The V2 Transition Ratio

Betensky, Brian P.; Park, Robert E.; Marchlinski, Francis E.; Hutchinson, Mathew D.; García, Fermin C.; Dixit, Sanjay; Callans, David J.; Cooper, Joshua M.; Bala, Rupa; Lin, David; Riley, Michael P.; Gerstenfeld, Edward P.

doi:10.1016/j.jacc.2011.01.035

Cited by 268 publications

(66 citation statements)

References 17 publications

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“…The V 2 transition ratio (algorithm B) correctly predicted LVOT vs RVOT origin in 91% of the cases in their study 10 . In our cohort, the algorithm was correct in 67%–71% of the patients when applied by 3 independent electrophysiologists with an acceptable inter-rater kappa agreement value of 0.72.…”

Section: Discussionmentioning

confidence: 55%

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Noninvasive electrocardiographic mapping to guide ablation of outflow tract ventricular arrhythmias

et al. 2014

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BackgroundLocalizing the origin of outflow tract ventricular tachycardias (OTVT) is hindered by lack of accuracy of electrocardiographic (ECG) algorithms and infrequent spontaneous premature ventricular complexes (PVCs) during electrophysiological studies.ObjectivesTo prospectively assess the performance of noninvasive electrocardiographic mapping (ECM) in the pre-/periprocedural localization of OTVT origin to guide ablation and to compare the accuracy of ECM with that of published ECG algorithms.MethodsPatients with symptomatic OTVT/PVCs undergoing clinically indicated ablation were recruited. The OTVT/PVC origin was mapped preprocedurally by using ECM, and 3 published ECG algorithms were applied to the 12-lead ECG by 3 blinded electrophysiologists. Ablation was guided by using ECM. The OTVT/PVC origin was defined as the site where ablation caused arrhythmia suppression. Acute success was defined as abolition of ectopy after ablation. Medium-term success was defined as the abolition of symptoms and reduction of PVC to less than 1000 per day documented on Holter monitoring within 6 months.ResultsIn 24 patients (mean age 50 ± 18 years) recruited ECM successfully identified OTVT/PVC origin in 23/24 (96%) (right ventricular outflow tract, 18; left ventricular outflow tract, 6), sublocalizing correctly in 100% of this cohort. Acute ablation success was achieved in 100% of the cases with medium-term success in 22 of 24 patients. PVC burden reduced from 21,837 ± 23,241 to 1143 ± 4039 (P < .0001). ECG algorithms identified the correct chamber of origin in 50%–88% of the patients and sublocalized within the right ventricular outflow tract (septum vs free-wall) in 37%–58%.ConclusionsECM can accurately identify OTVT/PVC origin in the left and the right ventricle pre- and periprocedurally to guide catheter ablation with an accuracy superior to that of published ECG algorithms.

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Section: Discussionmentioning

confidence: 55%

“…The V 2 transition ratio (algorithm B) published by Betensky et al 10 localizes ectopy origin to either the LV or the RV. Zhang et al 11 (algorithm A) and Ito et al 12 (algorithm C) published criteria that allow further sublocalization within the RV (septum vs free-wall).…”

Section: Methodsmentioning

confidence: 99%

Noninvasive electrocardiographic mapping to guide ablation of outflow tract ventricular arrhythmias

et al. 2014

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“…digitalis overdose) since Ca 2+ waves are the fundamental mechanism in all cases. The clinical efficacy of flecainide in CPVT patients with RyR2 mutations further supports this concept [47]. …”

Section: Discussionmentioning

confidence: 95%

Efficacy and potency of class I antiarrhythmic drugs for suppression of Ca2+ waves in permeabilized myocytes lacking calsequestrin

Galimberti¹,

Knollmann²

2011

Journal of Molecular and Cellular Cardiology

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Background Ca2+ waves can trigger ventricular arrhythmias such as catecholaminergic-polymorphic ventricular tachycardia (CPVT). Drugs that prevent Ca2+ waves may have antiarrhythmic properties. Here, we use permeabilized ventricular myocytes from a CPVT mouse model lacking calsequestrin (casq2) to screen all clinically available class I antiarrhythmic drugs and selected other antiarrhythmic agents for activity against Ca2+ waves. Methods and Results Casq2−/− myocytes were imaged in line-scan mode and the following Ca2+ wave parameters analyzed: wave incidence, amplitude, frequency, and propagation speed. IC50 (potency) and maximum inhibition (efficacy) were calculated for each drug. Drugs fell into 3 distinct categories. Category 1 drugs (flecainide, R-propafenone) suppressed wave parameters with the highest potency (IC50 < 10 μM) and efficacy (> 50% maximum wave inhibition). Category 2 drugs (encainide, quinidine, lidocaine, verapamil) had intermediate potency (IC50 20 μ 40 μM) and efficacy (20% - 40% maximum wave inhibition). Category 3 drugs (procainamide, disopyramide, mexilitine, cibenzoline, ranolazine) had no significant effects on Ca2+ waves at the highest concentration tested (100 μM). Propafenone was stereoselective, with R-propafenone suppressing waves more potently than S-propafenone (IC50: R-propafenone 2±0.2 μM vs. S-propafenone 54±18 μM). Both flecainide and R-propafenone decreased Ca2+ spark mass and converted propagated Ca2+ waves into non-propagated wavelets and frequent sparks, suggesting that reduction in spark mass, not spark frequency, was responsible for wave suppression. Conclusions Among all class I antiarrhythmic drugs, flecainide and R-propafenone inhibit Ca2+ waves with the highest potency and efficacy. Permeabilized casq2−/− myocytes are a simple in-vitro assay for finding drugs with activity against Ca2+ waves.

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“…Note: Precordial leads transition index [8] = Precordial leads transitional region at sinus rhythm - Precordial leads transitional region at premature ventricular contractions; Comparison of RVOT and LVOT groups #p < 0.01, ## p < 0.05; Comparison of right coronary sinus group with left coronary sinus group *p < 0.01,** p < 0.05; Comparison of right coronary sinus group with under left coronary sinus group △p < 0.01,△△p < 0.05; Comparison of left coronary sinus group with under left coronary sinus group ☆p < 0.01.…”

Section: Resultsmentioning

confidence: 99%

“…When judging the origin of PVCs/VTs, researchers should examine the PVC/VT and the configuration of the QRS in precordial leads during sinus rhythms. Betensky et al [8] reported that if the precordial lead transition of VT emerges after that of the sinus rhythm, the origin of the LVOT can be completely excluded. However, if the two elements are equal or the former emerges earlier, the transition ratio in lead V2 should be calculated by computing the percentage R-wave during PVC/VT (R/R+S) divided by the percentage R-wave in sinus rhythm (R/R+S).…”

Section: Discussionmentioning

confidence: 99%

Electrocardiogram features of premature ventricular contractions/ventricular tachycardia originating from the left ventricular outflow tract and the treatment outcome of radiofrequency catheter ablation

et al. 2012

BMC Cardiovasc Disord

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BackgroundRadiofrequency catheter ablation (RFCA) has been used for the ablation of premature ventricular contractions (PVCs) or ventricular tachycardia (VT). To date, the mapping and catheter ablation of the arrhythmias originating from the left ventricular outflow tract (LVOT) has not been specified. This study investigates the electrocardiogram (ECG) feature of PVCs or VT originating from the LVOT. Moreover, the treatment outcome of RFCA is analyzed.MethodsMapping and ablation were performed on the supravalvular or subvalvular aorta in 52 cases with PVCs/VT originating from the LVOT. The data were compared with those from 104 patients with PVCs/VT originating from the right ventricular outflow tract (RVOT). A differential procedure was prepared based on the comparison of the ECG features of PVCs/VT originating from the RVOT, LVOT, and their different parts.ResultsAmong 52 cases with PVCs originating from the LVOT, 47 were successfully treated by RFCA, with a success rate of 90.38%. Several differences among the 12-lead ECG features were observed from the RVOT and LVOT in the left and right coronary sinus groups, as well as under the left coronary sinus group (left fibrous trigone): (1) If the precordial leads transition 0 are considered as the diagnostic parameters of PVCs/VT originating from the LVOT, then the sensitivity, specificity, as well as positive and negative predictive values are 94.12%, 93.00%, 87.27%, and 96.88%, respectively; (2) The analysis of different subgroups of the LVOT are as follows: (a) A mainly positive wave of r or m pattern was recorded in the lead I in 72.73% of patients in the right coronary sinus group, versus 12.90% of patients in the left coronary sinus group, and 0% in the under left coronary sinus group. (b) All patients in the right coronary sinus group presented waves of RII>RIII and QSaVR>QSaVL, whereas most patients in the other two groups showed waves of RIII>RII and QSaVL>QSaVR. (c) Most patients in the under left coronary sinus group in lead V1 had a mainly positive wave (R) (77.78%), whereas those in the right (81.82%) and left (62.50%) coronary sinus groups had mainly negative waves (rS).ConclusionsRFCA is a safe and effective curative therapy for PVCs/VT originating from the LVOT. The 12-lead ECG features of the LVOT from different origins exhibit certain distinctions.

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The V2 Transition Ratio

Abstract: The V(2) transition ratio is a novel electrocardiographic measure that reliably distinguishes LVOT from RVOT origin in patients with lead V(3) precordial transition. This measure might be useful for counseling patients and planning an ablation strategy.

Cited by 268 publications

References 17 publications

Noninvasive electrocardiographic mapping to guide ablation of outflow tract ventricular arrhythmias

Noninvasive electrocardiographic mapping to guide ablation of outflow tract ventricular arrhythmias

Efficacy and potency of class I antiarrhythmic drugs for suppression of Ca2+ waves in permeabilized myocytes lacking calsequestrin

Electrocardiogram features of premature ventricular contractions/ventricular tachycardia originating from the left ventricular outflow tract and the treatment outcome of radiofrequency catheter ablation

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