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Peters CJ, Marchlinski FE. Left Ventricular Summit Arrhythmias: Have We Reached the Peak of Ablation Success or Just a Higher Plateau? Circ Arrhythm Electrophysiol 2024; 17:e012969. [PMID: 38716652 DOI: 10.1161/circep.124.012969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
Affiliation(s)
- Carli J Peters
- Cardiac Electrophysiology Section, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia
| | - Francis E Marchlinski
- Cardiac Electrophysiology Section, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia
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2
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Zhang W, Huang K, Qu J, Su G, Li X, Kong Q, Jiang H. A novel ECG algorithm to differentiate between ventricular arrhythmia from right versus left ventricular outflow tract. J Cardiovasc Med (Hagerstown) 2023; 24:853-863. [PMID: 37724483 DOI: 10.2459/jcm.0000000000001559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
AIM The aim of this study was to evaluate the accuracy of the diagnostic criteria for determining the origin of outflow tract ventricular arrhythmia (OTVA) and develop an ECG algorithm to predict its origin. METHOD We analyzed the ECGs of 100 patients with OTVA who underwent successful ablation. The QRS complex was measured during sinus rhythm and ventricular arrhythmia. After the ECG algorithm was developed, it was validated in an additional 100 patients from two different hospitals. RESULTS In this retrospective study, among the parameters without restrictions in the transition lead, the V2S/V3R index (AUC = 0.96) was significantly better in predicting ventricular arrhythmia originating from the right ventricular outflow tract (RVOT). Further, the larger initial r wave surface area (ISA) in V1 and V2 (AUC = 0.06) was significantly better in predicting ventricular arrhythmias originating from the left ventricular outflow tract (LVOT). Among the parameters with the transition lead in V3, the V2S/V3R index (AUC = 0.82) was significantly better in predicting VAs originating from the RVOT. On the contrary, the V3 R-wave deflection interval (AUC = 0.19) was significantly better in predicting ventricular arrhythmias originating from the LVOT. The algorithm combining the V2S/V3R index and the larger ISA in V1 and V2 could predict OTVA origin with an accuracy of 95.00%, a sensitivity of 87.18%, a specificity of 100.00%, a positive predictive value (PPV) of 100.00%, and a negative predictive value (NPV) of 92.42%. In the validation study, the algorithm exhibited excellent accuracy (95.00%) and AUC (AUC = 0.95), with a sensitivity of 94.12%, a specificity of 95.45%, a PPV of 91.43%, and an NPV of 96.92%. CONCLUSION Our developed algorithm can reliably predict OTVA origin without restrictions in the transition lead.
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Affiliation(s)
- Wei Zhang
- Department of Cardiology, Chest Hospital, Tianjin University
- Tianjin Key Laboratory of Cardiovascular Emergency and Critical Care, Tianjin Municipal Science and Technology Bureau, Tianjin
| | - Kui Huang
- Department of Cardiology, Chest Hospital, Tianjin University
- Tianjin Key Laboratory of Cardiovascular Emergency and Critical Care, Tianjin Municipal Science and Technology Bureau, Tianjin
| | - Jun Qu
- Department of Cardiology, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai
| | - Guoying Su
- Department of Cardiology, Central Hospital Affiliated to Shandong First Medical University (Previous Name: Jinan Central Hospital Affiliated to Shandong University), Jinan, Shangdong, China
| | - Xinyun Li
- Department of Cardiology, Central Hospital Affiliated to Shandong First Medical University (Previous Name: Jinan Central Hospital Affiliated to Shandong University), Jinan, Shangdong, China
| | - Qingzan Kong
- Department of Cardiology, Central Hospital Affiliated to Shandong First Medical University (Previous Name: Jinan Central Hospital Affiliated to Shandong University), Jinan, Shangdong, China
| | - Hua Jiang
- Department of Cardiology, Chest Hospital, Tianjin University
- Tianjin Key Laboratory of Cardiovascular Emergency and Critical Care, Tianjin Municipal Science and Technology Bureau, Tianjin
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3
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Liao Z, Dai S, Nie Z, Song X, Huang X, Wang J, Yang F, Liu X, Du Z, Wei H, Liu F, Zhan X, Xue Y, Yang P, Ma J, Ouyang F, Ge J, Wu S. Reappraisal and New Observations on Idiopathic Ventricular Arrhythmias Ablated From the Noncoronary Aortic Sinus. JACC Clin Electrophysiol 2023; 9:1279-1291. [PMID: 36951815 DOI: 10.1016/j.jacep.2023.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND The electrophysiological characteristics of idiopathic ventricular arrhythmias (VAs) from the noncoronary sinus (NCS) have not been fully described. OBJECTIVES This study sought to investigate electrophysiological characteristics and catheter ablation in patients with idiopathic NCS-VA. METHODS This study comprised 11 patients undergoing radiofrequency (RF) catheter ablation for idiopathic NCS-VA. Angiography was performed to confirm the origin in the aortic sinus before RF ablation. RESULTS Clinical arrhythmias presented left bundle block/inferior axis morphology in all patients. QRS morphology of R' and R/s' pattern was dominantly found in lead III. Mapping in the right ventricle demonstrated the earliest ventricular activation (EVA) site at the His Bundle region, whereas mapping in the NCS demonstrated that the EVA preceded the activation at the His Bundle region by 12.1 ± 7.9 milliseconds. All VAs were successfully ablated in <2.5 seconds within the NCS with 1 RF application. The successful ablation site was at the nadir of NCS in 10 patients, and near the junction of NCS and the right coronary sinus in the remaining one. A discrete potential can be observed at the EVA site within the NCS in 10 patients (91%); however, an excellent pace mapping at the EVA site was obtained in only 2 patients. Junctional beats did not occur during RF application in all 11 patients. There were no complications or clinical recurrence during a mean follow-up of 26.0 ± 9.8 months. CONCLUSIONS NCS-VA presents a peculiar electrocardiogram. A discrete potential can be mapped within the NCS during VA and sinus rhythm, and can be used in guiding ablation.
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Affiliation(s)
- Zili Liao
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People's Republic of China
| | - Shimo Dai
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, People's Republic of China
| | - Zhenning Nie
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, People's Republic of China
| | - Xudong Song
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Xingfu Huang
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Jing Wang
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - Fei Yang
- Department of Cardiology, the Third People's Hospital, Huizhou, People's Republic of China
| | - Xu Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Zhongpeng Du
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Huiqiang Wei
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People's Republic of China
| | - Fangzhou Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People's Republic of China
| | - Xianzhang Zhan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People's Republic of China
| | - Yumei Xue
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People's Republic of China.
| | - Pingzhen Yang
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Jian Ma
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - Feifan Ouyang
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany/Hongkong Asian Medical Group, Hong Kong, China.
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, People's Republic of China
| | - Shulin Wu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, People's Republic of China
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4
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Romero J, Gamero M, Alviz I, Grushko M, Diaz JC, Lorente M, Gabr M, Toquica CC, Krishnan S, Velasco A, Lin A, Natale A, Zou F, Di Biase L. Catheter Ablation of Left Ventricular Summit Arrhythmias from Adjacent Anatomic Vantage Points. Card Electrophysiol Clin 2023; 15:31-37. [PMID: 36774134 DOI: 10.1016/j.ccep.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Idiopathic ventricular arrhythmias (VA), particularly left ventricular outflow tract (LVOT) VA accounts for up to 10% of all VAs referred for ablative therapy. In addition to being infrequent, its intricate anatomy and its pathophysiology make catheter ablation (CA) of these arrhythmias a challenge even for experts. In this scenario, detailed right ventricular outflow tract as well as LVOT electroanatomic mapping including epicardial mapping are essential. In this article, we will emphasize our approach toward the CA technique used for LVOT VA, particularly IVS and/or LVS VA originating from intramural foci, along with its acute and long-term efficacy and safety.
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Affiliation(s)
- Jorge Romero
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Maria Gamero
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Isabella Alviz
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Michael Grushko
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Juan Carlos Diaz
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Marta Lorente
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mohamed Gabr
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Suraj Krishnan
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Alejandro Velasco
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Aung Lin
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Fengwei Zou
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
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5
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Zhang Z, Zhang Z, Zou C, Pei Z, Yang Z, Wu J, Sun S, Gu F. ECGNet: An Efficient Network for Detecting Premature Ventricular Complexes Based on ECG Images. IEEE Trans Biomed Eng 2023; 70:446-458. [PMID: 35881595 DOI: 10.1109/tbme.2022.3193906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Preoperative prediction of the origin site of premature ventricular complexes (PVCs) is critical for the success of operations. However, current methods are not efficient or accurate enough. In addition, among the proposed strategies, there are few good prediction methods for electrocardiogram (ECG) images combined with deep learning aspects. METHODS We propose ECGNet, a new neural network for the classification of 12-lead ECG images. In ECGNet, 609 ECG images from 310 patients who had undergone successful surgery in the Division of Cardiology, the First Affiliated Hospital of Soochow University, are utilized to construct the dataset. We adopt dense blocks, special convolution kernels and divergent paths to improve the performance of ECGNet. In addition, a new loss function is designed to address the sample imbalance situation, whose cause is the uneven distribution of cases themselves, which often occurs in the medical field. We also conduct extensive experiments in terms of network prediction accuracy to compare ECGNet with other networks, such as ResNet and DarkNet. RESULTS Our ECGNet achieves extremely high prediction accuracy (91.74%) and efficiency with very small datasets. Our newly proposed loss function can solve the problem of sample imbalance during the training process. CONCLUSION The proposed ECGNet can quickly and accurately realize the multiclassification of PVCs after training with little data. Our network has the potential to be helpful to doctors with a preoperative diagnosis of PVCs. We will continue to collect similar cases and perfect our network structure to further improve the accuracy of our network's prediction.
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6
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Evaluation of five algorithms in predicting the sublocalisation of right ventricular outflow tract arrhythmia (RVOTA) when compared to 3D electroanatomical mapping origin. COR ET VASA 2022. [DOI: 10.33678/cor.2022.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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7
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Zhao W, Zhu R, Zhang J, Mao Y, Chen H, Ju W, Li M, Yang G, Gu K, Wang Z, Liu H, Shi J, Jiang X, Kojodjojo P, Chen M, Zhang F. Machine learning for distinguishing right from left premature ventricular contraction origin using surface electrocardiogram features. Heart Rhythm 2022; 19:1781-1789. [PMID: 35843464 DOI: 10.1016/j.hrthm.2022.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 06/30/2022] [Accepted: 07/11/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Precise localization of the site of origin of premature ventricular contractions (PVCs) before ablation can facilitate the planning and execution of the electrophysiological procedure. OBJECTIVE The purpose of this study was to develop a predictive model that can be used to differentiate PVCs between the left ventricular outflow tract and right ventricular outflow tract (RVOT) using surface electrocardiogram characteristics. METHODS A total of 851 patients undergoing radiofrequency ablation of premature ventricular beats from January 2015 to March 2022 were enrolled. Ninety-two patients were excluded. The other 759 patients were enrolled into the development (n = 605), external validation (n = 104), or prospective cohort (n = 50). The development cohort consisted of the training group (n = 423) and the internal validation group (n = 182). Machine learning algorithms were used to construct predictive models for the origin of PVCs using body surface electrocardiogram features. RESULTS In the development cohort, the Random Forest model showed a maximum receiver operating characteristic curve area of 0.96. In the external validation cohort, the Random Forest model surpasses 4 reported algorithms in predicting performance (accuracy 94.23%; sensitivity 97.10%; specificity 88.57%). In the prospective cohort, the Random Forest model showed good performance (accuracy 94.00%; sensitivity 85.71%; specificity 97.22%). CONCLUSION Random Forest algorithm has improved the accuracy of distinguishing the origin of PVCs, which surpasses 4 previous standards, and would be used to identify the origin of PVCs before the interventional procedure.
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Affiliation(s)
- Wei Zhao
- Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Rui Zhu
- Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Jian Zhang
- Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Yangming Mao
- Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Hongwu Chen
- Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Weizhu Ju
- Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Mingfang Li
- Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Gang Yang
- Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Kai Gu
- Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Zidun Wang
- Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Hailei Liu
- Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Jiaojiao Shi
- Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Xiaohong Jiang
- Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Pipin Kojodjojo
- Department of Cardiology, National University Heart Centre, Singapore
| | - Minglong Chen
- Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Fengxiang Zhang
- Section of Pacing and Electrophysiology, Division of Cardiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China.
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8
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Intracardiac electrogram characteristics of intramural outflow tract ventricular arrhythmias. J Interv Card Electrophysiol 2022; 66:621-627. [PMID: 36121541 DOI: 10.1007/s10840-022-01374-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 09/13/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Annotation of earliest depolarization which depends on maximum dV/dt of unipolar-electrograms and unipolar QS morphology identify site of origin for ventricular premature contractions (VPC). However, identification of unipolar QS morphology has limitations due to low spatial resolution. This study aims to compare electrogram characteristics at successful ablation site in patients with outflow tract (OT) VPC. METHODS Local activation time (LAT), duration, and voltage data of each bipolar- and unipolar-electrogram at the successful ablation sites from the right ventricle OT (RVOT) and the left ventricle OT (LVOT) cases were analyzed. RESULTS Forty-four of 60 (73%) of patients were ablated from RVOT and in 16/60 (27%) required ablation from both sides. All patients had acute VPC suppression. Bipolar-electrogram-QRS onset was earlier (36.4 ± 14.5 ms vs 26.3 ± 7.4 ms, p = 0.01), duration of bipolar-electrogram was shorter (56.9 ± 18.9 ms vs 78.9 ± 21.8 ms, p = 0.002), and bi-voltage amplitude was higher (3.2 ± 2.3 mV vs 1.4 ± 1.1 mV, p = 0.07) for patients with RVOT-only ablation. Mean bipolar-unipolar-electrogram difference was 4.4 ± 4.5 ms in the RVOT group vs 12.8 ± 4.9 ms in RVOT + LVOT group (p < 0.001). Unipolar QS morphology was recorded in 3.0 ± 3.9 vs 3.6 ± 1.8 cm2 in RVOT and RVOT + LVOT group, respectively (p = 0.41). Unipolar-electrogram revealed W pattern in 3/44 of RVOT vs 5/16 of RVOT + LVOT group, respectively (p = 0.01). In 18/60 (30%) of patients, unipolar QS was not identified at successful ablation site. CONCLUSION QS in unipolar-electrogram was not a perfect predictor for successful ablation sites. Analysis of bipolar voltage amplitude and duration with bipolar-unipolar-electrogram time difference may identify presence of a deeper source.
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9
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Narumi T, Naruse Y, Kaneko Y, Sakakibara T, Sano M, Mogi S, Suwa K, Ohtani H, Urushida T, Saotome M, Maekawa Y. Individualised left anterior oblique projection for lead implantation into interventricular septum. Open Heart 2022; 9:openhrt-2022-002009. [PMID: 35961693 PMCID: PMC9379537 DOI: 10.1136/openhrt-2022-002009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 07/25/2022] [Indexed: 11/12/2022] Open
Abstract
Objective We sought to investigate whether it is possible to obtain individualised left anterior oblique (LAO) by preprocedural electrocardiographic parameters and, if so, whether these parameters can help to improve the success rate of right ventricular (RV) lead implantation into the interventricular septum. Methods In this observational study, we assessed the relationship between preoperative electrocardiographic parameters and the angle of the interventricular septum obtained using thoracic CT. The participants were divided into two groups: a retrospective derivation cohort to derive the optimal formula for the individual septum axis, and a prospective internal validation cohort to which we applied the optimal formula and implanted using the new method. Results In the retrospective derivation cohort (n=39), the mean angle of individualised LAO assessed by thoracic CT was 53.1°±8.9°, and the preoperative ECG QRS axis was strongly correlated with the interventricular septum axis (R2=0.490). LAO projection derived from the preoperative ECG QRS axis confirmed that the RV lead was placed in the interventricular septum during the pacemaker procedure in the prospective internal validation group (n=30). The success rate for placing the RV lead into the interventricular septum was significantly improved in the internal validation cohort (93% vs 64%, p<0.05). In addition, the N-terminal pro-brain natriuretic peptide level decreased significantly after surgery in the interventricular septal indwelling group. Conclusions Individualised LAO angle derived from the preoperative ECG QRS axis is a new useful and simple method for RV lead implantation into the interventricular septum. Trial registration number UMIN000045741.
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Affiliation(s)
- Taro Narumi
- Department of Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yoshihisa Naruse
- Department of Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yutaro Kaneko
- Department of Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Tomoaki Sakakibara
- Department of Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Makoto Sano
- Department of Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Satoshi Mogi
- Department of Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Kenichiro Suwa
- Department of Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Hayato Ohtani
- Department of Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Tsuyoshi Urushida
- Department of Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Masao Saotome
- Department of Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yuichiro Maekawa
- Department of Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
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10
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Electrocardiogram Parameters That Affect the Success Rate of Radiofrequency Ablation in Patients with Outflow Tract Ventricular Premature Complexes. Cardiovasc Ther 2022; 2022:8160144. [PMID: 35936796 PMCID: PMC9337924 DOI: 10.1155/2022/8160144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 06/14/2022] [Accepted: 06/29/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives. The objectives of this study are to assess the efficacy of radiofrequency catheter ablation (RFCA) in patients with outflow tract (OT) ventricular premature complexes (VPCs) and to explore the electrocardiographic (ECG) features of initially successful procedures. Methods. Based on the outcome of ablation, 154 consecutive patients with OT-VPCs who underwent RFCA from January 2017 to December 2019 were divided into two groups. The rate of successful procedures and the ECG features were analyzed and compared between the two groups. Results. The highest success rate was found in patients with VPCs from the right ventricular outflow tract (RVOT), and the lowest success rate was evident among patients with complexes from both the RVOT and the left ventricular OT (LVOT). The patients with successful procedures (136) reflected a lower pseudo delta wave ratio (16.2% vs. 44.4%,
), a smaller R-wave amplitude in lead V1 (V1) (
mV vs.
mV,
), shorter intrinsicoid deflection time in lead V2 (V2) (
ms vs.
ms,
), a shorter RS duration in V2 (
ms vs.
ms,
), and smaller R/S-waveratios in V2. Furthermore, multivariate analysis demonstrated that RS duration in V2 was above 109.17 ms and R/S ratio in V2 was above 0.28, forecasting a failed procedure. Conclusions. The ECG predictors of failed ablation were characterized by RS duration and R/S ratio in V2.
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11
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Nakasone K, Nishimori M, Kiuchi K, Shinohara M, Fukuzawa K, Takami M, El Hamriti M, Sommer P, Sakai J, Nakamura T, Yatomi A, Sonoda Y, Takahara H, Yamamoto K, Suzuki Y, Tani K, Iwai H, Nakanishi Y, Hirata KI. Development of a Visualization Deep Learning Model for Classifying Origins of Ventricular Arrhythmias. Circ J 2022; 86:1273-1280. [PMID: 35387940 DOI: 10.1253/circj.cj-22-0065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Several algorithms have been proposed for differentiating the right and left outflow tracts (RVOT/LVOT) arrhythmia origins from 12-lead electrocardiograms (ECGs); however, the procedure is complicated. A deep learning (DL) model, a form of artificial intelligence, can directly use ECGs and depict the importance of the leads and waveforms. This study aimed to create a visualized DL model that could classify arrhythmia origins more accurately.Methods and Results: This study enrolled 80 patients who underwent catheter ablation. A convolutional neural network-based model that could classify arrhythmia origins with 12-lead ECGs and visualize the leads that contributed to the diagnosis using a gradient-weighted class activation mapping method was developed. The average prediction results of the origins by the DL model were 89.4% (88.2-90.6) for accuracy and 95.2% (94.3-96.2) for recall, which were significantly better than when a conventional algorithm is used. The ratio of the contribution to the prediction differed between RVOT and LVOT origins. Although leads V1 to V3 and the limb leads had a focused balance in the LVOT group, the contribution ratio of leads aVR, aVL, and aVF was higher in the RVOT group. CONCLUSIONS This study diagnosed the arrhythmia origins more accurately than the conventional algorithm, and clarified which part of the 12-lead waveforms contributed to the diagnosis. The visualized DL model was convincing and may play a role in understanding the pathogenesis of arrhythmias.
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Affiliation(s)
- Kazutaka Nakasone
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Makoto Nishimori
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine.,Division of Epidemiology, Kobe University Graduate School of Medicine
| | - Kunihiko Kiuchi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine.,Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | | | - Koji Fukuzawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine.,Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Mitsuru Takami
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Mustapha El Hamriti
- Clinic of Electrophysiology, Heart and Diabetes Center NRW, University Hospital of Ruhr-University Bochum
| | - Philipp Sommer
- Clinic of Electrophysiology, Heart and Diabetes Center NRW, University Hospital of Ruhr-University Bochum
| | - Jun Sakai
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Toshihiro Nakamura
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Atsusuke Yatomi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Yusuke Sonoda
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Hiroyuki Takahara
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Kyoko Yamamoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Yuya Suzuki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Kenichi Tani
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Hidehiro Iwai
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Yusuke Nakanishi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
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12
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Zheng J, Fu G, Struppa D, Abudayyeh I, Contractor T, Anderson K, Chu H, Rakovski C. A High Precision Machine Learning-Enabled System for Predicting Idiopathic Ventricular Arrhythmia Origins. Front Cardiovasc Med 2022; 9:809027. [PMID: 35360041 PMCID: PMC8962834 DOI: 10.3389/fcvm.2022.809027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 02/15/2022] [Indexed: 11/22/2022] Open
Abstract
Background Radiofrequency catheter ablation (CA) is an efficient antiarrhythmic treatment with a class I indication for idiopathic ventricular arrhythmia (IVA), only when drugs are ineffective or have unacceptable side effects. The accurate prediction of the origins of IVA can significantly increase the operation success rate, reduce operation duration and decrease the risk of complications. The present work proposes an artificial intelligence-enabled ECG analysis algorithm to estimate possible origins of idiopathic ventricular arrhythmia at a clinical-grade level accuracy. Method A total of 18,612 ECG recordings extracted from 545 patients who underwent successful CA to treat IVA were proportionally sampled into training, validation and testing cohorts. We designed four classification schemes responding to different hierarchical levels of the possible IVA origins. For every classification scheme, we compared 98 distinct machine learning models with optimized hyperparameter values obtained through extensive grid search and reported an optimal algorithm with the highest accuracy scores attained on the testing cohorts. Results For classification scheme 4, our pioneering study designs and implements a machine learning-based ECG algorithm to predict 21 possible sites of IVA origin with an accuracy of 98.24% on a testing cohort. The accuracy and F1-score for the left three schemes surpassed 99%. Conclusion In this work, we developed an algorithm that precisely predicts the correct origins of IVA (out of 21 possible sites) and outperforms the accuracy of all prior studies and human experts.
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Affiliation(s)
- Jianwei Zheng
- Schmid College of Science and Technology, Chapman University, Orange, CA, United States
| | - Guohua Fu
- Arrhythmia Center, Ningbo First Hospital, Zhejiang University, Ningbo, China
| | - Daniele Struppa
- Schmid College of Science and Technology, Chapman University, Orange, CA, United States
| | - Islam Abudayyeh
- Interventional Cardiology, Loma Linda University Health, Loma Linda, CA, United States
| | - Tahmeed Contractor
- Interventional Cardiology, Loma Linda University Health, Loma Linda, CA, United States
| | - Kyle Anderson
- Schmid College of Science and Technology, Chapman University, Orange, CA, United States
| | - Huimin Chu
- Arrhythmia Center, Ningbo First Hospital, Zhejiang University, Ningbo, China
- *Correspondence: Huimin Chu
| | - Cyril Rakovski
- Schmid College of Science and Technology, Chapman University, Orange, CA, United States
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13
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Taymasova IA, Yashkov MV, Dedukh EV, Artyukhina EA, Revishvili AS. [History of development of ventricular arrhythmias diagnostics]. KARDIOLOGIIA 2021; 61:108-116. [PMID: 35057727 DOI: 10.18087/cardio.2021.12.n1469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/16/2021] [Accepted: 02/26/2021] [Indexed: 06/14/2023]
Abstract
This review shows historical steps in the development of topical diagnostics for ventricular arrhythmias, the current status of this issue, and the relevance of developing topical, noninvasive electrophysiological cardiac mapping.
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Affiliation(s)
- I A Taymasova
- A.V. Vishnevskiy National Medical Research Center of Surgery, Moscow
| | - M V Yashkov
- A.V. Vishnevskiy National Medical Research Center of Surgery, Moscow
| | - E V Dedukh
- A.V. Vishnevskiy National Medical Research Center of Surgery, Moscow
| | - E A Artyukhina
- A.V. Vishnevskiy National Medical Research Center of Surgery, Moscow
| | - A Sh Revishvili
- A.V. Vishnevskiy National Medical Research Center of Surgery, Moscow
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14
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Prisecaru RS, Leatu C, Riahi L, Costache V. Evaluation of five algorithms in predicting the sublocalisation of right ventricular outflow tract arrhythmia (RVOTA) when compared to 3D electroanatomical mapping origin. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2021. [DOI: 10.1186/s42444-021-00050-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Purpose
To compare the predictive accuracy of five different algorithms as verified by successful ablation site using 3D electroanatomical non-contact mapping in patients with symptomatic and asymptomatic but high ventricular burden RVOT tachycardias.
Methods
28 Consecutive patients admitted for radiofrequency catheter ablation for symptomatic and asymptomatic, but high ventricular burden idiopathic VPC were recruited for this study. All patients had previous failed or intolerant to beta-blocker and/or at least one class IC anti-arrhythmic agents, and they had normal left ventricular ejection fraction. All patients had documented monomorphic VPC with left bundle branch block morphology and an inferior axis. Concordance of the arrhythmia origin based on ECG algorithm and 3D mapping system site were further evaluated. Of the five algorithms, two algorithms with easy‐applicability and having a memorable design (Dixit and Joshi) and three algorithms with more complex and detailed design (Ito, Zhang, Pytkowski) were selected for comparisons.
Results
Assessment of the diagnostic accuracy showed that each of the five algorithms had only moderate accuracy, and the greatest accuracy was observed in the algorithm proposed by Pytkowski algorithm when assessed by a general cardiologist and Dixit algorithm when evaluated by the electrophysiologist. However, when the algorithms were compared for their accuracy, specificity, sensitivity, no significant differences were found (p = 0.99).
Conclusions
The ECG based algorithms for precise localising RVOTA origin simplify the mapping process, reduce the procedural and fluoroscopic time, and improve clinical outcomes, resulting in greater clinical utility. All the five published 12-lead ECG algorithms for ROTVA differentiation were similar in terms of the diagnostic accuracy, specificity, sensitivity and LRs.
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15
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Gabriels JK, Abdelrahman M, Nambiar L, Kim J, Ip JE, Thomas G, Liu CF, Markowitz SM, Lerman BB, Cheung JW. Reappraisal of electrocardiographic criteria for localization of idiopathic outflow region ventricular arrhythmias. Heart Rhythm 2021; 18:1959-1965. [PMID: 34375724 DOI: 10.1016/j.hrthm.2021.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/20/2021] [Accepted: 08/01/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Electrocardiographic (ECG) criteria have been proposed to localize the site of origin of outflow region ventricular arrhythmias (VAs). Many factors influence the QRS morphology of VAs and may limit the accuracy of these criteria. OBJECTIVE The purpose of this study was to assess the accuracy of ECG criteria that differentiate right from left outflow region VAs and localize VAs within the aortic sinus of Valsalva (ASV). METHODS One hundred one patients (mean age 52 ± 16 years; 55 [54%] women) undergoing catheter ablation of right ventricular outflow tract (RVOT) or ASV VAs with a left bundle branch block, inferior axis morphology were studied. ECG measurements including V2 transition ratio, transition zone index, R-wave duration index, R/S amplitude index, V2S/V3R index, V1-3 QRS morphology, R-wave amplitude in the inferior leads were tabulated for all VAs. Comparisons were made between the predicted site of origin using these criteria and the successful ablation site. RESULTS Patients had successful ablation of 71 RVOT and 38 ASV VAs. For the differentiation of RVOT from ASV VAs, the positive predictive values and negative predictive values for all tested ECG criteria ranged from 42% to 75% and from 71% to 82%, respectively, with the V2S/V3R index having the largest area under the curve of 0.852. Morphological QRS criteria in leads V1 through V3 did not localize ASV VAs. The maximum R-wave amplitude in the inferior leads was the sole criterion demonstrating a significant difference between right ASV, right-left ASV commissure, and left ASV sites. CONCLUSION ECG criteria for differentiating right from left ventricular outflow region VAs and for localizing ASV VAs have a limited accuracy.
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Affiliation(s)
- James K Gabriels
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York
| | - Mohamed Abdelrahman
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York
| | - Lakshmi Nambiar
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York
| | - Jiwon Kim
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York
| | - James E Ip
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York
| | - George Thomas
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York
| | - Christopher F Liu
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York
| | - Steven M Markowitz
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York
| | - Bruce B Lerman
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York
| | - Jim W Cheung
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine - New York Presbyterian Hospital, New York, New York.
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16
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Left Ventricular Summit-Concept, Anatomical Structure and Clinical Significance. Diagnostics (Basel) 2021; 11:diagnostics11081423. [PMID: 34441357 PMCID: PMC8393416 DOI: 10.3390/diagnostics11081423] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 01/18/2023] Open
Abstract
The left ventricular summit (LVS) is a triangular area located at the most superior portion of the left epicardial ventricular region, surrounded by the two branches of the left coronary artery: the left anterior interventricular artery and the left circumflex artery. The triangle is bounded by the apex, septal and mitral margins and base. This review aims to provide a systematic and comprehensive anatomical description and proper terminology in the LVS region that may facilitate exchanging information among anatomists and electrophysiologists, increasing knowledge of this cardiac region. We postulate that the most dominant septal perforator (not the first septal perforator) should characterize the LVS definition. Abundant epicardial adipose tissue overlying the LVS myocardium may affect arrhythmogenic processes and electrophysiological procedures within the LVS region. The LVS is divided into two clinically significant regions: accessible and inaccessible areas. Rich arterial and venous coronary vasculature and a relatively dense network of cardiac autonomic nerve fibers are present within the LVS boundaries. Although the approach to the LVS may be challenging, it can be executed indirectly using the surrounding structures. Delivery of the proper radiofrequency energy to the arrhythmia source, avoiding coronary artery damage at the same time, may be a challenge. Therefore, coronary angiography or cardiac computed tomography imaging is strongly recommended before any procedure within the LVS region. Further research on LVS morphology and physiology should increase the safety and effectiveness of invasive electrophysiological procedures performed within this region of the human heart.
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17
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto S, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 guideline on non-pharmacotherapy of cardiac arrhythmias. J Arrhythm 2021; 37:709-870. [PMID: 34386109 PMCID: PMC8339126 DOI: 10.1002/joa3.12491] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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18
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The QRS-right ventricular apex interval as a cut-off value to differentiate the origin of outflow tract premature ventricular complexes. Herzschrittmacherther Elektrophysiol 2021; 32:341-345. [PMID: 34255142 DOI: 10.1007/s00399-021-00785-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 06/16/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Many electrocardiography (ECG) criteria have been proposed for the localization of outflow tract premature ventricular contractions (PVCs); however, in some cases, it is difficult to accurately localize the origin of PVCs using the surface ECG. The authors aimed to study the QRS-right ventricular apex (RVA) interval measured during electrophysiological study and its role in the differentiation between different sites of origin of outflow tract PVCs. METHODS The study included 90 patients (81 females, mean age 37.20 ± 7.87) referred for outflow tract PVC ablation. The authors measured the interval from the onset of the earliest QRS complex of the PVCs to the distal RVA intracardiac signal (the QRS-RVA interval) during the electrophysiological study and correlated this interval with the origin of outflow tract PVCs as identified by successful ablation during the procedure. RESULTS The QRS-RVA interval was significantly longer in PVCs originating from the left ventricular outflow tract (LVOT) compared to the right ventricular outflow tract (RVOT) (67.33 ± 7.56 for LVOT PVCs vs. 37.11 ± 4.34 for RVOT PVCs, p < 0.001). Receiver operating characteristic (ROC) analysis showed that a QRS-RVA interval ≥ 48 ms predicted an LVOT origin of PVCs. A shorter interval was noted in PVCs originating from the RVOT free wall rather than the septal RVOT wall, and a shorter interval was also noted in LVOT PVCs originating from the right coronary cusp as compared to other LVOT PVCs, although these differences did not reach statistical significance. CONCLUSION Measuring the QRS-RVA interval is a simple and accurate method for differentiating the origin of outflow tract PVCs during an electrophysiological study. A QRS-RVA interval ≥ 48 ms predicts an LVOT origin of PVCs rather than an RVOT origin.
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19
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Monaci S, Gillette K, Puyol-Antón E, Rajani R, Plank G, King A, Bishop M. Automated Localization of Focal Ventricular Tachycardia From Simulated Implanted Device Electrograms: A Combined Physics-AI Approach. Front Physiol 2021; 12:682446. [PMID: 34276403 PMCID: PMC8281305 DOI: 10.3389/fphys.2021.682446] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/31/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Focal ventricular tachycardia (VT) is a life-threating arrhythmia, responsible for high morbidity rates and sudden cardiac death (SCD). Radiofrequency ablation is the only curative therapy against incessant VT; however, its success is dependent on accurate localization of its source, which is highly invasive and time-consuming. Objective: The goal of our study is, as a proof of concept, to demonstrate the possibility of utilizing electrogram (EGM) recordings from cardiac implantable electronic devices (CIEDs). To achieve this, we utilize fast and accurate whole torso electrophysiological (EP) simulations in conjunction with convolutional neural networks (CNNs) to automate the localization of focal VTs using simulated EGMs. Materials and Methods: A highly detailed 3D torso model was used to simulate ∼4000 focal VTs, evenly distributed across the left ventricle (LV), utilizing a rapid reaction-eikonal environment. Solutions were subsequently combined with lead field computations on the torso to derive accurate electrocardiograms (ECGs) and EGM traces, which were used as inputs to CNNs to localize focal sources. We compared the localization performance of a previously developed CNN architecture (Cartesian probability-based) with our novel CNN algorithm utilizing universal ventricular coordinates (UVCs). Results: Implanted device EGMs successfully localized VT sources with localization error (8.74 mm) comparable to ECG-based localization (6.69 mm). Our novel UVC CNN architecture outperformed the existing Cartesian probability-based algorithm (errors = 4.06 mm and 8.07 mm for ECGs and EGMs, respectively). Overall, localization was relatively insensitive to noise and changes in body compositions; however, displacements in ECG electrodes and CIED leads caused performance to decrease (errors 16-25 mm). Conclusion: EGM recordings from implanted devices may be used to successfully, and robustly, localize focal VT sources, and aid ablation planning.
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Affiliation(s)
| | - Karli Gillette
- Division of Biophysics, Medical University of Graz, Graz, Austria
| | | | | | - Gernot Plank
- Division of Biophysics, Medical University of Graz, Graz, Austria
| | - Andrew King
- King’s College London, London, United Kingdom
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20
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto SI, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 Guideline on Non-Pharmacotherapy of Cardiac Arrhythmias. Circ J 2021; 85:1104-1244. [PMID: 34078838 DOI: 10.1253/circj.cj-20-0637] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Haruhiko Abe
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital
| | - Toshiyuki Ishikawa
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University
| | - Katsuhiko Imai
- Department of Cardiovascular Surgery, Kure Medical Center and Chugoku Cancer Center
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kaoru Okishige
- Department of Cardiology, Yokohama City Minato Red Cross Hospital
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | | | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Yoshihiro Seo
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | | | - Yuji Nakazato
- Department of Cardiovascular Medicine, Juntendo University Urayasu Hospital
| | - Takashi Nishimura
- Department of Cardiac Surgery, Tokyo Metropolitan Geriatric Hospital
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | | | - Yuji Murakawa
- Fourth Department of Internal Medicine, Teikyo University Hospital Mizonokuchi
| | - Teiichi Yamane
- Department of Cardiology, Jikei University School of Medicine
| | - Takeshi Aiba
- Division of Arrhythmia, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Koichi Inoue
- Division of Arrhythmia, Cardiovascular Center, Sakurabashi Watanabe Hospital
| | - Yuki Iwasaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kikuya Uno
- Arrhythmia Center, Chiba Nishi General Hospital
| | - Michio Ogano
- Department of Cardiovascular Medicine, Shizuoka Medical Center
| | - Masaomi Kimura
- Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine
| | | | - Shingo Sasaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | | | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University
| | - Tsugutoshi Suzuki
- Departments of Pediatric Electrophysiology, Osaka City General Hospital
| | - Yukio Sekiguchi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Kyoko Soejima
- Arrhythmia Center, Second Department of Internal Medicine, Kyorin University Hospital
| | - Masahiko Takagi
- Division of Cardiac Arrhythmia, Department of Internal Medicine II, Kansai Medical University
| | - Masaomi Chinushi
- School of Health Sciences, Faculty of Medicine, Niigata University
| | - Nobuhiro Nishi
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hitoshi Hachiya
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | | | | | - Yasushi Miyauchi
- Department of Cardiovascular Medicine, Nippon Medical School Chiba-Hokusoh Hospital
| | - Aya Miyazaki
- Department of Pediatric Cardiology, Congenital Heart Disease Center, Tenri Hospital
| | - Tomoshige Morimoto
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Hiro Yamasaki
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | | | - Takeshi Kimura
- Department of Cardiology, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
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21
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Im SI, Voskoboinik A, Lee A, Higuchi S, Moss JD, Hsia H, Tseng ZH, Lee R, Marcus GM, Vedantham V, Scheinman M, Lee B, Park KM, Gerstenfeld EP. Predictors of long-term success after catheter ablation of premature ventricular complexes. J Cardiovasc Electrophysiol 2021; 32:2254-2261. [PMID: 34041816 DOI: 10.1111/jce.15114] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 04/23/2021] [Accepted: 05/17/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Some patients have late recurrence after acutely successful radiofrequency catheter ablation (RFCA) of premature ventricular complexes (PVCs). The aim of this study was to evaluate predictors of long-term success following acutely successful PVC RFCA. METHODS We identified consecutive patients at our institution with frequent PVCs undergoing RFCA and reviewed procedural data and medical records. Acute success was defined as elimination of targeted PVCs for at least 30-min after RFCA. Long-term success was defined as absence of targeted PVCs during all follow-up visits and PVC-burden <5% on follow-up monitoring. RESULTS Among 241 patients (mean age 57 ± 15 years, 58% male), 161 (66.8%) had long-term success with median follow-up of 17.7 (IQR, 12.2-29.8) months. Unadjusted predictors of late PVC recurrence were increasing age, diabetes mellitus and alcohol use, while female-sex, shorter ablation-time, right ventricular PVC-origin, single PVC morphology, and earliest bipolar activation ≥24 ms pre-QRS were predictors of long-term success. In multivariate-analysis, female-sex, single-PVC morphology and earliest-onset of PVC ≥ 24 ms pre-QRS were independent predictors for long-term success. The positive-predictive value of earliest-bipolar onset of PVC ≥ 24 ms pre-QRS for long-term success was 0.77 (p < .001). Negative-predictive value of PVC < 15 ms pre-QRS for long-term success was 0.86 (p = .003), suggesting that RFCA when the bipolar electrogram preceded QRS by <15 ms was unlikely to result in long-term success. CONCLUSIONS Female-sex, single-PVC morphology, and earliest-onset of bipolar electrogram ≥24 ms pre-QRS were multivariable predictors of long-term success in patients with PVCs undergoing RFCA. RFCA at sites with local onset <15 ms pre-QRS are unlikely to be successful.
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Affiliation(s)
- Sung-Il Im
- Department of Medicine, Division of Cardiology, Section of Cardiac Electrophysiology, University of California San Francisco, San Francisco, California, USA
| | - Aleksandr Voskoboinik
- Department of Medicine, Division of Cardiology, Section of Cardiac Electrophysiology, University of California San Francisco, San Francisco, California, USA
| | - Adam Lee
- Department of Medicine, Division of Cardiology, Section of Cardiac Electrophysiology, University of California San Francisco, San Francisco, California, USA
| | - Satoshi Higuchi
- Department of Medicine, Division of Cardiology, Section of Cardiac Electrophysiology, University of California San Francisco, San Francisco, California, USA
| | - Joshua D Moss
- Department of Medicine, Division of Cardiology, Section of Cardiac Electrophysiology, University of California San Francisco, San Francisco, California, USA
| | - Henry Hsia
- Department of Medicine, Division of Cardiology, Section of Cardiac Electrophysiology, University of California San Francisco, San Francisco, California, USA
| | - Zian H Tseng
- Department of Medicine, Division of Cardiology, Section of Cardiac Electrophysiology, University of California San Francisco, San Francisco, California, USA
| | - Randall Lee
- Department of Medicine, Division of Cardiology, Section of Cardiac Electrophysiology, University of California San Francisco, San Francisco, California, USA
| | - Gregory M Marcus
- Department of Medicine, Division of Cardiology, Section of Cardiac Electrophysiology, University of California San Francisco, San Francisco, California, USA
| | - Vasanth Vedantham
- Department of Medicine, Division of Cardiology, Section of Cardiac Electrophysiology, University of California San Francisco, San Francisco, California, USA
| | - Melvin Scheinman
- Department of Medicine, Division of Cardiology, Section of Cardiac Electrophysiology, University of California San Francisco, San Francisco, California, USA
| | - Byron Lee
- Department of Medicine, Division of Cardiology, Section of Cardiac Electrophysiology, University of California San Francisco, San Francisco, California, USA
| | - Kyoung-Min Park
- Division of Cardiology, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Edward P Gerstenfeld
- Department of Medicine, Division of Cardiology, Section of Cardiac Electrophysiology, University of California San Francisco, San Francisco, California, USA
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22
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Khan F, Srinivasan NT. Catheter ablation of the valsalva region using intracardiac echocardiography guidance. Indian Pacing Electrophysiol J 2021; 21:145-146. [PMID: 33934819 PMCID: PMC8116809 DOI: 10.1016/j.ipej.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Neil T Srinivasan
- Essex Cardiothoracic Centre, UK; Anglia Ruskin University (ARU) Medical School, UK.
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23
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Lee J, Adeola O, Garan H, Stevenson WG, Yarmohammadi H. Electrocardiographic recognition of benign and malignant right ventricular arrhythmias. Europace 2021; 23:1338-1349. [PMID: 33864080 DOI: 10.1093/europace/euab047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/17/2021] [Indexed: 11/12/2022] Open
Abstract
Ventricular arrhythmias (VAs) can originate from different anatomical locations of the right ventricle. Ventricular arrhythmias originating from right ventricle have unique electrocardiographic (ECG) characteristics that can be utilized to localize the origin of the arrhythmia. This is crucial in pre-procedural planning particularly for ablation treatments. Moreover, non-ischaemic structural heart diseases, such as infiltrative and congenital heart diseases, are associated with the VAs that exhibit particular ECG findings. This article comprehensively reviews discriminatory ECG characteristics of VAs in the right ventricle with and without structural right ventricular diseases.
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Affiliation(s)
- John Lee
- Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Oluwaseun Adeola
- Division of Cardiology, Vanderbilt Heart and Vascular Institute, Nashville, TN, USA
| | - Hasan Garan
- Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, 177 Fort Washington Avenue, Room 637, New York, NY 10032, USA
| | - William G Stevenson
- Division of Cardiology, Vanderbilt Heart and Vascular Institute, Nashville, TN, USA
| | - Hirad Yarmohammadi
- Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, 177 Fort Washington Avenue, Room 637, New York, NY 10032, USA
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24
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Mariani MV, Piro A, Della Rocca DG, Forleo GB, Pothineni NV, Romero J, Di Biase L, Fedele F, Lavalle C. Electrocardiographic Criteria for Differentiating Left from Right Idiopathic Outflow Tract Ventricular Arrhythmias. Arrhythm Electrophysiol Rev 2021; 10:10-16. [PMID: 33936738 PMCID: PMC8076969 DOI: 10.15420/aer.2020.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Idiopathic ventricular arrhythmias are ventricular tachycardias or premature ventricular contractions presumably not related to myocardial scar or disorders of ion channels. Of the ventricular arrhythmias (VAs) without underlying structural heart disease, those arising from the ventricular outflow tracts (OTs) are the most common. The right ventricular outflow tract (RVOT) is the most common site of origin for OT-VAs, but these arrhythmias can, less frequently, originate from the left ventricular outflow tract (LVOT). OT-VAs are focal and have characteristic ECG features based on their anatomical origin. Radiofrequency catheter ablation (RFCA) is an effective and safe treatment strategy for OT-VAs. Prediction of the OT-VA origin according to ECG features is an essential part of the preprocedural planning for RFCA procedures. Several ECG criteria have been proposed for differentiating OT site of origin. Unfortunately, the ECG features of RVOT-VAs and LVOT-VAs are similar and could possibly lead to misdiagnosis. The authors review the ECG criteria used in clinical practice to differentiate RVOT-VAs from LVOT-VAs.
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Affiliation(s)
- Marco V Mariani
- Department of Cardiovascular, Respiratory, Nephrology, Anaesthesiology and Geriatric Sciences, Sapienza University of Rome, Italy
| | - Agostino Piro
- Department of Cardiovascular, Respiratory, Nephrology, Anaesthesiology and Geriatric Sciences, Sapienza University of Rome, Italy
| | | | | | | | - Jorge Romero
- Department of Cardiology, Montefiore Medical Center, New York, NY, US
| | - Luigi Di Biase
- Department of Cardiology, Montefiore Medical Center, New York, NY, US
| | - Francesco Fedele
- Department of Cardiovascular, Respiratory, Nephrology, Anaesthesiology and Geriatric Sciences, Sapienza University of Rome, Italy
| | - Carlo Lavalle
- Department of Cardiovascular, Respiratory, Nephrology, Anaesthesiology and Geriatric Sciences, Sapienza University of Rome, Italy
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25
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Zheng J, Fu G, Abudayyeh I, Yacoub M, Chang A, Feaster WW, Ehwerhemuepha L, El-Askary H, Du X, He B, Feng M, Yu Y, Wang B, Liu J, Yao H, Chu H, Rakovski C. A High-Precision Machine Learning Algorithm to Classify Left and Right Outflow Tract Ventricular Tachycardia. Front Physiol 2021; 12:641066. [PMID: 33716788 PMCID: PMC7947246 DOI: 10.3389/fphys.2021.641066] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 01/18/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction Multiple algorithms based on 12-lead ECG measurements have been proposed to identify the right ventricular outflow tract (RVOT) and left ventricular outflow tract (LVOT) locations from which ventricular tachycardia (VT) and frequent premature ventricular complex (PVC) originate. However, a clinical-grade machine learning algorithm that automatically analyzes characteristics of 12-lead ECGs and predicts RVOT or LVOT origins of VT and PVC is not currently available. The effective ablation sites of RVOT and LVOT, confirmed by a successful ablation procedure, provide evidence to create RVOT and LVOT labels for the machine learning model. Methods We randomly sampled training, validation, and testing data sets from 420 patients who underwent successful catheter ablation (CA) to treat VT or PVC, containing 340 (81%), 38 (9%), and 42 (10%) patients, respectively. We iteratively trained a machine learning algorithm supplied with 1,600,800 features extracted via our proprietary algorithm from 12-lead ECGs of the patients in the training cohort. The area under the curve (AUC) of the receiver operating characteristic curve was calculated from the internal validation data set to choose an optimal discretization cutoff threshold. Results The proposed approach attained the following performance: accuracy (ACC) of 97.62 (87.44–99.99), weighted F1-score of 98.46 (90–100), AUC of 98.99 (96.89–100), sensitivity (SE) of 96.97 (82.54–99.89), and specificity (SP) of 100 (62.97–100). Conclusions The proposed multistage diagnostic scheme attained clinical-grade precision of prediction for LVOT and RVOT locations of VT origin with fewer applicability restrictions than prior studies.
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Affiliation(s)
- Jianwei Zheng
- Computational and Data Science, Chapman University, Orange, CA, United States
| | - Guohua Fu
- Department of Cardiology, Ningbo First Hospital of Zhejiang University, Hangzhou, China
| | - Islam Abudayyeh
- Department of Cardiology, Loma Linda University, Loma Linda, CA, United States
| | - Magdi Yacoub
- Harefield Heart Science Center, Imperial College London, London, United Kingdom
| | | | | | | | - Hesham El-Askary
- Computational and Data Science, Chapman University, Orange, CA, United States.,Department of Environmental Sciences, Faculty of Science, Alexandria University, Alexandria, Egypt
| | - Xianfeng Du
- Department of Cardiology, Ningbo First Hospital of Zhejiang University, Hangzhou, China
| | - Bin He
- Department of Cardiology, Ningbo First Hospital of Zhejiang University, Hangzhou, China
| | - Mingjun Feng
- Department of Cardiology, Ningbo First Hospital of Zhejiang University, Hangzhou, China
| | - Yibo Yu
- Department of Cardiology, Ningbo First Hospital of Zhejiang University, Hangzhou, China
| | - Binhao Wang
- Department of Cardiology, Ningbo First Hospital of Zhejiang University, Hangzhou, China
| | - Jing Liu
- Department of Cardiology, Ningbo First Hospital of Zhejiang University, Hangzhou, China
| | - Hai Yao
- Zhejiang Cachet Jetboom Medical Devices Co., Ltd., Hangzhou, China
| | - Huimin Chu
- Department of Cardiology, Ningbo First Hospital of Zhejiang University, Hangzhou, China
| | - Cyril Rakovski
- Computational and Data Science, Chapman University, Orange, CA, United States
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26
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Zheng J, Fu G, Abudayyeh I, Yacoub M, Chang A, Feaster WW, Ehwerhemuepha L, El-Askary H, Du X, He B, Feng M, Yu Y, Wang B, Liu J, Yao H, Chu H, Rakovski C. A High-Precision Machine Learning Algorithm to Classify Left and Right Outflow Tract Ventricular Tachycardia. Front Physiol 2021. [PMID: 33716788 DOI: 10.6084/m9.figshare.c.4668086.v2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction Multiple algorithms based on 12-lead ECG measurements have been proposed to identify the right ventricular outflow tract (RVOT) and left ventricular outflow tract (LVOT) locations from which ventricular tachycardia (VT) and frequent premature ventricular complex (PVC) originate. However, a clinical-grade machine learning algorithm that automatically analyzes characteristics of 12-lead ECGs and predicts RVOT or LVOT origins of VT and PVC is not currently available. The effective ablation sites of RVOT and LVOT, confirmed by a successful ablation procedure, provide evidence to create RVOT and LVOT labels for the machine learning model. Methods We randomly sampled training, validation, and testing data sets from 420 patients who underwent successful catheter ablation (CA) to treat VT or PVC, containing 340 (81%), 38 (9%), and 42 (10%) patients, respectively. We iteratively trained a machine learning algorithm supplied with 1,600,800 features extracted via our proprietary algorithm from 12-lead ECGs of the patients in the training cohort. The area under the curve (AUC) of the receiver operating characteristic curve was calculated from the internal validation data set to choose an optimal discretization cutoff threshold. Results The proposed approach attained the following performance: accuracy (ACC) of 97.62 (87.44-99.99), weighted F1-score of 98.46 (90-100), AUC of 98.99 (96.89-100), sensitivity (SE) of 96.97 (82.54-99.89), and specificity (SP) of 100 (62.97-100). Conclusions The proposed multistage diagnostic scheme attained clinical-grade precision of prediction for LVOT and RVOT locations of VT origin with fewer applicability restrictions than prior studies.
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Affiliation(s)
- Jianwei Zheng
- Computational and Data Science, Chapman University, Orange, CA, United States
| | - Guohua Fu
- Department of Cardiology, Ningbo First Hospital of Zhejiang University, Hangzhou, China
| | - Islam Abudayyeh
- Department of Cardiology, Loma Linda University, Loma Linda, CA, United States
| | - Magdi Yacoub
- Harefield Heart Science Center, Imperial College London, London, United Kingdom
| | | | | | | | - Hesham El-Askary
- Computational and Data Science, Chapman University, Orange, CA, United States.,Department of Environmental Sciences, Faculty of Science, Alexandria University, Alexandria, Egypt
| | - Xianfeng Du
- Department of Cardiology, Ningbo First Hospital of Zhejiang University, Hangzhou, China
| | - Bin He
- Department of Cardiology, Ningbo First Hospital of Zhejiang University, Hangzhou, China
| | - Mingjun Feng
- Department of Cardiology, Ningbo First Hospital of Zhejiang University, Hangzhou, China
| | - Yibo Yu
- Department of Cardiology, Ningbo First Hospital of Zhejiang University, Hangzhou, China
| | - Binhao Wang
- Department of Cardiology, Ningbo First Hospital of Zhejiang University, Hangzhou, China
| | - Jing Liu
- Department of Cardiology, Ningbo First Hospital of Zhejiang University, Hangzhou, China
| | - Hai Yao
- Zhejiang Cachet Jetboom Medical Devices Co., Ltd., Hangzhou, China
| | - Huimin Chu
- Department of Cardiology, Ningbo First Hospital of Zhejiang University, Hangzhou, China
| | - Cyril Rakovski
- Computational and Data Science, Chapman University, Orange, CA, United States
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27
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Zhou X, Fang L, Wang Z, Liu H, Mao W. Comparative analysis of electrocardiographic imaging and ECG in predicting the origin of outflow tract ventricular arrhythmias. J Int Med Res 2021; 48:300060520913132. [PMID: 32228331 PMCID: PMC7132561 DOI: 10.1177/0300060520913132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives The aim of this study was to investigate the accuracy of
electrocardiographic imaging (ECGI) in localizing the origin of
outflow tract ventricular arrhythmias (OTVAs) and compare its
performance with that of seven published 12-lead
electrocardiography (ECG) algorithms. Methods Patients with OTVAs who were undergoing catheter ablation were
prospectively investigated. The OVTA origins were localized
using both ECGI and seven 12-lead ECG algorithms, with the
successful ablation site set as the gold standard. The
performance of the ECGI and 12-lead ECG algorithms were
compared. Results Twenty-seven patients were enrolled into the study. The ECGI system
correctly identified the chamber of OTVA origin in 27/27 (100%)
patients and the sublocalization within the right ventricular
outflow tract (RVOT) in 21/22 (95.5%) patients. However, the ECG
algorithms correctly diagnosed the chamber and sublocalization
in only 21/27 (77.8%) patients and 13/22 (59.1%) patients,
respectively, which was significantly lower compared with the
ECGI system. Conclusions Non-invasive ECGI can accurately predict the origin of OTVAs in a
manner that is superior to that of conventional 12-lead ECGs in
differentiating the RVOT from the left ventricular outflow tract
(LVOT) and septum from free wall in the RVOT. This provides a
useful tool to guide catheter ablation. This trial has been registered in the Chinese Clinical Trial
Registry (Registration number: ChiCTR1900025527).
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Affiliation(s)
- Xinbin Zhou
- Department of Cardiology, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Lin Fang
- State Key Lab of Modern Optical Instrumentation, Zhejiang University, Hangzhou, China
| | - Zhijun Wang
- Department of Cardiology, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Huafeng Liu
- State Key Lab of Modern Optical Instrumentation, Zhejiang University, Hangzhou, China
| | - Wei Mao
- Department of Cardiology, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
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28
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Mizutani Y, Yanagisawa S, Kanashiro M, Inden Y, Murohara T. Safety and efficacy of first-line cryoablation for para-hisian ventricular arrhythmias using a cryomapping protocol approach: A case series. Clin Case Rep 2020; 8:3248-3253. [PMID: 33363914 PMCID: PMC7752434 DOI: 10.1002/ccr3.3401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 08/31/2020] [Accepted: 09/05/2020] [Indexed: 02/06/2023] Open
Abstract
A first-line cryoablation for para-Hisian VAs using a strict cryomapping protocol is useful and safe, even if the His bundle potential is recorded on the ablation catheter.
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Affiliation(s)
- Yoshiaki Mizutani
- Department of CardiologyYokkaichi Municipal HospitalYokkaichiJapan
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaJapan
| | - Satoshi Yanagisawa
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaJapan
| | | | - Yasuya Inden
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaJapan
| | - Toyoaki Murohara
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaJapan
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29
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Prospective Multicenter Assessment of a New Intraprocedural Automated System for Localizing Idiopathic Ventricular Arrhythmia Origins. JACC Clin Electrophysiol 2020; 7:395-407. [PMID: 33736758 DOI: 10.1016/j.jacep.2020.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/31/2020] [Accepted: 09/06/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The objective of this study was to present a new system, the Automatic Arrhythmia Origin Localization (AAOL) system, which used incomplete electroanatomic mapping (EAM) for localization of idiopathic ventricular arrhythmia (IVA) origin on the patient-specific geometry of left ventricular, right ventricular, and neighboring vessels. The study assessed the accuracy of the system in localizing IVA source sites on cardiac structures where pace mapping is challenging. BACKGROUND An intraprocedural automated site of origin localization system was previously developed to identify the origin of early left ventricular activation by using 12-lead electrocardiograms (ECGs). However, it has limitations, as it could not identify the site of origin in the right ventricle and relied on acquiring a complete EAM. METHODS Twenty patients undergoing IVA catheter ablation had a 12-lead ECG recorded during clinical arrhythmia and during pacing at various locations identified on EAM geometries. The new system combined 3-lead (III, V2, and V6) 120-ms QRS integrals and patient-specific EAM geometry with pace mapping to predict the site of earliest ventricular activation. The predicted site was projected onto EAM geometry. RESULTS Twenty-three IVA origin sites were clinically identified by activation mapping and/or pace mapping (8, right ventricle; 15, left ventricle, including 8 from the posteromedial papillary muscle, 2 from the aortic root, and 1 from the distal coronary sinus). The new system achieved a mean localization accuracy of 3.6 mm for the 23 mapped IVAs. CONCLUSIONS The new intraprocedural AAOL system achieved accurate localization of IVA origin in ventricles and neighboring vessels, which could facilitate ablation procedures for patients with IVAs.
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30
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Sekihara T, Miyazaki S, Nagao M, Kakehashi S, Mukai M, Aoyama D, Nodera M, Eguchi T, Hasegawa K, Tada H. A case of outflow tract premature ventricular contractions with very distant exit sites suspected to have a single origin. J Electrocardiol 2020; 63:41-45. [PMID: 33075617 DOI: 10.1016/j.jelectrocard.2020.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/15/2020] [Indexed: 11/25/2022]
Abstract
Outflow tract premature ventricular contractions sometimes demonstrate multiple exit sites in the right and left outflow tracts with preferential pathways. Here we present a case of outflow tract premature ventricular contractions, which were eliminated by ablation from the right ventricular outflow tract accompanied by additional ablation from the very distant endocardial left ventricular outflow tract. The findings during the ablation indicated there was a single origin with multiple exit sites rather than multiple origins for each QRS morphology. This case illustrates that the preferential pathways can demonstrate very distant multiple exit sites.
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Affiliation(s)
- Takayuki Sekihara
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
| | - Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Moeko Nagao
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Shota Kakehashi
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Moe Mukai
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Daisetsu Aoyama
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Minoru Nodera
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Tomoya Eguchi
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Kanae Hasegawa
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
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31
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Choe WS, Lee SR, Cha MJ, Choi EK, Oh S. Differentiation of the right versus left outflow tract ventricular arrhythmias using local activation time at the His bundle electrogram. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2020. [DOI: 10.1186/s42444-020-00023-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Although multiple algorithms based on surface electrocardiographic criteria have been introduced to localize idiopathic ventricular arrhythmia (VA) origins from the outflow tract (OT), their diagnostic accuracy and clinical usefulness remain limited. We evaluated whether local activation time of the His bundle region could differentiate left and right ventricular OT VA origins in the early stage of electrophysiology study.
Methods
We studied 30 patients who underwent catheter ablation for OT VAs with a left bundle branch block pattern and inferior axis QRS morphology. The interval between the local V signal on the mapping catheter placed in the RVOT and His bundle region (V(RVOT)-V(HB) interval) and the interval from QRS complex onset to the local V signal on the His bundle region (QRS-V(HB) interval) were measured during VAs.
Results
The V(RVOT)-V(HB) and QRS-V(HB) intervals were significantly shorter in patients with LVOT VAs. The area under the curve (AUC) for the V(RVOT)-V(HB) interval by receiver operating characteristic analysis was 0.865. A cutoff value of ≤ 50 ms predicted an LVOT origin of VA with sensitivity, specificity, and positive and negative predictive values of 100%, 62.5%, 40%, and 100%, respectively. The QRS-V(HB) interval showed similar diagnostic accuracy (AUC, 0.840), and a cutoff value of ≤ 15 ms predicted an LVOT origin of VA with a sensitivity, specificity, and positive and negative predictive values of 100%, 70.8%, 45.2%, and 100%, respectively.
Conclusion
The V(RVOT)-V(HB) and QRS-V(HB) intervals could differentiate left from right OT origins of VA with high sensitivity and negative predictive values.
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32
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Yu M, Li X, Zhang H, Xia Y, Liu J, Fang P. A Simplified Two-Stepwise Electrocardiographic Algorithm to Distinguish Left from Right Ventricular Outflow Tract Tachycardia Origin. Cardiology 2020; 145:710-719. [PMID: 32841940 DOI: 10.1159/000507360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/13/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND There are several electrocardiographic algorithms to predict the origin of idiopathic outflow tract ventricular arrhythmias (OT-VAs). This study aimed to develop a more accurate and efficient stepwise electrocardiographic algorithm to discriminate left ventricular outflow tract (LVOT) from right ventricular outflow tract (RVOT) origin. METHODS AND RESULTS We analyzed 12-lead electrocardiographic characteristics of 173 consecutive OT-VAs patients who underwent successful radiofrequency catheter ablation in the RVOT (n = 124) or LVOT (n = 49). Based on the areas under the receiver operating characteristic curves, the combination of transitional zone (TZ) index <0 and V2S/V3R index ≤1.5 exhibited 93.5% sensitivity, 85.9% specificity, and 87.3% accuracy. A further analysis was performed in the 71 OT-VAs with a V3-lead precordial transition. The sensitivity, specificity, and accuracy of the integration of V2S/V3R index ≤1.5 and R-wave deflection interval in lead V3 >80 ms were 91.7, 83.1, and 85.9%, respectively. In the prospective evaluation, the combination of TZ index and V2S/V3R index could identify the correct origin sites with 91.2% accuracy in the overall analysis, and the integration of V2S/V3R index ≤1.5 and R-wave deflection interval in lead V3 >80 ms exhibited 94% accuracy in V3-lead precordial transition. CONCLUSIONS The combination of TZ index <0 and V2S/V3R index ≤1.5 is a simple and efficient stepwise electrocardiographic algorithm for predicting LVOT origin. For the OT-VAs with a V3-lead precordial transition, the integration of V2S/V3R index ≤1.5 and R-wave deflection interval in lead V3 >80 ms would be a better choice.
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Affiliation(s)
- Miao Yu
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaofeng Li
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hao Zhang
- Department of Cardiology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, China
| | - Yu Xia
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Liu
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Pihua Fang
- Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,
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33
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Hisazaki K, Hasegawa K, Kaseno K, Miyazaki S, Aoyama D, Mukai M, Nodera M, Shiomi Y, Tama N, Ikeda H, Ishida K, Uzui H, Tada H. Idiopathic right ventricular arrhythmias requiring additional ablation from the left-sided outflow tract: ECG characteristics and efficacy of an anatomical approach. J Cardiovasc Electrophysiol 2020; 31:2653-2664. [PMID: 32639637 DOI: 10.1111/jce.14658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/28/2020] [Accepted: 06/14/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Despite the characteristic electrocardiogram (ECG) findings of early activation during ventricular tachyarrhythmias (VAs) and/or excellent pacemapping in the right ventricular outflow tract (RVOT), some VAs may require additional, left-sided ablation for a cure. METHODS AND RESULTS This study included five patients with idiopathic VAs whose QRS morphologies were highly suggestive of an RVOT origin. The ECG characteristics and intracardiac electrocardiograms during catheter ablation were assessed. In all patients, the clinical VAs had an LBBB QRS morphology and inferior axis with a precordial R/S transition through leads V3-V5, and negative components in lead I. The earliest activation during the VAs (local electrogram-QRS interval = -34 ± 6.8 ms) and excellent pacemapping were obtained at the posterior portion of the RVOT just beneath the pulmonary valve. However, ablation at those sites failed, and the QRS morphology of the VAs changed. During left-sided OT mapping, the earliest activation was found at sites just contralateral to the initially ablated sites of the RVOT (junction of the left and right coronary cusps = 2, left coronary cusp = 3). In spite of the late activation time and poor pacemapping scores, catheter ablation at those sites cured the VAs. Those successful sites were also near the transitional zone from the great cardiac vein to the anterior interventricular vein (GCV-AIV). CONCLUSIONS Some VAs, highly suggestive of having RVOT origins, require catheter ablation in the left-sided OT near the initially ablated RVOT site. Those VAs have the same ECG characteristics and might have intramural origins in the superobasal LV surrounded by the RVOT, LVOT, and GCV-AIV.
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Affiliation(s)
- Kaori Hisazaki
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Yoshida-gun, Fukui, Japan
| | - Kanae Hasegawa
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Yoshida-gun, Fukui, Japan
| | - Kenichi Kaseno
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Yoshida-gun, Fukui, Japan
| | - Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Yoshida-gun, Fukui, Japan
| | - Daisetsu Aoyama
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Yoshida-gun, Fukui, Japan
| | - Moe Mukai
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Yoshida-gun, Fukui, Japan
| | - Minoru Nodera
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Yoshida-gun, Fukui, Japan
| | - Yuichiro Shiomi
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Yoshida-gun, Fukui, Japan
| | - Naoto Tama
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Yoshida-gun, Fukui, Japan
| | - Hiroyuki Ikeda
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Yoshida-gun, Fukui, Japan
| | - Kentaro Ishida
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Yoshida-gun, Fukui, Japan
| | - Hiroyasu Uzui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Yoshida-gun, Fukui, Japan
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Yoshida-gun, Fukui, Japan
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Ergul Y, Ozgur S, Şahin GT, Kafali HC, Özcanoğlu HD, Güzeltaş A. Aortic cusp ablation for premature ventricular contractions and ventricular tachycardia in children: a 5-year single-center experience. J Interv Card Electrophysiol 2020; 61:283-292. [PMID: 32594368 DOI: 10.1007/s10840-020-00803-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 06/15/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Aortic cusps might be the source of supraventricular or ventricular arrhythmias. For many years, aortic cusp ablation has been widely used to treat premature ventricular contractions (PVCs) and ventricular tachycardia (VT). However, the data on the outcomes of this procedure in children are limited. The study aimed to convey or describe our own aortic cusp ablation experiences in children and, thus, contribute to the literature. METHODS The focus was pediatric cases of ventricular arrhythmia in which the origin of the PVCs was ablated above the Valsalva. The sample comprised patients who underwent aortic cusp ablation between 2013 and 2018. The demographic characteristics, noninvasive test results, procedure details, and follow-up results for the patients were noted. RESULTS The 3D EnSite Precision cardiac mapping system and limited fluoroscopy were used. A total of 26 procedures were performed on 22 patients. The mean age was 14.4 ± 3.0 (9-19) years, and the mean weight was 57.3 ± 17.5 (27-99) kg. The mean follow-up period after the first presentation was 38.6 ± 22.9 (3-72) months. There were significant differences in the values of the transition index, V2S/V3R, IIR/IIIR, aVRS/aVLS ratio, and QRS polarity in I at various locations. The most common ablation site was the left coronary cusp (LCC). Radio frequency (RF) ablation, cryoablation, and irrigated RF ablation were found to be effective energy sources in 15, 4, and 3 patients, respectively. Patients who underwent ablation at the LCC-right coronary cusp (RCC) commissure were more likely to present with only VT and to experience worsening symptoms. Twelve patients had previously undergone ablation of the right ventricular outflow tract (RVOT). Ablation in the RVOT had been previously performed in all the patients who eventually underwent ablation at the RCC and the LCC-RCC commissure. CONCLUSION Aortic cusp ablation can be safely performed in children. The careful evaluation of previous noninvasive tests provides important data for determining the location. There might be significant differences in the signs and requirements on the basis of the locations during mapping and ablation.
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Affiliation(s)
- Yakup Ergul
- Department of Pediatric Cardiology/Electrophysiology, Saglik Bilimleri University Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Center Hospital, Istanbul, Turkey
| | - Senem Ozgur
- Department of Pediatric Cardiology/Electrophysiology, Saglik Bilimleri University Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Center Hospital, Istanbul, Turkey. .,Department of Pediatric Cardiology/Electrophysiology, Dr. Sami Ulus Children Hospital Beştepe, Ankara, Turkey.
| | - Gülhan Tunca Şahin
- Department of Pediatric Cardiology/Electrophysiology, Saglik Bilimleri University Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Center Hospital, Istanbul, Turkey
| | - Hasan Candas Kafali
- Department of Pediatric Cardiology/Electrophysiology, Saglik Bilimleri University Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Center Hospital, Istanbul, Turkey
| | - Hatice Dilek Özcanoğlu
- Department of Anesthesiology, Pediatric Cardiology, Saglik Bilimleri University Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Center Hospital, Istanbul, Turkey
| | - Alper Güzeltaş
- Department of Pediatric Cardiology/Electrophysiology, Saglik Bilimleri University Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Center Hospital, Istanbul, Turkey
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Zhou S, AbdelWahab A, Horáček BM, MacInnis PJ, Warren JW, Davis JS, Elsokkari I, Lee DC, MacIntyre CJ, Parkash R, Gray CJ, Gardner MJ, Marcoux C, Choudhury R, Trayanova NA, Sapp JL. Prospective Assessment of an Automated Intraprocedural 12-Lead ECG-Based System for Localization of Early Left Ventricular Activation. Circ Arrhythm Electrophysiol 2020; 13:e008262. [PMID: 32538133 DOI: 10.1161/circep.119.008262] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND To facilitate ablation of ventricular tachycardia (VT), an automated localization system to identify the site of origin of left ventricular activation in real time using the 12-lead ECG was developed. The objective of this study was to prospectively assess its accuracy. METHODS The automated site of origin localization system consists of 3 steps: (1) localization of ventricular segment based on population templates, (2) population-based localization within a segment, and (3) patient-specific site localization. Localization error was assessed by the distance between the known reference site and the estimated site. RESULTS In 19 patients undergoing 21 catheter ablation procedures of scar-related VT, site of origin localization accuracy was estimated using 552 left ventricular endocardial pacing sites pooled together and 25 VT-exit sites identified by contact mapping. For the 25 VT-exit sites, localization error of the population-based localization steps was within 10 mm. Patient-specific site localization achieved accuracy of within 3.5 mm after including up to 11 pacing (training) sites. Using 3 remotes (67.8±17.0 mm from the reference VT-exit site), and then 5 close pacing sites, resulted in localization error of 7.2±4.1 mm for the 25 identified VT-exit sites. In 2 emulated clinical procedure with 2 induced VTs, the site of origin localization system achieved accuracy within 4 mm. CONCLUSIONS In this prospective validation study, the automated localization system achieved estimated accuracy within 10 mm and could thus provide clinical utility.
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Affiliation(s)
- Shijie Zhou
- Department of Biomedical Engineering (S.Z., N.A.T.), Johns Hopkins University, Baltimore, MD.,Alliance for Cardiovascular Diagnostic and Treatment Innovation (S.Z., N.A.T.), Johns Hopkins University, Baltimore, MD.,Heart Rhythm Service, Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S.Z., A.A., J.S.D., I.E., D.C.L., C.J.M., R.P., C.J.G., M.J.G., C.M., R.C., J.L.S.)
| | - Amir AbdelWahab
- Heart Rhythm Service, Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S.Z., A.A., J.S.D., I.E., D.C.L., C.J.M., R.P., C.J.G., M.J.G., C.M., R.C., J.L.S.)
| | - B Milan Horáček
- School of Biomedical Engineering (B.M.H.), Dalhousie University, Halifax, NS, Canada
| | - Paul J MacInnis
- Departments of Physiology and Biophysics (P.J.M., J.W.W., J.L.S.), Dalhousie University, Halifax, NS, Canada
| | - James W Warren
- Departments of Physiology and Biophysics (P.J.M., J.W.W., J.L.S.), Dalhousie University, Halifax, NS, Canada
| | - Jason S Davis
- Heart Rhythm Service, Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S.Z., A.A., J.S.D., I.E., D.C.L., C.J.M., R.P., C.J.G., M.J.G., C.M., R.C., J.L.S.)
| | - Ihab Elsokkari
- Heart Rhythm Service, Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S.Z., A.A., J.S.D., I.E., D.C.L., C.J.M., R.P., C.J.G., M.J.G., C.M., R.C., J.L.S.)
| | - David C Lee
- Heart Rhythm Service, Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S.Z., A.A., J.S.D., I.E., D.C.L., C.J.M., R.P., C.J.G., M.J.G., C.M., R.C., J.L.S.)
| | - Ciorsti J MacIntyre
- Heart Rhythm Service, Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S.Z., A.A., J.S.D., I.E., D.C.L., C.J.M., R.P., C.J.G., M.J.G., C.M., R.C., J.L.S.)
| | - Ratika Parkash
- Heart Rhythm Service, Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S.Z., A.A., J.S.D., I.E., D.C.L., C.J.M., R.P., C.J.G., M.J.G., C.M., R.C., J.L.S.)
| | - Chris J Gray
- Heart Rhythm Service, Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S.Z., A.A., J.S.D., I.E., D.C.L., C.J.M., R.P., C.J.G., M.J.G., C.M., R.C., J.L.S.)
| | - Martin J Gardner
- Heart Rhythm Service, Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S.Z., A.A., J.S.D., I.E., D.C.L., C.J.M., R.P., C.J.G., M.J.G., C.M., R.C., J.L.S.)
| | - Curtis Marcoux
- Heart Rhythm Service, Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S.Z., A.A., J.S.D., I.E., D.C.L., C.J.M., R.P., C.J.G., M.J.G., C.M., R.C., J.L.S.)
| | - Rajin Choudhury
- Heart Rhythm Service, Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S.Z., A.A., J.S.D., I.E., D.C.L., C.J.M., R.P., C.J.G., M.J.G., C.M., R.C., J.L.S.)
| | - Natalia A Trayanova
- Department of Biomedical Engineering (S.Z., N.A.T.), Johns Hopkins University, Baltimore, MD.,Alliance for Cardiovascular Diagnostic and Treatment Innovation (S.Z., N.A.T.), Johns Hopkins University, Baltimore, MD
| | - John L Sapp
- Heart Rhythm Service, Cardiology Division, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada (S.Z., A.A., J.S.D., I.E., D.C.L., C.J.M., R.P., C.J.G., M.J.G., C.M., R.C., J.L.S.).,Departments of Physiology and Biophysics (P.J.M., J.W.W., J.L.S.), Dalhousie University, Halifax, NS, Canada.,Medicine (J.L.S.), Dalhousie University, Halifax, NS, Canada
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36
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Affiliation(s)
- Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Zheng J, Fu G, Anderson K, Chu H, Rakovski C. A 12-Lead ECG database to identify origins of idiopathic ventricular arrhythmia containing 334 patients. Sci Data 2020; 7:98. [PMID: 32251335 PMCID: PMC7090065 DOI: 10.1038/s41597-020-0440-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 02/27/2020] [Indexed: 12/12/2022] Open
Abstract
Cardiac catheter ablation has shown the effectiveness of treating the idiopathic premature ventricular complex and ventricular tachycardia. As the most important prerequisite for successful therapy, criteria based on analysis of 12-lead ECGs are employed to reliably speculate the locations of idiopathic ventricular arrhythmia before a subsequent catheter ablation procedure. Among these possible locations, right ventricular outflow tract and left outflow tract are the major ones. We created a new 12-lead ECG database under the auspices of Chapman University and Ningbo First Hospital of Zhejiang University that aims to provide high quality data enabling detection of the distinctions between idiopathic ventricular arrhythmia from right ventricular outflow tract to left ventricular outflow tract. The dataset contains 334 subjects who successfully underwent a catheter ablation procedure that validated the accurate origins of idiopathic ventricular arrhythmia.
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Affiliation(s)
| | - Guohua Fu
- Ningbo First Hospital of Zhejiang University, Ningbo, China
| | | | - Huimin Chu
- Ningbo First Hospital of Zhejiang University, Ningbo, China.
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38
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Im SI, Lee SH, Gwag HB, Park Y, Park SJ, Kim JS, On YK, Park KM. Electrocardiographic characteristics for successful radiofrequency ablation of right coronary cusp premature ventricular contractions. Medicine (Baltimore) 2020; 99:e19398. [PMID: 32176065 PMCID: PMC7220497 DOI: 10.1097/md.0000000000019398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Electrocardiographic (ECG) criteria identifying right- and left-sided outflow tract origins have been established. The purpose of this study was to define the criteria for premature ventricular contractions (PVCs) originating from the right coronary cusp (RCC) adequately.We analyzed ECG and electrophysiologic study data from patients who underwent successful ablation of PVCs originating from the RCC and right ventricular outflow tract (RVOT). Eighteen RCC and 28 septal RVOT PVCs were studied. Among these 18 successful RCC PVCs, a predominantly positive QRS in lead I in 18/18 (100%), longer V1-2 R-wave duration (81.4 ± 31.1 vs 44.8 ± 7.0 ms, P = .02), V1-2 R wave duration index (RWDI) (51.3 ± 22.0 vs 31.2 ± 7.5%, P = .06) were observed compared to those with posteroseptal RVOT. Local ventricular activation time preceding QRS onset was significantly earlier (-38 ± 12 ms) at the successful RCC ablation site compared to the failed ablation site of the septal RVOT (-22 ± 8 ms), even without good pace mapping at the RVOT (P < .001). The receiver operating characteristic curve showed that a pre-QRS time of ≥-31 ms predicted successful RCC ablation with 67% sensitivity and 94% specificity. A predominantly positive QRS in lead I, longer R-wave duration and RWDI in lead V1 or V2 with a local ventricular activation preceding QRS onset by an average of -31 ms suggests an effective RCC ablation site.
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Affiliation(s)
- Sung Il Im
- Division of Cardiology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan
| | - Sung Ho Lee
- Division of Cardiology, Department of Internal Medicine, Kangbuk Samsung Hospital
| | - Hye Bin Gwag
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan university School of Medicine, Seoul, Republic of Korea
| | - Youngjun Park
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan university School of Medicine, Seoul, Republic of Korea
| | - Seung-Jung Park
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan university School of Medicine, Seoul, Republic of Korea
| | - June Soo Kim
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan university School of Medicine, Seoul, Republic of Korea
| | - Young Keun On
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan university School of Medicine, Seoul, Republic of Korea
| | - Kyoung-Min Park
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan university School of Medicine, Seoul, Republic of Korea
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39
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Asatryan B, Ebrahimi R, Strebel I, van Dam PM, Kühne M, Knecht S, Spies F, Abächerli R, Badertscher P, Kozhuharov N, Zeljkovic I, Schaer B, Osswald S, Sticherling C, Reichlin T. Man vs machine: Performance of manual vs automated electrocardiogram analysis for predicting the chamber of origin of idiopathic ventricular arrhythmia. J Cardiovasc Electrophysiol 2019; 31:410-416. [PMID: 31840899 DOI: 10.1111/jce.14320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 11/23/2019] [Accepted: 12/10/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Radiofrequency catheter ablation of idiopathic ventricular arrhythmias (VAs) is performed to eliminate symptoms and to prevent or reverse arrhythmia-induced cardiomyopathy. Preprocedural prediction of the chamber of VA origin is critical for patient counseling, procedure planning, and guidance of invasive mapping. OBJECTIVE We aimed to assess the performance of manual expert versus automated 12-lead electrocardiogram (ECG) analysis in the prediction of VA origin. METHODS Patients with ablation of idiopathic VA and sustained success were included. The VA origin was defined as the site where ablation caused arrhythmia suppression. Standard baseline 12-lead ECGs with documentation of the VA were analyzed manually in a blinded fashion by three electrophysiologists and three electrophysiology (EP) fellows. In addition, the same standard 12-lead ECG was analyzed by an automated computer algorithm using a vectorcardiographic approach. RESULTS Thirty-eight patients (median age, 47 [interquartile range, 37-58]; 68% female) were enrolled. The VA originated from the right ventricle in 24 (63%) and the left ventricle in 14 (37%) patients. The electrophysiologists and EP fellows identified the VA chamber of origin with a similar accuracy of 73% and 72% (P = .72). The automated algorithm showed a higher accuracy of 89% (P = .03 compared with electrophysiologists and EP fellows). This resulted in a sensitivity of 95% and specificity of 86%. CONCLUSION While the manual ECG analysis of the standard 12-lead ECG by both electrophysiologists and EP fellows correctly identified the chamber of VA origin in around 75% of cases, an automated vectorcardiographic computer algorithm achieved an accuracy of 89% with clinically acceptable diagnostic parameters.
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Affiliation(s)
- Babken Asatryan
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ramin Ebrahimi
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Ivo Strebel
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Peter M van Dam
- Department of Cardiology, UMC Utrecht, Utrecht, The Netherlands.,Peacs BV, Nieuwerbrug aan den Rijn, The Netherlands
| | - Michael Kühne
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Florian Spies
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Roger Abächerli
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.,Institute of Medical Engineering (IMT), Lucerne University of Applied Sciences and Arts, Horw, Switzerland
| | - Patrick Badertscher
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Nikola Kozhuharov
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Ivan Zeljkovic
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Beat Schaer
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
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40
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Premature ventricular complexes: diagnostic and therapeutic considerations in clinical practice : A state-of-the-art review by the American College of Cardiology Electrophysiology Council. J Interv Card Electrophysiol 2019; 57:5-26. [PMID: 31828560 DOI: 10.1007/s10840-019-00655-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 10/27/2019] [Indexed: 12/16/2022]
Abstract
Premature ventricular complexes (PVCs) are common arrhythmias in the clinical setting. PVCs in the structurally normal heart are usually benign, but in the presence of structural heart disease (SHD), they may indicate increased risk of sudden death. High PVC burden may induce cardiomyopathy and left ventricular (LV) dysfunction or worsen underlying cardiomyopathy. Sometimes PVCs may be a marker of underlying pathophysiologic process such as myocarditis. Identification of PVC burden is important, since cardiomyopathy and LV dysfunction can reverse after catheter ablation or pharmacological suppression. This state-of-the-art review discusses pathophysiology, clinical manifestations, how to differentiate benign and malignant PVCs, PVCs in the structurally normal heart, underlying SHD, diagnostic procedures (physical examination, electrocardiogram, ambulatory monitoring, exercise testing, echocardiography, cardiac magnetic resonance imaging, coronary angiography, electrophysiology study), and treatment (lifestyle modification, electrolyte imbalance, medical, and catheter ablation).
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41
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Parwani AS, Hohendanner F, Boldt LH. [Catheter ablation of ventricular tachycardia : Clinical outcome]. Herzschrittmacherther Elektrophysiol 2019; 30:349-355. [PMID: 31713027 DOI: 10.1007/s00399-019-00653-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 10/11/2019] [Indexed: 11/30/2022]
Abstract
Catheter-based ablation of ventricular tachycardia (VT) is increasingly used in clinical practice. The reported success rates are especially high in idiopathic VT. In randomized controlled clinical trials like VANISH, ablation of scar-associated VT was superior in terms of mortality when compared to antiarrhythmic therapy. Treatment at experienced centers, e.g., using state-of-the-art electroanatomical mapping systems, is a promising option for these complex and often multimorbid patients.
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Affiliation(s)
- Abdul S Parwani
- Medizinische Klinik mit Schwerpunkt Kardiologie, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - Felix Hohendanner
- Medizinische Klinik mit Schwerpunkt Kardiologie, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - Leif-Hendrik Boldt
- Medizinische Klinik mit Schwerpunkt Kardiologie, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland.
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Aita S, Ogata K, Yoshida K, Inaba T, Kosuge H, Machino T, Tsumagari Y, Hattori A, Ito Y, Komatsu Y, Sekihara K, Horigome H, Aonuma K, Nogami A, Kandori A, Ieda M. Noninvasive Mapping of Premature Ventricular Contractions by Merging Magnetocardiography and Computed Tomography. JACC Clin Electrophysiol 2019; 5:1144-1157. [DOI: 10.1016/j.jacep.2019.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/14/2019] [Accepted: 06/19/2019] [Indexed: 11/29/2022]
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43
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Yamada T. Twelve-lead electrocardiographic localization of idiopathic premature ventricular contraction origins. J Cardiovasc Electrophysiol 2019; 30:2603-2617. [PMID: 31502322 DOI: 10.1111/jce.14152] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/16/2019] [Accepted: 08/29/2019] [Indexed: 11/29/2022]
Abstract
The major sites of origins of idiopathic ventricular arrhythmias have been elucidated. Idiopathic ventricular arrhythmias most often present as premature ventricular contractions (PVCs) with a focal mechanism, and commonly occur without structural heart disease. Idiopathic ventricular arrhythmias usually originate from specific anatomical structures, commonly endocardial but sometimes epicardial and exhibit characteristic electrocardiograms (ECGs) based on their anatomical background. There are general and specific ECG characteristics that can localize the site of idiopathic PVC origins. The general ECG characteristics include the bundle branch block pattern, axis, QRS polarity in lead V6, QRS duration, precordial transition, maximal deflection index, and so forth. They can roughly localize the site of idiopathic PVC origins. Several major sites of idiopathic PVC origins are located close to each other, and specific ECG characteristics are helpful for localizing the site of origins more accurately in those PVCs. Twelve-lead surface ECG algorithms usually can localize the site of idiopathic PVC origins with a high accuracy, but their accuracy can be limited by the patients' physique, heart rotation, specific conduction properties, presence of structural heart disease, and so forth. This review describes an overview of the approaches to the 12-lead surface ECG localization of idiopathic PVCs, and also discusses their caveats and limitations.
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Affiliation(s)
- Takumi Yamada
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
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44
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Di C, Wan Z, Tse G, Letsas KP, Liu T, Efremidis M, Li J, Lin W. The V 1-V 3 transition index as a novel electrocardiographic criterion for differentiating left from right ventricular outflow tract ventricular arrhythmias. J Interv Card Electrophysiol 2019; 56:37-43. [PMID: 31478158 DOI: 10.1007/s10840-019-00612-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 08/12/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of this study was to develop a new electrocardiographic criterion for differentiating the origin of outflow tract ventricular arrhythmias (OT-VAs) with precordial transition in lead V3. METHODS A total of 147 consecutive patients with OT-VAs displaying precordial transition in lead V3 who underwent successful catheter ablation in the right ventricular outflow tract (RVOT) (n = 118) or left ventricular outflow tract (LVOT) (n = 29) were included in this study. The V1-V3 transition index was defined as the sum of S-wave amplitude in lead V1 and V2 during premature ventricular contractions (PVCs) divided by the S-wave amplitude during sinus rhythm (SR), respectively, minus the sum of R-wave amplitude in lead V1, V2, and V3 during PVCs divided by the R-wave amplitude during SR, respectively, i.e., [(SPVC/SSR)V1 + (SPVC/SSR)V2] - [(RPVC/RSR) V1 + (RPVC/RSR)V2 + (RPVC/RSR)V3]. RESULTS The V1-V3 transition index was significantly higher for RVOT origins than for LVOT origins (1.25 ± 2.48 vs. - 3.94 ± 3.11; P < 0.001). Receiver operating characteristic (ROC) analysis revealed an area under the curve (AUC) of 0.931 for the V1-V3 transition index, and a cutoff value of > - 1.60 predicted a RVOT origin with a 93% sensitivity and 86% specificity. With respect to AUC and accuracy, the V1-V3 transition index was superior to any previously proposed ECG indices for differentiating left from right OT-VAs. In 37 prospective cases, the new index was able to predict the site of a RVOT origin with 95% accuracy (35 of 37 cases). CONCLUSIONS The V1-V3 transition index is a useful novel ECG criterion for distinguishing left from right OT-VAs with precordial transition in lead V3.
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Affiliation(s)
- Chengye Di
- First Department of Cardiology, TEDA International Cardiovascular Hospital, Tianjin, People's Republic of China
| | - Zheng Wan
- Cardiovascular Center, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Gary Tse
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China.,Li Ka Shing Institute of Health Sciences, Chinese University of Hong Kong, Hong Kong, SAR, People's Republic of China
| | - Konstantinos P Letsas
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, 10676, Athens, Greece
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
| | - Michael Efremidis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, 10676, Athens, Greece
| | - Jianming Li
- Department of Cardiovascular Division, Minneapolis Veterans Affairs Medical Center, University of Minnesota, Minneapolis, MN, USA
| | - Wenhua Lin
- First Department of Cardiology, TEDA International Cardiovascular Hospital, Tianjin, People's Republic of China.
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45
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Suzuki G, Yotsukura A, Nanbu T, Sakurai M. Successful catheter cryoablation for premature ventricular contractions originating from the para-Hisian region. Clin Case Rep 2019; 7:1508-1513. [PMID: 31428377 PMCID: PMC6693052 DOI: 10.1002/ccr3.2246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 04/24/2019] [Accepted: 05/05/2019] [Indexed: 11/09/2022] Open
Abstract
We achieved successful catheter cryoablation in a patient with para-Hisian premature ventricular contractions (PVCs) without conduction disturbance using the freeze-thaw-freeze method while observing the atrial-His bundle interval. Cryoablation could be considered an alternative to radiofrequency ablation for patients with para-Hisian PVCs.
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Affiliation(s)
- George Suzuki
- Division of Arrhythmias and Cardiac Electrophysiology, Department of Cardiovascular MedicineHokko Memorial HospitalSapporoJapan
| | - Akihiko Yotsukura
- Division of Arrhythmias and Cardiac Electrophysiology, Department of Cardiovascular MedicineHokko Memorial HospitalSapporoJapan
| | - Tadafumi Nanbu
- Division of Arrhythmias and Cardiac Electrophysiology, Department of Cardiovascular MedicineHokko Memorial HospitalSapporoJapan
| | - Masayuki Sakurai
- Division of Arrhythmias and Cardiac Electrophysiology, Department of Cardiovascular MedicineHokko Memorial HospitalSapporoJapan
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46
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Busch S, Eckardt L, Sommer P, Meyer C, Bonnemeier H, Thomas D, Neuberger HR, Tilz RR, Steven D, von Bary C, Kuniss M, Voss F, Estner HL. [Premature ventricular contractions and tachycardia in a structurally normal heart : Idiopathic PVC and VT]. Herzschrittmacherther Elektrophysiol 2019; 30:212-224. [PMID: 30767064 DOI: 10.1007/s00399-019-0607-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 01/21/2019] [Indexed: 06/09/2023]
Abstract
Premature ventricular contractions (PVC) are a common, often incidental and mostly benign finding. Treatment is indicated in frequent and symptomatic PVC or in cases of worsening of left ventricular function. Idiopathic ventricular tachycardia (VT) is mostly found in patients with a structurally healthy heart. These PVC/VT usually have a focal origin. The most likely mechanism is delayed post-depolarization. Localization of the origin is based on the creation of an activation map with or without combination of pace mapping. Idiopathic PVC/VT are most frequently located on the outflow tracts of the right and left ventricles, including the aortic root. Other typical locations include the annulus of the tricuspid or mitral valve, papillary muscles and Purkinje fibers. Catheter ablation is an alternative to antiarrhythmic medication in symptomatic monomorphic PVC/VT. The success rate is good whereby mapping and ablation can often represent a challenge. This article is the fifth part of a series dedicated to specific advanced training in the field of special rhythmology and invasive electrophysiology. It describes the pathophysiological principles, types and typical findings that can be obtained during an electrophysiological investigation.
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Affiliation(s)
- Sonia Busch
- II. Med. Klinik, Klinik für Kardiologie, Angiologie, Pneumologie, Klinikum Coburg, Ketschendorfer Str. 33, 96450, Coburg, Deutschland.
| | - Lars Eckardt
- Klinik für Kardiologie II - Rhythmologie, Universitätsklinikum Münster, Münster, Deutschland
| | - Philipp Sommer
- Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Deutschland
| | - Christian Meyer
- Klinik für Kardiologie mit Schwerpunkt Elektrophysiologie, Universitäres Herzzentrum Hamburg, Hamburg, Deutschland
| | - Hendrik Bonnemeier
- Klinik für Innere Medizin III, Kardiologie, Angiologie, Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - Dierk Thomas
- Department of Cardiology, Medical University Hospital, Heidelberg, Deutschland
- HCR (Heidelberg Center for Heart Rhythm Disorders), Heidelberg, Deutschland
- partner site Heidelberg/Mannheim, DZHK (German Center for Cardiovascular Research), Heidelberg, Deutschland
| | | | - Roland Richard Tilz
- Medizinische Klinik II (Kardiologie, Angiologie, Intensivmedizin) - Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Lübeck, Deutschland
| | - Daniel Steven
- Herzzentrum, Abteilung für Elektrophysiologie, Uniklinik Köln, Köln, Deutschland
| | - Christian von Bary
- Medizinische Klinik I, Rotkreuzklinikum München - Akademisches Lehrkrankenhaus der Technischen Universität München, München, Deutschland
| | - Malte Kuniss
- Abteilung für Kardiologie, Kerckhoff-Klinik GmbH, Bad Nauheim, Deutschland
| | - Frederic Voss
- Innere Medizin 3, Krankenhaus der Barmherzigen Brüder Trier, Trier, Deutschland
| | - Heidi L Estner
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität München (LMU München), München, Deutschland
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47
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Anderson RD, Kumar S, Parameswaran R, Wong G, Voskoboinik A, Sugumar H, Watts T, Sparks PB, Morton JB, McLellan A, Kistler PM, Kalman J, Lee G. Differentiating Right- and Left-Sided Outflow Tract Ventricular Arrhythmias. Circ Arrhythm Electrophysiol 2019; 12:e007392. [DOI: 10.1161/circep.119.007392] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Robert D. Anderson
- Department of Cardiology, Royal Melbourne Hospital, Faculty of Medicine, Dentistry, and Health Science, University of Melbourne, VIC, Australia (R.D.A., R.P., G.W., A.V., H.S., T.W., P.B.S., J.B.M., A.M., P.M.K., J.K., G.L.)
| | - Saurabh Kumar
- Department of Cardiology, Westmead Hospital, NSW, Australia (S.K.)
| | - Ramanathan Parameswaran
- Department of Cardiology, Royal Melbourne Hospital, Faculty of Medicine, Dentistry, and Health Science, University of Melbourne, VIC, Australia (R.D.A., R.P., G.W., A.V., H.S., T.W., P.B.S., J.B.M., A.M., P.M.K., J.K., G.L.)
| | - Geoffrey Wong
- Department of Cardiology, Royal Melbourne Hospital, Faculty of Medicine, Dentistry, and Health Science, University of Melbourne, VIC, Australia (R.D.A., R.P., G.W., A.V., H.S., T.W., P.B.S., J.B.M., A.M., P.M.K., J.K., G.L.)
| | - Aleksandr Voskoboinik
- Department of Cardiology, Royal Melbourne Hospital, Faculty of Medicine, Dentistry, and Health Science, University of Melbourne, VIC, Australia (R.D.A., R.P., G.W., A.V., H.S., T.W., P.B.S., J.B.M., A.M., P.M.K., J.K., G.L.)
- Department of Cardiology, Alfred Hospital, VIC, Australia (A.V., H.S., A.M., P.M.K.)
- Baker IDI Heart & Diabetes Institute, Melbourne, VIC, Australia (A.V., H.S., A.M., P.M.K.)
| | - Hariharan Sugumar
- Department of Cardiology, Royal Melbourne Hospital, Faculty of Medicine, Dentistry, and Health Science, University of Melbourne, VIC, Australia (R.D.A., R.P., G.W., A.V., H.S., T.W., P.B.S., J.B.M., A.M., P.M.K., J.K., G.L.)
- Department of Cardiology, Alfred Hospital, VIC, Australia (A.V., H.S., A.M., P.M.K.)
- Baker IDI Heart & Diabetes Institute, Melbourne, VIC, Australia (A.V., H.S., A.M., P.M.K.)
| | - Troy Watts
- Department of Cardiology, Royal Melbourne Hospital, Faculty of Medicine, Dentistry, and Health Science, University of Melbourne, VIC, Australia (R.D.A., R.P., G.W., A.V., H.S., T.W., P.B.S., J.B.M., A.M., P.M.K., J.K., G.L.)
| | - Paul B. Sparks
- Department of Cardiology, Royal Melbourne Hospital, Faculty of Medicine, Dentistry, and Health Science, University of Melbourne, VIC, Australia (R.D.A., R.P., G.W., A.V., H.S., T.W., P.B.S., J.B.M., A.M., P.M.K., J.K., G.L.)
| | - Joseph B. Morton
- Department of Cardiology, Royal Melbourne Hospital, Faculty of Medicine, Dentistry, and Health Science, University of Melbourne, VIC, Australia (R.D.A., R.P., G.W., A.V., H.S., T.W., P.B.S., J.B.M., A.M., P.M.K., J.K., G.L.)
| | - Alex McLellan
- Department of Cardiology, Royal Melbourne Hospital, Faculty of Medicine, Dentistry, and Health Science, University of Melbourne, VIC, Australia (R.D.A., R.P., G.W., A.V., H.S., T.W., P.B.S., J.B.M., A.M., P.M.K., J.K., G.L.)
- Department of Cardiology, Alfred Hospital, VIC, Australia (A.V., H.S., A.M., P.M.K.)
- Baker IDI Heart & Diabetes Institute, Melbourne, VIC, Australia (A.V., H.S., A.M., P.M.K.)
| | - Peter M. Kistler
- Department of Cardiology, Royal Melbourne Hospital, Faculty of Medicine, Dentistry, and Health Science, University of Melbourne, VIC, Australia (R.D.A., R.P., G.W., A.V., H.S., T.W., P.B.S., J.B.M., A.M., P.M.K., J.K., G.L.)
- Department of Cardiology, Alfred Hospital, VIC, Australia (A.V., H.S., A.M., P.M.K.)
- Baker IDI Heart & Diabetes Institute, Melbourne, VIC, Australia (A.V., H.S., A.M., P.M.K.)
| | - Jonathan Kalman
- Department of Cardiology, Royal Melbourne Hospital, Faculty of Medicine, Dentistry, and Health Science, University of Melbourne, VIC, Australia (R.D.A., R.P., G.W., A.V., H.S., T.W., P.B.S., J.B.M., A.M., P.M.K., J.K., G.L.)
| | - Geoffrey Lee
- Department of Cardiology, Royal Melbourne Hospital, Faculty of Medicine, Dentistry, and Health Science, University of Melbourne, VIC, Australia (R.D.A., R.P., G.W., A.V., H.S., T.W., P.B.S., J.B.M., A.M., P.M.K., J.K., G.L.)
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48
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Di Biase L, Romero J, Zado ES, Diaz JC, Gianni C, Hranitzki PM, Sanchez JE, Mohanty S, Al-Ahmad A, Mohanty P, Trivedi C, Della Rocca D, Santangeli P, Burkhardt JD, Garcia FC, Marchlinski FE, Natale A. Variant of ventricular outflow tract ventricular arrhythmias requiring ablation from multiple sites: Intramural origin. Heart Rhythm 2019; 16:724-732. [DOI: 10.1016/j.hrthm.2018.11.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Indexed: 10/27/2022]
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49
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Dong X, Sun Q, Tang M, Zhang S. Catheter ablation of ventricular arrhythmias originating from the junction of the pulmonary sinus cusp via a nonreversed U curve approach. Heart Rhythm 2019; 16:1513-1520. [PMID: 30959204 DOI: 10.1016/j.hrthm.2019.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Ventricular arrhythmias (VAs) can originate from the pulmonary sinus cusp, and reversed U curve ablation has been highly efficient treatment. OBJECTIVE The purpose of this study was to clarify the characteristics of VAs originating from the pulmonary sinus junction (PSJ): left cusp-anterior cusp (LC-AC), right cusp-left cusp (RC-LC), and right cusp-anterior cusp (RC-AC). METHODS One hundred twenty-five consecutive patients with right ventricular outflow (RVOT)-type VAs were enrolled in the study and analyzed. RESULTS Seventeen RVOT-type VAs (13.6%) had an anatomic origin at the PSJ (9 at LC-AC, 6 at RC-LC, 4 at RC-AC). For PSJ-VA patients, the earliest activation site was identified at the PSJ 22.65 ± 2.47 mm above the pulmonary sinus base and preceded QRS onset by 35.7 ± 12.7 ms (P <.001). Fourteen of the 17 PSJ-VA patients underwent successful ablation via a nonreversed U curve after failed reversed U curve ablation. The bipolar proximal potential was earlier, equal to, or later than the distal potential when the reversed U curve catheter tip was positioned at the bottom, middle, or junction region of individual sinus. Electrocardiographic analysis revealed a lower amplitude of RC-AC than LC-AC and RC-LC VAs (P <.001). CONCLUSION The PSJ is a nonrare but distinct origin of RVOT-type VAs. The nonreversed U curve approach is a more feasible alternative for PSJ-VAs than the reversed U curve approach.
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Affiliation(s)
- Xiaonan Dong
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
| | - Qi Sun
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
| | - Min Tang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China.
| | - Shu Zhang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
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50
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Long-term mode and timing of premature ventricular complex recurrence following successful catheter ablation. J Interv Card Electrophysiol 2019; 55:153-160. [PMID: 30734139 DOI: 10.1007/s10840-019-00520-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 01/15/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Catheter ablation of premature ventricular contractions (PVCs) is highly successful and has become the hallmark treatment for symptomatic or highly prevalent cases. However, few studies exist that evaluate the outcomes of ablation and likely mechanisms of PVC recurrence beyond 1 year of follow-up. METHODS This study is a retrospective analysis of patients who underwent catheter ablation for symptomatic PVCs with acute procedural success and had clinical follow-up ≥ 12 months. RESULTS Forty-four patients (24 women; age 53.5 ± 4.8 years) following acutely successful PVC ablation with long-term follow-up were studied. At a mean of 36 ± 6 months, overall long-term ablation success was 75% (33/44 patients). Notably, recurrence of the targeted PVC focus was low (6.8%, 3/44 patients); the majority of recurrences were from a new source location (18.2%, 8/44 patients). The time course for targeted versus de novo PVC recurrences was significantly different: recurrence of a PVC similar to the targeted PVC morphology occurred at a mean of 5.0 ± 2.0 months, while recurrence of a PVC different from the index case occurred at a mean of 35.8 ± 17.1 months (p = 0.01). Non-ischemic cardiomyopathy was associated with increased risk of PVC recurrence (odds ratio [OR] 14.50 (95% confidence interval [CI] 1.92-109.33, p = 0.01)) and was a significant negative prognostic factor in multivariate analysis for PVC recurrence survival (hazard ratio [HR] 4.63, 95% CI 1.03-20.74, p = 0.04). CONCLUSIONS The majority of long-term PVC recurrences occur late in follow-up, at locations remote from the targeted PVC source or sources. Such sites may represent ongoing substrate evolution; additional work is required to determine the precise substrate alterations which promote such arrhythmogenic changes.
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