessioned | 2015-07-28T04:07:08Z | - |
dc.date.available | 2015-07-28T04:07:08Z | - |
dc.date.issued | 2014 | - |
dc.identifier.citation | Journal of Cardiovascular Electrophysiology, 2014, v. 25, n. 4, p. 404-410 | - |
dc.identifier.issn | 1045-3873 | - |
dc.identifier.uri | http://hdl.handle.net/10722/213393 | - |
dc.description.abstract | ECG Lead I and Outflow Tract Arrhythmia Introduction Outflow tract ventricular arrhythmia (OTVA) can be complicated to target for ablation when originating from either the periaortic or pulmonary valve (PV) region. Both sites may present with a small R wave in lead V1. However, the utility of lead I in distinguishing these arrhythmia locations is unknown. Methods and Results Thirty-six consecutive patients (mean age 41 ± 14 years, 13 male) underwent catheter ablation for OTVA. OTVA origin was determined from intracardiac electrogram tracings and electroanatomic maps. Observers blinded to results measured QRS waveform amplitude and duration from standard 12-lead ECG tracings. Measurements with highest diagnostic performance were modeled into an algorithm. Sites of successful ablation were anterior right ventricular outflow tract (RVOT; n = 6), posterior RVOT (n = 4), PV (n = 18), and right coronary cusp (RCC; n = 8). Highest performing surface ECG discriminators were from lead I to V1 vectors: RCC, lead I R wave ≥ 1.5 mV, and V1 R wave ≥2.0 mV (sensitivity 87%, specificity 93%); PV, V1 R wave > 0 mV, and lead I R/(R+S) ≤ 0.75 (sensitivity 78%, specificity 72%); anterior RVOT, V1 R wave = 0 mV, and lead I R/(R+S) <0.4 (sensitivity 67%, specificity 97%); posterior RVOT, V1 R wave > 0 mV, and lead I R/(R+S) > 0.75 (sensitivity 75%, specificity 84%). Sequential algorithmic application of these criteria resulted in an overall accuracy of 72% in predicting site of OTVA origin. Conclusions A relatively large R wave in lead I is seen with RCC origin but not PV origin. A sequential algorithm has limited but potentially significant value beyond assessment of lead I in approaching OTVA. © 2013 Wiley Periodicals, Inc. | - |
dc.language | eng | - |
dc.relation.ispartof | Journal of Cardiovascular Electrophysiology | - |
dc.subject | catheter ablation | - |
dc.subject | ventricular tachycardia | - |
dc.subject | sinus of Valsalva | - |
dc.subject | right coronary cusp | - |
dc.subject | premature ventricular contractions | - |
dc.subject | outflow tract | - |
dc.title | Distinguishing ventricular arrhythmia originating from the right coronary cusp, peripulmonic valve area, and the right ventricular outflow tract: Utility of lead I | - |
dc.type | Article | - |
dc.description.nature | link_to_subscribed_fulltext | - |
dc.identifier.doi | 10.1111/jce.12330 | - |
dc.identifier.pmid | 24806530 | - |
dc.identifier.scopus | eid_2-s2.0-84897998318 | - |
dc.identifier.hkuros | 269589 | - |
dc.identifier.volume | 25 | - |
dc.identifier.issue | 4 | - |
dc.identifier.spage | 404 | - |
dc.identifier.epage | 410 | - |
dc.identifier.eissn | 1540-8167 | - |
dc.identifier.isi | WOS:000334165500011 | - |
dc.identifier.issnl | 1045-3873 | - |