1
|
Morita H, Asada S, Ueoka A, Mizuno T, Masuda T, Miyamoto M, Kawada S, Nakagawa K, Nishii N, Yuasa S. Risk stratification for the occurrence of ventricular fibrillation in patients with early repolarization syndrome. Heart Rhythm 2024:S1547-5271(24)02535-9. [PMID: 38710349 DOI: 10.1016/j.hrthm.2024.04.101] [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: 11/30/2023] [Revised: 04/21/2024] [Accepted: 04/27/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND Several signs of malignant early repolarizations have been proposed in patients with early repolarization syndrome (ERS). However, reports have challenged the efficacy of these signs in predicting future ventricular fibrillation (VF) in patients with ERS. OBJECTIVE This study aimed to assess the predictive value of various electrocardiogram (ECG) markers for future VF events in patients with ERS. METHODS We retrospectively evaluated the clinical characteristics of 44 patients with ERS to identify risk factors for VF during follow-up. RESULTS After the initial event, 16 patients experienced VF (VF group), whereas 28 did not (non-VF group). The VF group had a longer QRS interval, more fragmented QRS (fQRS), and a higher T/R voltage ratio than the non-VF group. Wide J waves were more prevalent in the VF group; however, other J-wave markers did not differ between the groups. Positive late potentials recorded on signal-averaged ECGs were more frequent in the VF group. Whereas none of the patients showed spontaneous Brugada syndrome on ECG, the VF group frequently exhibited pilsicainide-induced ST-segment elevation. These ECG markers were significantly associated with the occurrence of VF during follow-up. Patients with multiple ECG factors, including QRS abnormalities (wide QRS or fQRS), wide J waves, and a high T/R ratio, had a worse prognosis than patients without multiple factors, effectively stratifying patient risk. CONCLUSION The occurrence of VF in patients with ERS may be associated with conduction abnormalities such as QRS widening, fQRS, high T/R ratio, positive late potentials, and pilsicainide test results. Therefore, ECG factors could be useful in identifying high-risk patients.
Collapse
Affiliation(s)
- Hiroshi Morita
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
| | - Saori Asada
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan
| | - Akira Ueoka
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan
| | - Tomofumi Mizuno
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan
| | - Takuro Masuda
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan
| | - Masakazu Miyamoto
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan
| | - Satoshi Kawada
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan
| | - Koji Nakagawa
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan
| | - Nobuhiro Nishii
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shinsuke Yuasa
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan
| |
Collapse
|
2
|
Morita H, Ueoka A, Mizuno T, Masuda T, Asada S, Ejiri K, Miyamoto M, Kawada S, Nakagawa K, Nishii N, Yuasa S. Clinical characteristics of electrical storm in patients with early repolarization syndrome. Heart Rhythm 2024; 21:562-570. [PMID: 38242221 DOI: 10.1016/j.hrthm.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND Early repolarization syndrome (ERS) is an idiopathic ventricular fibrillation (VF) associated with inferolateral J waves. While electrical storm (ES) in ERS is not rare, their characteristics and risk factors are not fully understood. OBJECTIVE This study aimed to clarify the significance of ES in ERS. METHODS We evaluated 44 patients with ERS who experienced VF/sudden cardiac death or arrhythmic syncope. We assessed clinical characteristics to identify the risk factors for ES. RESULTS In total, 13 patients (30%) experienced ES (ES group). Of these, 11 patients (85%) experienced ES during the acute phase of initial VF episodes and 2 patients (2%) experienced ES during follow-up. VF associated with ES occurred during therapeutic hypothermia in 6 of 13 patients (46%). The J-wave voltage during therapeutic hypothermia was higher in the ES group than that in the patients without ES. Isoproterenol was used in 5 patients (38%), which decreased J-wave voltage and relieved ES. Among the clinical markers, shorter QT and QTp intervals (the interval from QRS onset to the peak of T wave), pilsicainide-induced ST elevation, and high scores on the Shanghai Score System were associated with ES. Although pilsicainide induced ST elevation in 6 of 34 patients (18%), spontaneous Brugada electrocardiographic patterns did not appear to be associated with VF. Therapeutic hypothermia was also a risk factor for acute phase ES. CONCLUSION Patients with ERS in the ES group frequently had short QT and QTp intervals, pilsicainide-induced ST elevations, and high Shanghai Score System scores. Therapeutic hypothermia was also associated with acute phase ES.
Collapse
Affiliation(s)
- Hiroshi Morita
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Okayama, Japan.
| | - Akira Ueoka
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and Dentistry, Okayama City, Okayama, Japan
| | - Tomofumi Mizuno
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and Dentistry, Okayama City, Okayama, Japan
| | - Takuro Masuda
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and Dentistry, Okayama City, Okayama, Japan
| | - Saori Asada
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and Dentistry, Okayama City, Okayama, Japan
| | - Kentaro Ejiri
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and Dentistry, Okayama City, Okayama, Japan
| | - Masakazu Miyamoto
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and Dentistry, Okayama City, Okayama, Japan
| | - Satoshi Kawada
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and Dentistry, Okayama City, Okayama, Japan
| | - Koji Nakagawa
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and Dentistry, Okayama City, Okayama, Japan
| | - Nobuhiro Nishii
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Okayama, Japan
| | - Shinsuke Yuasa
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and Dentistry, Okayama City, Okayama, Japan
| |
Collapse
|
3
|
Miyamoto M, Morita H, Mizuno T, Masuda T, Ueoka A, Asada S, Kawada S, Nakagawa K, Nishii N. Significance of left posterior extension of early repolarization in patients with J-wave syndrome. Heart Rhythm 2023; 20:1729-1736. [PMID: 37634559 DOI: 10.1016/j.hrthm.2023.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/22/2023] [Accepted: 08/22/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND J waves in the inferior or lateral leads are characteristic electrocardiographic (ECG) changes in patients with early repolarization syndrome (ERS). However, the presence of J waves in the left posterior region has not yet been evaluated. OBJECTIVE The purpose of this study was to clarify the significance of J waves in the posterior left ventricle using leads V7-V9 and a body surface mapping (BSM) system. METHODS Forty patients diagnosed with ERS were included. All patients exhibited J waves in either the contiguous inferior, lateral, or posterior leads. We evaluated the incidence of J waves in the inferolateral and posterior leads using a 15-lead ECG with synthesized V7-V9 and an 87-lead BSM. Additionally, we assessed the arrhythmogenicity of the posterior regions based on the morphology of the premature ventricular complexes (PVCs) associated with ventricular fibrillation (VF). RESULTS J waves were observed in the lateral, inferior, and posterior leads of 26 (65%), 31 (78%), and 39 (97%) patients, respectively. J waves were found only in the posterior leads of 5 patients. BSM was evaluated in 9 patients, all of whom exhibited a positive area on the posterior region. PVCs associated with VF were recorded in 5 patients. Among patients with inferolateral and posterior J waves, all except 1 patient who displayed left bundle branch block morphology showed PVCs originating from the posterior left ventricular region. CONCLUSION Posterior J waves are common in ERS patients. This abnormality can be detected using leads V7-V9 and the BSM system and may be associated with arrhythmogenesis.
Collapse
Affiliation(s)
- Masakazu Miyamoto
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan
| | - Hiroshi Morita
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
| | - Tomofumi Mizuno
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan
| | - Takuro Masuda
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan
| | - Akira Ueoka
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan
| | - Saori Asada
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan
| | - Satoshi Kawada
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan
| | - Koji Nakagawa
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan
| | - Nobuhiro Nishii
- Department of Cardiovascular Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine and Dentistry, Okayama, Japan; Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| |
Collapse
|
4
|
Tsiachris D, Botis M, Doundoulakis I, Bartsioka LI, Tsioufis P, Kordalis A, Antoniou CK, Tsioufis K, Gatzoulis KA. Electrocardiographic Characteristics, Identification, and Management of Frequent Premature Ventricular Contractions. Diagnostics (Basel) 2023; 13:3094. [PMID: 37835837 PMCID: PMC10572222 DOI: 10.3390/diagnostics13193094] [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: 08/17/2023] [Revised: 09/09/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
Premature ventricular complexes (PVCs) are frequently encountered in clinical practice. The association of PVCs with adverse cardiovascular outcomes is well established in the context of structural heart disease, yet not so much in the absence of structural heart disease. However, cardiac magnetic resonance (CMR) seems to contribute prognostically in the latter subgroup. PVC-induced myocardial dysfunction refers to the impairment of ventricular function due to PVCs and is mostly associated with a PVC burden > 10%. Surface 12-lead ECG has long been used to localize the anatomic site of origin and multiple algorithms have been developed to differentiate between right ventricular and left ventricular outflow tract (RVOT and LVOT, respectively) origin. Novel algorithms include alternative ECG lead configurations and, lately, sophisticated artificial intelligence methods have been utilized to determine the origins of outflow tract arrhythmias. The decision to therapeutically address PVCs should be made upon the presence of symptoms or the development of PVC-induced myocardial dysfunction. Therapeutic modalities include pharmacological therapy (I-C antiarrhythmic drugs and beta blockers), as well as catheter ablation, which has demonstrated superior efficacy and safety.
Collapse
Affiliation(s)
- Dimitris Tsiachris
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, “Hippokration” Hospital, 11527 Athens, Greece; (M.B.); (I.D.); (L.I.B.); (P.T.); (A.K.); (C.-K.A.); (K.T.); (K.A.G.)
- Athens Heart Center, Athens Medical Center, 15125 Athens, Greece
| | - Michail Botis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, “Hippokration” Hospital, 11527 Athens, Greece; (M.B.); (I.D.); (L.I.B.); (P.T.); (A.K.); (C.-K.A.); (K.T.); (K.A.G.)
| | - Ioannis Doundoulakis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, “Hippokration” Hospital, 11527 Athens, Greece; (M.B.); (I.D.); (L.I.B.); (P.T.); (A.K.); (C.-K.A.); (K.T.); (K.A.G.)
| | - Lamprini Iro Bartsioka
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, “Hippokration” Hospital, 11527 Athens, Greece; (M.B.); (I.D.); (L.I.B.); (P.T.); (A.K.); (C.-K.A.); (K.T.); (K.A.G.)
| | - Panagiotis Tsioufis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, “Hippokration” Hospital, 11527 Athens, Greece; (M.B.); (I.D.); (L.I.B.); (P.T.); (A.K.); (C.-K.A.); (K.T.); (K.A.G.)
| | - Athanasios Kordalis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, “Hippokration” Hospital, 11527 Athens, Greece; (M.B.); (I.D.); (L.I.B.); (P.T.); (A.K.); (C.-K.A.); (K.T.); (K.A.G.)
| | - Christos-Konstantinos Antoniou
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, “Hippokration” Hospital, 11527 Athens, Greece; (M.B.); (I.D.); (L.I.B.); (P.T.); (A.K.); (C.-K.A.); (K.T.); (K.A.G.)
- Athens Heart Center, Athens Medical Center, 15125 Athens, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, “Hippokration” Hospital, 11527 Athens, Greece; (M.B.); (I.D.); (L.I.B.); (P.T.); (A.K.); (C.-K.A.); (K.T.); (K.A.G.)
| | - Konstantinos A. Gatzoulis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, “Hippokration” Hospital, 11527 Athens, Greece; (M.B.); (I.D.); (L.I.B.); (P.T.); (A.K.); (C.-K.A.); (K.T.); (K.A.G.)
| |
Collapse
|
5
|
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]
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
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.
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
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).
Collapse
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
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Estimation of the accessory pathway location of the manifest Wolf-Parkinson-White syndrome using synthesized right-sided chest leads. J Interv Card Electrophysiol 2019; 59:43-48. [PMID: 31728876 DOI: 10.1007/s10840-019-00648-2] [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: 06/05/2019] [Accepted: 10/14/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The classification using QRS morphology of V1 lead is a useful simple predictor of accessory pathway location (type A, R or Rs pattern; type B, rS pattern; type C, QS or Qr pattern), but often leads to misdiagnosis of accessory pathway location, especially in types B and C. The synthesized 18-lead electrocardiography (ECG) derived from standard 12-lead ECG can provide virtual waveforms of right-sided chest leads. This study aimed to evaluate the usefulness of the right-sided chest lead ECG for prediction of accessory pathway location. METHODS This retrospective study included 44 patients in whom successful ablation of manifest Wolff-Parkinson-White (WPW) syndrome was performed. Synthesized ECG waveforms were automatically generated, and ECG data obtained before the procedure. RESULTS There were 26, 4, and 14 patients with left, right, and septal accessory pathways, respectively. All left accessory pathway cases have type A in V1 and syn-V4R leads. Of the 4 right accessory pathway cases, 2 have type B in V1 and syn-V4R leads. Other 2 of 4 cases have type C. In V1 lead, 5 of 14 septal accessory pathway cases have type C, 7 of 14 cases have type B, and 2 of 14cases have type A. In syn-V4R lead, all 14 septal accessory pathway cases have type C. The QRS morphology of V1 and syn-V4 leads could predict the site of accessory pathway with overall accuracy of 79% and 95%, respectively. CONCLUSIONS QRS morphology of syn-V4R lead may be useful for predicting accessory pathway location of manifest WPW syndrome.
Collapse
|
13
|
Cheng D, Ju W, Zhu L, Chen K, Zhang F, Chen H, Yang G, Li X, Li M, Gu K, Han B, Fan J, Lin Y, Cao K, Kojodjojo P, Yang B, Chen M. V 3R/V 7 Index: A Novel Electrocardiographic Criterion for Differentiating Left From Right Ventricular Outflow Tract Arrhythmias Origins. Circ Arrhythm Electrophysiol 2019; 11:e006243. [PMID: 30571180 DOI: 10.1161/circep.118.006243] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Several algorithms have been proposed to predict the origin of outflow tract (OT) ventricular arrhythmias (VAs) using standard 12-lead ECG. However, the additive value of right precordial and posterior leads is unknown. METHODS Standard 12-lead ECG, right precordial leads ECG (V3R, V4R, V5R) and posterior leads ECG (V7, V8, V9) were recorded and analyzed in a development cohort of consecutive patients undergoing OT-VAs ablation at a single center. These findings informed the development of a novel algorithm incorporating right precordial and posterior leads to discriminate between left ventricular OT (LVOT) and right ventricular OT (RVOT) foci. The performance of this novel algorithm which includes the V3R/V7 index was prospectively tested in a validation cohort of consecutive patients undergoing OT-VA ablation at 4 centers and compared with published algorithms. The location of the foci was determined by the successful ablation site. RESULTS One hundred ninety-one patients were recruited, of which 94 formed the validation cohort (mean age of 45.7±15.6, 39% male, 79% RVOT foci). During OT-VAs, a QS pattern in lead V3R and an S wave in lead V7 were exclusively recorded in RVOT and LVOT foci, respectively. The V3R/V7 index of LVOT origin was significantly greater than that of RVOT (1.05±0.83 versus 0.28±0.23, P<0.001). The V3R/V7 index ≥0.85 predicted an LVOT origin with 87% sensitivity and 96% specificity. In the prospective evaluation, when the V3R/V7 index ≥0.85, an RVOT origin could be excluded with 98.6% accuracy. The area under the curve of V3R/V7 index (0.954) was larger than that of previously reported ECG criteria, including V2S/V3R (0.896), V2 transition ratio (0.792), and transition zone index (0.666). This novel index was also accurate in both patients without obvious LVOT or RVOT origins and subgroups with cardiac rotation or lead V3 R/S transition. CONCLUSIONS The V3R/V7 index is a novel and accurate ECG criterion that predicts OT-VAs origin.
Collapse
Affiliation(s)
- Dian Cheng
- Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, China (D.C., W.J., L.Z., K.C., F.Z., H.C., G.Y., X.L., M.L., K.G., K.C., B.Y., M.C.)
| | - Weizhu Ju
- Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, China (D.C., W.J., L.Z., K.C., F.Z., H.C., G.Y., X.L., M.L., K.G., K.C., B.Y., M.C.)
| | - Lili Zhu
- Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, China (D.C., W.J., L.Z., K.C., F.Z., H.C., G.Y., X.L., M.L., K.G., K.C., B.Y., M.C.)
| | - Kanghui Chen
- Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, China (D.C., W.J., L.Z., K.C., F.Z., H.C., G.Y., X.L., M.L., K.G., K.C., B.Y., M.C.)
| | - Fengxiang Zhang
- Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, China (D.C., W.J., L.Z., K.C., F.Z., H.C., G.Y., X.L., M.L., K.G., K.C., B.Y., M.C.)
| | - Hongwu Chen
- Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, China (D.C., W.J., L.Z., K.C., F.Z., H.C., G.Y., X.L., M.L., K.G., K.C., B.Y., M.C.)
| | - Gang Yang
- Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, China (D.C., W.J., L.Z., K.C., F.Z., H.C., G.Y., X.L., M.L., K.G., K.C., B.Y., M.C.)
| | - Xiaorong Li
- Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, China (D.C., W.J., L.Z., K.C., F.Z., H.C., G.Y., X.L., M.L., K.G., K.C., B.Y., M.C.)
| | - Mingfang Li
- Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, China (D.C., W.J., L.Z., K.C., F.Z., H.C., G.Y., X.L., M.L., K.G., K.C., B.Y., M.C.)
| | - Kai Gu
- Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, China (D.C., W.J., L.Z., K.C., F.Z., H.C., G.Y., X.L., M.L., K.G., K.C., B.Y., M.C.)
| | - Bing Han
- Division of Cardiology, Xuzhou Central Hospital, China (B.H.)
| | - Jie Fan
- Division of Cardiology, First People's Hospital of Yunnan Province, Kunming, China (J.F.)
| | - Yazhou Lin
- Division of Cardiology, Fujian Provincial Hospital, China (Y.L.)
| | - Kejiang Cao
- Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, China (D.C., W.J., L.Z., K.C., F.Z., H.C., G.Y., X.L., M.L., K.G., K.C., B.Y., M.C.)
| | - Pipin Kojodjojo
- Division of Cardiology, National University Hospital, Singapore (P.K.)
| | - Bing Yang
- Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, China (D.C., W.J., L.Z., K.C., F.Z., H.C., G.Y., X.L., M.L., K.G., K.C., B.Y., M.C.)
| | - Minglong Chen
- Division of Cardiology, First Affiliated Hospital of Nanjing Medical University, China (D.C., W.J., L.Z., K.C., F.Z., H.C., G.Y., X.L., M.L., K.G., K.C., B.Y., M.C.)
| |
Collapse
|
14
|
The P wave morphology in lead V7 on the synthesized 18-lead ECG is a useful parameter for identifying arrhythmias originating from the right inferior pulmonary vein. Heart Vessels 2019; 35:246-251. [PMID: 31440830 DOI: 10.1007/s00380-019-01483-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/14/2019] [Indexed: 10/26/2022]
Abstract
Atrial tachyarrhythmias often originate from the superior vena cava (SVC), and right superior (RSPV) and inferior pulmonary veins (RIPV). However, a precise differentiation of those origins is challenging using the standard 12-lead electrocardiogram (ECG) P-wave morphology due to the anatomical proximity. The recently developed synthesized 18-lead ECG provides virtual waveforms of the right-sided chest and back leads. This study evaluated the utility of the synthesized 18-lead ECG to differentiate atrial arrhythmias originating from 3 adjacent structures. Synthesized 18-lead ECGs were obtained during SVC-, RSPV-, and RIPV-pacing in 20 patients with lone paroxysmal atrial fibrillation to develop an algorithm. The P-wave morphologies were classified into 4 patterns: positive, negative, biphasic, and isoelectric. Subsequently, the algorithm's accuracy was validated prospectively in another 40 patients. In retrospective analyses, isoelectric P-waves in synthesized V7 distinguished RIPV-pacing from the others (sensitivity = 81%, specificity = 92%) (first criteria). The P wave morphologies in Leads II (sensitivity = 83%, specificity = 94%) and V1 (sensitivity = 84%, specificity = 80%) distinguished SVC- and RSPV-pacing (second criteria). In a prospective evaluation, the sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], and accuracy of the first criteria for identifying RIPV-pacing was 97%, 90%, 78%, 99%, and 92%, respectively. The sensitivity, specificity, RPV, NPV, and accuracy of the second criteria (amplitudes > 1 mV in lead II or biphasic P-waves in lead V1) for discriminating SVC- and RSPV-pacing was 66%, 95%, 98%, 50%, and 74%, respectively. The P wave morphology pattern in lead V7 in synthesized 18-lead ECGs is useful for differentiating RIPV origins from RSPV/SVC origins.
Collapse
|
15
|
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.)
| |
Collapse
|
16
|
Characteristics of synthesized right-sided chest electrocardiograms in patients with acute pulmonary embolism. J Cardiol 2018; 73:313-317. [PMID: 30594338 DOI: 10.1016/j.jjcc.2018.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/08/2018] [Accepted: 10/22/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND The significance of right-sided chest lead electrocardiogram (ECG) abnormalities in acute pulmonary embolism (APE) is unclear. This study evaluated the characteristics of such abnormalities in APE patients. METHODS This retrospective study included consecutive patients who were diagnosed with APE by contrast-enhanced computed tomography or pulmonary artery angiography. A standard 12-lead ECG and a synthesized right-sided chest ECG were obtained from these patients. Waveform differences were noted between the acute and post-treatment phases. RESULTS In total, 56 APE patients (18 men and 38 women, mean age 66.7±13.3 years) were included. Traditional ECG findings, such as right-axis deviation, the S1Q3T3 pattern, and clockwise rotation, were found in relatively few patients (14.3%, 32.1%, and 21.4%, respectively). In some cases, a negative T wave in standard 12-lead ECGs was observed in leads III, V1, and V2 (46.4%, 60.7%, and 39.9%, respectively). Syn-V3R ECG showed a higher frequency of negative T waves (66.1%) at the onset and significantly (p<0.01) decreased at the follow-up. Multiple logistic regression analyses for differentiating APE revealed that the negative T waves only in lead syn-V3R were significantly related (odds ratio: 6.95, 95% confidence interval: 2.50-19.32, p<0.001). CONCLUSIONS The presence of a negative T wave in a synthesized right-sided chest ECG, particularly in the V3R lead, is a new and distinctive finding denoting pulmonary embolism. To confirm the utility of this characteristic using synthesized right-sided chest ECGs for the diagnosis of APE, further studies with larger populations will be required.
Collapse
|
17
|
Miyazawa K, Ueda M, Kondo Y, Hayashi T, Nakano M, Ishimura M, Nakano M, Kobayashi Y. Rapid mapping and differentiation in ventricular outflow tract arrhythmia using non-contact mapping. J Interv Card Electrophysiol 2017; 49:41-49. [DOI: 10.1007/s10840-017-0250-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/29/2017] [Indexed: 11/24/2022]
|
18
|
Nakatsuji A, Miyauchi Y, Iwasaki YK, Tsuboi I, Hayashi H, Uetake S, Takahashi K, Yodogawa K, Hayashi M, Shimizu W. Detection and Evaluation of Pulmonary Hypertension by a Synthesized Right-Sided Chest Electrocardiogram. J NIPPON MED SCH 2016; 82:136-45. [PMID: 26156667 DOI: 10.1272/jnms.82.136] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Current standard 12-lead electrocardiogram (ECG) criteria for diagnosing pulmonary hypertension (PH) have a low sensitivity. Although the right-sided chest ECG (V3R-V5R) increases the diagnostic accuracy, these additional leads are not routinely recorded. The aim of the present study was to assess the usefulness of the synthesized right-sided chest ECG (Syn-ECG), generated from 12-lead ECG information, in the detection and evaluation of PH. PATIENTS AND METHODS The Syn-ECG waveforms in 30 patients with PH, defined as an estimated pulmonary arterial systolic pressure (PASP) >35 mmHg, were compared to those in 30 age- and gender-matched normal subjects. RESULTS The R wave amplitude and R/S ratio in the Syn-ECGs were significantly (P<0.01) greater in patients with PH than in the controls. The R wave amplitude in the Syn-ECGs exhibited a significant and better correlation (correlation coefficient 0.513-0.596, P<0.001) with the PASP than lead V1 (correlation coefficient 0.375, P=0.02). A receiver-operating characteristic curve analysis showed that the R wave amplitude (AUC 0.802, P<0.001) and R/S ratio (AUC 0.823, P<0.001) in the synthesized V5R was a good predictor of PH. New criteria, including 1) an R in V5R>0.12 mV, and 2) R/S ratio in V5R>0.42, had an improved sensitivity (0.63 and 0.73, respectively) and comparable specificity (0.93 and 0.87, respectively) to the conventional criteria (sensitivity 0.10-0.43, specificity 0.90-1.00). CONCLUSION The diagnostic criteria derived from the Syn-ECG provided better diagnostic accuracy than the known conventional criteria from the standard 12-lead ECG. This technique described in the present study may be useful for diagnosing and evaluating PH.
Collapse
Affiliation(s)
- Ayano Nakatsuji
- Department of Cardiovascular Medicine, Nippon Medical School
| | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
LIU ZHENG, JIA YUHE, REN LAN, FANG PIHUA, ZHOU GONGBU, HE JIA, ZHANG SHU. Multiple Intercostal Space Electrocardiogram Allows Accurate Localization of Outflow Tract Ventricular Arrhythmia Origin. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 39:173-81. [PMID: 26549840 DOI: 10.1111/pace.12781] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 10/07/2015] [Accepted: 10/28/2015] [Indexed: 11/26/2022]
Affiliation(s)
- ZHENG LIU
- Cardiac 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 People's Republic of China
| | - YU-HE JIA
- Cardiac 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 People's Republic of China
| | - LAN REN
- Department of Cardiology; Beijing Jishuitan Hospital; Beijing People's Republic of China
| | - PI-HUA FANG
- Cardiac 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 People's Republic of China
| | - GONG-BU ZHOU
- Cardiac 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 People's Republic of China
| | - JIA HE
- Cardiac 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 People's Republic of China
| | - SHU ZHANG
- Cardiac 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 People's Republic of China
| |
Collapse
|
20
|
Nishiuchi S, Kaseno K, Naito S, Tsukada N, Sasaki T, Hayano M, Nakamura K, Sato C, Ikeda E, Miki Y, Nakamura K, Kumagai K, Kimura T, Oshima S, Tada H. A potential pitfall of the modified 12 lead electrocardiogram (Mason-Likar modification) in catheter ablation of idiopathic ventricular arrhythmias originating from the outflow tract. Europace 2015; 17:1840-7. [PMID: 26045502 DOI: 10.1093/europace/euu371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 11/22/2014] [Indexed: 11/15/2022] Open
Abstract
AIMS The Mason-Likar modified electrocardiogram (ML-ECG) can be interchanged with standard 12 lead ECG electrode positions (standard ECG) without affecting the diagnostic interpretation during sinus rhythm, but the morphological differences during ventricular arrhythmias have not been sufficiently evaluated. This study aimed to elucidate the morphological changes in the ML-ECG precordial leads. METHODS AND RESULTS In 53 consecutive patients with premature ventricular contractions predicted to originate from the outflow tract (OT-PVCs), the arrhythmias were analysed by those two ECG methods. The OT-PVC origin sites, which were predicted by currently published criteria with the respective ECG methods prior to catheter ablation, were compared with the successful ablation sites. Compared with the standard-ECG, S-waves in the ML-ECG became shallower in leads V1-4 (P < 0.05 in lead V1; P < 0.001 in leads V2-4), and pseudo-R-waves in lead V1 appeared in seven patients. The precordial leads transition zone shifted counter-clockwise in 18 patients in the ML-ECG. In leads I and aVL, the negative deflection amplitudes of the ML-ECG were greater than those of the standard ECG (P < 0.001), and polarity reversals in lead I appeared in 18 patients. The R-wave amplitudes in all ML-ECG inferior leads were greater than those in the standard-ECG leads (all for P < 0.001). Those changes had an effect on the diagnostic indexes for the localization, and the specificity of the criteria for the ML-ECG was poorer than that for the standard-ECG. CONCLUSION Great differences were found between those two ECG methods. Predicting OT-PVC origins by diagnostic criteria with the ML-ECG might result in a misdiagnosis and inefficient ablation.
Collapse
Affiliation(s)
- Suguru Nishiuchi
- Department of Cardiology, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Gunma, Japan
| | - Kenichi Kaseno
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Yoshida-gun, Fukui, Japan
| | - Shigeto Naito
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Gunma, Japan
| | - Naofumi Tsukada
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Gunma, Japan
| | - Takehito Sasaki
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Gunma, Japan
| | - Mamoru Hayano
- Department of Cardiology, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Keijiro Nakamura
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Gunma, Japan
| | - Chizuru Sato
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Gunma, Japan
| | - Etsuko Ikeda
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Yoshida-gun, Fukui, Japan
| | - Yuko Miki
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Gunma, Japan
| | - Kohki Nakamura
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Gunma, Japan
| | - Koji Kumagai
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Gunma, Japan
| | - Takeshi Kimura
- Department of Cardiology, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Shigeru Oshima
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Gunma, Japan
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Yoshida-gun, Fukui, Japan
| |
Collapse
|
21
|
Zhang F, Yang B, Chen H, Ju W, Kojodjojo P, Li M, Gu K, Yang G, Cao K, Chen M. Non-contact mapping-guided ablation of ventricular arrhythmias originating from the pulmonary artery. Europace 2015; 18:281-7. [DOI: 10.1093/europace/euv049] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 02/13/2015] [Indexed: 11/15/2022] Open
|
22
|
Efimova E, Dinov B, Acou WJ, Schirripa V, Kornej J, Kosiuk J, Rolf S, Sommer P, Richter S, Bollmann A, Hindricks G, Arya A. Differentiating the origin of outflow tract ventricular arrhythmia using a simple, novel approach. Heart Rhythm 2015; 12:1534-40. [PMID: 25847476 DOI: 10.1016/j.hrthm.2015.04.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Numerous electrocardiographic (ECG) criteria have been proposed to identify localization of outflow tract ventricular arrhythmias (OT-VAs); however, in some cases, it is difficult to accurately localize the origin of OT-VA using the surface ECG. OBJECTIVE The purpose of this study was to assess a simple criterion for localization of OT-VAs during electrophysiology study. METHODS We measured the interval from the onset of the earliest QRS complex of premature ventricular contractions (PVCs) to the distal right ventricular apical signal (the QRS-RVA interval) in 66 patients (31 men aged 53.3 ± 14.0 years; right ventricular outflow tract [RVOT] origin in 37) referred for ablation of symptomatic outflow tract PVCs. We prospectively validated this criterion in 39 patients (22 men aged 52 ± 15 years; RVOT origin in 19). RESULTS Compared with patients with RVOT PVCs, the QRS-RVA interval was significantly longer in patients with left ventricular outflow tract (LVOT) PVCs (70 ± 14 vs 33.4±10 ms, P < .001). Receiver operating characteristic analysis showed that a QRS-RVA interval ≥49 ms had sensitivity, specificity, and positive and negative predictive values of 100%, 94.6%, 93.5%, and 100%, respectively, for prediction of an LVOT origin. The same analysis in the validation cohort showed sensitivity, specificity, and positive and negative predictive values of 94.7%, 95%, 95%, and 94.7%, respectively. When these data were combined, a QRS-RVA interval ≥49 ms had sensitivity, specificity, and positive and negative predictive values of 98%, 94.6%, 94.1%, and 98.1%, respectively, for prediction of an LVOT origin. CONCLUSION A QRS-RVA interval ≥49 ms suggests an LVOT origin. The QRS-RVA interval is a simple and accurate criterion for differentiating the origin of outflow tract arrhythmia during electrophysiology study; however, the accuracy of this criterion in identifying OT-VA from the right coronary cusp is limited.
Collapse
Affiliation(s)
- Elena Efimova
- Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Borislav Dinov
- Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Willem-Jan Acou
- Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Valentina Schirripa
- Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Jelena Kornej
- Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Jedrzej Kosiuk
- Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Sascha Rolf
- Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Philipp Sommer
- Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Sergio Richter
- Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany
| | - Arash Arya
- Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany.
| |
Collapse
|
23
|
Kusa S, Hachiya H, Iwasawa J, Ichihara N, Komatsu Y, Taniguchi H, Miyazaki S, Nakamura H, Iesaka Y. Ventricular arrhythmias with superior axis originating from the left ventricular septum: electrocardiographic characteristics predicting successful ablation and insights into their mechanism-observations from a small series of patients. Europace 2015; 17:1587-95. [DOI: 10.1093/europace/euu396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 12/15/2014] [Indexed: 11/13/2022] Open
|
24
|
Kuteszko R, Pytkowski M, Farkowski MM, Maciag A, Sterlinski M, Jankowska A, Kowalik I, Zajac D, Firek B, Demkow M, Szwed H. Utility of automated template matching for the interpretation of pace mapping in patients ablated due to outflow tract ventricular arrhythmias. Europace 2015; 17:1428-34. [PMID: 25736562 DOI: 10.1093/europace/euu392] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Accepted: 12/12/2014] [Indexed: 01/30/2023] Open
Abstract
AIMS One of the disadvantages of classic pace mapping (PM) is the operator's subjective interpretation. The aim of this single-centre retrospective study was to evaluate the value of automated template matching (AMT) in patients ablated due to ventricular outflow tract arrhythmias (OTAs). METHODS AND RESULTS From an overall group of 105 patients with OTA who were scheduled for transcatheter ablation (TA), AMT was accessible in 42 patients [21 right ventricular outflow tract (RVOT), 21 left ventricular outflow tract (LVOT), 28 women, aged 51.5 ± 12.7 years]. We used AMT to compare spontaneous arrhythmia ORS (spontQRS) with paced QRS complexes during PM in sites where radiofrequency (RF) applications were successful and in sites where RF applications were unsuccessful. The concordance was presented in per cents as objective matching scores (OMS). Then, at the successful ablation sites, we examined the relationship between OMS and the visual interpretation of PM was presented as electrophysiologists matching scores (EMS). The OMS of PM at sites of successful ablation varied from 78 to 99% (mean 94.1 ± 3.8) and from 47 to 95% (mean 80.2 ± 12.6%) at sites of unsuccessful ablation. Pace mapping in unsuccessful RF sites was significantly less similar to spontQRS morphologies than in successful RF sites (P = 0.0001). There was a significant correlation between OMS and EMS (r = 0.82; P < 0.0001). The OMS that indicated optimal ablation site was 89% (sensitivity = 95%; specificity = 80%). The mean OMS for successful sites at RVOT (95.1 ± 1.8%) and LVOT (93.1 ± 4.9%) were not different (P = 0.0551). CONCLUSION This analysis revealed that AMT is a valuable technique for the interpretation of PM and for the identification of successful ablation sites in OTA.
Collapse
Affiliation(s)
- Rafal Kuteszko
- The Second Department of Coronary Artery Disease, Institute of Cardiology, 1 Spartanska Street, Warsaw 02-637, Poland
| | - Mariusz Pytkowski
- The Second Department of Coronary Artery Disease, Institute of Cardiology, 1 Spartanska Street, Warsaw 02-637, Poland
| | - Michal M Farkowski
- The Second Department of Coronary Artery Disease, Institute of Cardiology, 1 Spartanska Street, Warsaw 02-637, Poland
| | - Aleksander Maciag
- The Second Department of Coronary Artery Disease, Institute of Cardiology, 1 Spartanska Street, Warsaw 02-637, Poland
| | - Maciej Sterlinski
- The Second Department of Coronary Artery Disease, Institute of Cardiology, 1 Spartanska Street, Warsaw 02-637, Poland
| | - Agnieszka Jankowska
- The Second Department of Coronary Artery Disease, Institute of Cardiology, 1 Spartanska Street, Warsaw 02-637, Poland
| | - Ilona Kowalik
- The Second Department of Coronary Artery Disease, Institute of Cardiology, 1 Spartanska Street, Warsaw 02-637, Poland
| | - Dariusz Zajac
- The Second Department of Coronary Artery Disease, Institute of Cardiology, 1 Spartanska Street, Warsaw 02-637, Poland
| | - Bohdan Firek
- The Second Department of Coronary Artery Disease, Institute of Cardiology, 1 Spartanska Street, Warsaw 02-637, Poland
| | - Marcin Demkow
- Department of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw, Poland
| | - Hanna Szwed
- The Second Department of Coronary Artery Disease, Institute of Cardiology, 1 Spartanska Street, Warsaw 02-637, Poland
| |
Collapse
|
25
|
Igarashi M, Nogami A, Sekiguchi Y, Kuroki K, Yamasaki H, Machino T, Yui Y, Ogawa K, Talib AK, Murakoshi N, Kuga K, Aonuma K. The QRS morphology pattern in V5R is a novel and simple parameter for differentiating the origin of idiopathic outflow tract ventricular arrhythmias. Europace 2015; 17:1107-16. [PMID: 25564550 DOI: 10.1093/europace/euu337] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 10/21/2014] [Indexed: 11/13/2022] Open
Abstract
AIMS There are many reports on the ECG characteristics of idiopathic outflow tract ventricular arrhythmias (OT-VAs) to predict their origin. However, differentiating near regions using 12-lead ECGs is still complicated. The synthesized 18-lead ECG derived from the 12-lead ECG can provide virtual waveforms of the right-sided chest leads (V3R, V4R, and V5R) and back leads (V7, V8, and V9). The aim of this study was to develop a simple and useful parameter for differentiating OT-VA origins using the 18-lead ECG. METHODS AND RESULTS We studied 28 and 73 patients with idiopathic VAs in a pacemapping study and validation cohort, respectively. In the pacemapping study, several sites out of five different sites were paced in each patient: the anterior and posterior right ventricular OT (RVOT-ant and RVOT-post), right and left coronary cusps (RCC and LCC), and junction of both cusps (RLJ). The 18-lead ECGs during pacemapping among the five sites were compared for establishing a simple parameter to predict VA origins. A novel parameter using 18-lead ECGs was tested prospectively in 73 patients. In the pacemapping study, the dominant QRS morphology pattern in the synthesized V5R significantly differed among those sites (RVOT-ant:Rs, RVOT-post:rS, RCC:QS, RLJ:qR, and LCC:R). The patients in the validation cohort were divided into five groups depending on those QRS morphology patterns during VAs in the synthesized V5R. Each V5R QRS morphology pattern could predict a precise origin of the OT-VAs with an overall accuracy of 75%. CONCLUSION The QRS morphology pattern in V5R was a simple and useful parameter for differentiating detailed OT-VA origins.
Collapse
Affiliation(s)
- Miyako Igarashi
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Akihiko Nogami
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Yukio Sekiguchi
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Kenji Kuroki
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Hiro Yamasaki
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Takeshi Machino
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Yoshiaki Yui
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Kojiro Ogawa
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Ahmed Karim Talib
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Nobuyuki Murakoshi
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Keisuke Kuga
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - Kazutaka Aonuma
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| |
Collapse
|