Downloads
Abstract
Background: Although numerous electrocardiographic (ECG) algorithms have been proposed for differentiating the origin of outflow tract ventricular arrhythmias, the best one has yet to be determined. The purpose of this research was to develop an ECG diagnosis model based on prior ECG algorithms. The aim of the study is to establish and evaluate the new index Y = -1.15 * TZ - 0.494 * (V2S/V3R) based on Transitional Zone (TZ) index and V2S/V3R index criteria.
Methods: A cross - sectional descriptive study was conducted on 84 patients with the diagnosis of premature ventricular complex or ventricular tachycardia underwent catheter ablation at Vietnam National Heart Institute from August 2021 to August 2022.
Results: The mean age was 50.4 ± 14.5 years old and the male/female ratio was 1/1.6. The percentage of premature ventricular complex and ventricular tachycardia was at 89.3% and 10.7%, respectively. The QRS complex morphology on the standard 12 - lead electrocardiography, including left bundle branch block pattern and inferior axis, implied the site of origin which was from ventricular outflow. The number of right ventricular outflow and left ventricular outflow patients was at 68 patients and 16 patients, respectively. The area under the curve for the ECG diagnostic model was 0.87, with a cut-off value of - 0.721 predicting a left ventricular outflow tract (LVOT) origin with a sensitivity of 85.3% and a specificity of 87.2%, which was greater than some previous ECG algorithms in this research.
Conclusions: A highly reliable ECG diagnostic model for distinguishing between LVOT and right ventricular outflow tract origin was established.
References
Lerman BB, Stein KM, Markowitz SM. Idiopathic right ventricular outflow tract tachycardia: a clinical approach. Pacing and Clinical Electrophysiology. 1996;19:2120-2137.
Coggins DL, Lee RJ, Sweeney J, Chein WW, Van Hare G, Epstein L, et al. Radiofrequency catheter ablation as a cure for idiopathic tachycardia of both left and right ventricular origin. Journal of the American College of Cardiology. 1994;23:1333-1341.
Pedersen CT, Kay GN, Kalman J, Borggrefe M, Della-Bella P, Dickfeld T, et al. EHRA/HRS/APHRS expert consensus on ventricular arrhythmias. Europace. 2014;16:1257-1283.
Yu M, Chen S, Zhang D, Shu Z, Tan X. To the editor - correction of transitional zone index. Heart Rhythm. 2011;8:e13-e15.
Negida A, Fahim NK, Negida Y. Sample Size Calculation Guide - Part 4: How to Calculate the Sample Size for a Diagnostic Test Accuracy Study based on Sensitivity, Specificity, and the Area Under the ROC Curve. Advanced Journal of Emergency Medicine. 2019;3:e33.
He Z, Liu M, Yu M, Lu N, Li J, Xu T, et al. An electrocardiographic diagnostic model for differentiating left from right ventricular outflow tract tachycardia origin. Journal of Cardiovascular Electrophysiology. 2018;29:908-915.
Anderson RD, Kumar S, Parameswaran R, Wong G, Voskoboinik A, Sugumar H, et al. Differentiating Right- and Left-Sided Outflow Tract Ventricular Arrhythmias: Classical ECG Signatures and Prediction Algorithms. Circulation: Arrhythmia and Electrophysiology. 2019;12:e007392.
Yoshida N, Inden Y, Uchikawa T, Kamiya H, Kitamura K, Shimano M, et al. Novel transitional zone index allows more accurate differentiation between idiopathic right ventricular outflow tract and aortic sinus cusp ventricular arrhythmias. Heart Rhythm. 2011;8:349-356.
Yoshida N, Yamada T, McElderry HT, Inden Y, Shimano M, Murohara T, et al. A novel electrocardiographic criterion for differentiating a left from right ventricular outflow tract tachycardia origin: the V2S/V3R index. Journal of Cardiovascular Electrophysiology. 2014;25:747-753.
Asirvatham SJ. Correlative anatomy for the invasive electrophysiologist: outflow tract and supravalvar arrhythmia. Journal of Cardiovascular Electrophysiology. 2009;20:955-968.
Hutchinson MD, Garcia FC. An organized approach to the localization, mapping, and ablation of outflow tract ventricular arrhythmias. Journal of Cardiovascular Electrophysiology. 2013;24:1189-1197.
Ouyang F, Fotuhi P, Ho SY, Hebe J, Volkmer M, Goya M, et al. Repetitive monomorphic ventricular tachycardia originating from the aortic sinus cusp: electrocardiographic characterization for guiding catheter ablation. Journal of the American College of Cardiology. 2002;39:500-508.
Jiao ZY, Li YB, Mao J, Liu XY, Yang XC, Tan C, et al. Differentiating origins of outflow tract ventricular arrhythmias: a comparison of three different electrocardiographic algorithms. Brazilian Journal of Medical and Biological Research. 2016;49:e5206.
| Published | 20-01-2023 | |
| Fulltext |
|
|
| Language |
|
|
| Issue | No. 84 (2023) | |
| Section | Original article | |
| DOI | 10.38103/jcmhch.84.5 | |
| Keywords | Ngoại tâm thu thất, cơn tim nhanh thất, đường ra tâm thất, điện tâm đồ, triệt đốt Premature ventricular complex, Ventricular tachycardia, Ventricular outflow tract, Electrocardiogram, Catheter ablation |
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Copyright (c) 2025 Journal of Clinical Medicine Hue Central Hospital