Spot diagnosis of inferior axis and concordant R-pattern predicts left ventricular inflow tract tachycardia

Bogossian, Harilaos; Frommeyer, Gerrit; Ninios, Ilias; Hasan, Fuad; Nguyen, Quy Suu; Karosiene, Zana; Mijic, Dejan; Bandorski, Dirk; Seyfarth, Melchior; Friemann, J.; Lemke, Bernd; Eckardt, Lars; Zarse, Markus

doi:10.1016/j.ijcard.2016.03.183

Cited by 8 publications

(6 citation statements)

References 21 publications

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“…Baman et al 6 reported that 15% of successful IVA ablations were performed from the coronary venous system. Bogossian et al 11 reported that with proper localization of the PVCs, the RFCAs solely in the coronary venous system resulted in a success rate of 80%. Similar to the widely accepted concept of the muscular coat around the proximal pulmonary veins causing atrial arrhythmias, the media of coronary veins contain embryologically derived myocytes, which may play a role in arrhythmogenesis 12,13 .…”

Section: Discussionmentioning

confidence: 99%

“…Multiple studies compared RFCAs that were initially unsuccessful from the endocardium and ultimately successful from the epicardium to validate previously reported parameters such as the pseudo‐delta wave, IDT, and QRS duration 5 . However, there are limitations with individual interval‐based ECG criteria 11 . First, the endocardial structures in the vicinity of the LV summit share many ECG features.…”

Section: Discussionmentioning

confidence: 99%

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Electrocardiographic localization of ventricular arrhythmias successfully ablated from the distal great cardiac vein

Chang

Gabriels

Vaishnav

et al. 2020

Cardiovasc electrophysiol

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Background: Idiopathic ventricular arrhythmias (IVAs) from the left ventricular (LV) summit may be successfully ablated from the distal great cardiac vein (dGCV). Using a 12-lead electrocardiogram (ECG) to localize IVAs that can be ablated from the dGCV is valuable for ablation planning. Objective: To determine if a "w" wave, a notch in the Q wave in lead I, and other ECG features can identify IVAs that can be successfully ablated from the dGCV. Methods: We reviewed outflow tract premature ventricular contraction (PVC) ablations performed at two centers between September 2010 and June 2018. Successful PVC ablations, in which the PVCs were mapped from the right ventricular outflow tract, coronary cusps, commissures, endocardial LV, and the coronary venous system including the dGCV were included. ECG characteristics were compared between patients with successful ablations in the dGCV and non-dGCV sites. Results: Of the 120 patients (age 56.8 ± 13.8 years, 45% female) that met the inclusion criteria, the dGCV was the successful ablation site in 18 patients (15%). Multivariate analysis with binary logistic regression showed that a "w" in lead I in combination with an early precordial pattern break and a maximum deflection index (MDI) ≥ 0.5 had sensitivity and specificity for a successful ablation in the dGCV of 94.4% and 96.1%, respectively. Conclusion: Combining a "w" wave in lead I with an early precordial pattern break and an MDI ≥ 0.5 is highly sensitive and specific for identifying the dGCV as a successful ablation site for PVCs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Electrocardiographic localization of ventricular arrhythmias successfully ablated from the distal great cardiac vein

Chang

Gabriels

Vaishnav

et al. 2020

Cardiovasc electrophysiol

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“…1,4,5 However, no studies demonstrated that the ECG pattern, except for these interval criteria, was specific for epicardial VAs. Bogossian et al 6 found that an inferior axis and concordant R pattern in all precordial leads serve as diagnostic markers for an LVOT origin on the surface ECG and suggest high primary ablation success via the GCV. In the present study, we found that DGCV VAs share these ECG features, including right bundle block morphology with inferior axis, dominant rs or rS pattern in lead I, monophasic R or Rs pattern in all precordial leads, monophasic R pattern in all inferior leads, transition zone beyond V 1 , and QS pattern in leads aVL and aVR.…”

Section: Ecg Characteristics Of Vas Originating From the Dgcvmentioning

confidence: 99%

“…Idiopathic ventricular arrhythmias (IVAs), including premature ventricular complexes (PVCs) and ventricular tachycardias (VTs), are the most common arrhythmias observed in patients without structural heart disease, and they can arise from the left ventricular endocardium (LV ENDO) and from the epicardium. [1][2][3][4][5][6][7][8] In recent studies, the reported incidence of an epicardial origin ranged from 2.5% to 15%. 7 We previously reported that the coronary vein system (CVS) provides a potential route for mapping and ablating ventricular arrhythmias (VAs) arising from an epicardial site.…”

Section: Introductionmentioning

confidence: 99%

An electrocardiographic sign of idiopathic ventricular tachycardia ablatable from the distal great cardiac vein

Yao

Pan

et al. 2020

Heart Rhythm

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BACKGROUND Idiopathic ventricular arrhythmias (IVAs) can originate from the distal great cardiac vein (DGCV). However, inadequate distinction sometimes occurs when electrocardiographic (ECG) characteristics are used to distinguish ventricular arrhythmias (VAs) arising from the DGCV from those arising from the adjacent left ventricular endocardium (LV ENDO).OBJECTIVE The purpose of this study was to identify distinct ECG features in patients with idiopathic IVAs originating from the DGCV.METHODS A total of 32 patients with IVAs originating from the DGCV were identified from a consecutive group of 874 patients undergoing IVAs ablation. Patients with IVAs from the DGCV were compared with a consecutively chosen series of 40 patients with IVAs in whom the site of origin was the adjacent LV ENDO. RESULTSOf the 32 patients with IVAs arising from the DGCV, 13 had distinct ECG characteristics compared with the LV ENDO group.Notches in both the upstroke and downstroke of the R wave in lead III were found in all 13 patients. However, the characteristic ECG pattern in lead III was found in 1 of 40 patients in the LV ENDO group. The ECG characteristic of both early notch and late notches in lead III has sensitivity of 40.6%, specificity of 97.5%, negative predictive value of 67.2%, and positive predictive value of 92.9% to predict VAs arising from the DGCV.CONCLUSION The distinct ECG characteristics of VAs originating from the DGCV can help differentiate from adjacent LV ENDO sites of origin.

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“…5 A 12lead ECG in the case presented by Vyas et al had the characteristics of VTs/PVCs originating from the GCV (an inferior axis and concordant R pattern in all precor dial leads served as diagnostic markers for an LVOT origin in the surface ECG and suggested high ablation success via the GCV). 6 Distal (DGCV) VTs/PVCs share the following ECG features: inferior axis, R pattern in all inferior leads, QS pattern in augmented vector left (aVL) and augmented vector right (aVR) leads, a dominant rs or rS pattern in lead I, a monophasic R or Rs pattern in all precordial leads, and a monophasic (positive concord ance), transition occurring earlier than V1. 7 The distinct ECG characteristics of VTs originating from the DGCV can help to differentiate VTs originating from adjacent LV endocardium sites of origin.…”

Section: Dr Mehdirad Commentsmentioning

confidence: 99%

Mapping the Left Ventricular Summit for Ablation Success

Mehdirad¹,

Hutchinson²,

Gerstenfeld³

2020

J Innov Cardiac Rhythm Manage.

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Spot diagnosis of inferior axis and concordant R-pattern predicts left ventricular inflow tract tachycardia

Cited by 8 publications

References 21 publications

Electrocardiographic localization of ventricular arrhythmias successfully ablated from the distal great cardiac vein

Electrocardiographic localization of ventricular arrhythmias successfully ablated from the distal great cardiac vein

An electrocardiographic sign of idiopathic ventricular tachycardia ablatable from the distal great cardiac vein

Mapping the Left Ventricular Summit for Ablation Success

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