The V1–V3 transition index as a novel electrocardiographic criterion for differentiating left from right ventricular outflow tract ventricular arrhythmias

A High-Precision Machine Learning Algorithm to Classify Left and Right Outflow Tract Ventricular Tachycardia

“…We used DeLong's test (DeLong et al, 1988) to demonstrate that the automated ECG feature extraction method had a significantly higher AUC compared with that attained by the conventional QRS morphological feature extraction approach with a P-value = 0.035. The comparison of our approach against methods from 12 prior studies (Kamakura et al, 1998;Zhang et al, 2009;Betensky et al, 2011;Yoshida et al, 2011Yoshida et al, , 2014Cheng et al, 2013Cheng et al, , 2018Nakano et al, 2014;Efimova et al, 2015;He et al, 2018;Xie et al, 2018;Di et al, 2019) shows that our algorithm achieved the highest performance scores (shown in Table 3). Additionally, we evaluated the general classification capability of each criterion proposed by previous studies using the database in this study.…”

“…The classification confusion matrix for these three methods shows correct and incorrect frequency counts in Supplementary Section A and Table 3. Furthermore, we compared our approach against related methods from 12 prior studies (Kamakura et al, 1998;Zhang et al, 2009;Betensky et al, 2011;Yoshida et al, 2011Yoshida et al, , 2014Cheng et al, 2013Cheng et al, , 2018Nakano et al, 2014;Efimova et al, 2015;He et al, 2018;Xie et al, 2018;Di et al, 2019). ACC, F 1 -score, SE, SP, positive predictive value, negative predictive value, and AUC were used to compare performances and are shown in Table 3.…”

“…SR and VT ECG morphology were measured on the same 12-lead ECG by a customized MATLAB program. During the clinical arrhythmia, the following measurements (presented in Supplementary Section B.3 and Figure 1) were obtained from both one SR beat and one PVC: (Dukes et al, 2015) amplitude of Q-, R-, and S-waves (Cronin et al, 2019) duration of Q-, R-, and S-waves as well as QRS complex; and (Joshi and Wilber, 2005) R/S amplitude ratio (Kamakura et al, 1998;Ito et al, 2003), transitional zone (Hachiya et al, 2000;Tanner et al, 2005), V 2 transition ratio (Betensky et al, 2011), transitional zone index (Yoshida et al, 2011;Di et al, 2019), R-wave deflection interval (Cheng et al, 2013), V 2 S/V 3 R index (Yoshida et al, 2014), R-wave duration index (Ouyang et al, 2002), and R/S amplitude index (Ouyang et al, 2002). The T-P segment was considered one of the isoelectric baselines to measure R-and S-wave amplitudes.…”

“…An accurate prediction of RVOT and LVOT origins of OTVT can optimize the CA strategy, reduce ablation duration, and avoid operative complications. Previous studies (Kamakura et al, 1998;Hachiya et al, 2000;Ito et al, 2003;Joshi and Wilber, 2005;Tanner et al, 2005;Haqqani et al, 2009;Zhang et al, 2009;Betensky et al, 2011;Yoshida et al, 2011Yoshida et al, , 2014Cheng et al, 2013Cheng et al, , 2018Nakano et al, 2014;Efimova et al, 2015;He et al, 2018;Xie et al, 2018;Di et al, 2019;Enriquez et al, 2019;Yamada, 2019) propose several criteria or models to estimate RVOT and LVOT origins. However, these results have been limited by sample size, scope of studies, ECG measurement efficiency, and generalizability of the models.…”

Zero‐fluoroscopy catheter ablation of premature ventricular contractions at left coronary cusp near left main coronary artery

“…It is very difficult to separate the coronary cusp focus from RVOT PVC, because they are so close to each other 8 . The QRS morphology of outflow PVC can be affected by several factors such as lead position, cardiac anatomy, cardiac rotation, ventricular hypertrophy, breast size, body physique, gender, chest wall deformities, and conduction across the ventricular outflow tract septum 9 . Differentiation between left vs right site of origin especially in cases with early activation site (EAS) located in the septal RVOT, in which the sensitivity and specificity of ECG criteria, has been shown to be lower than described 10 .…”