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Chen N, Wang L, Jiao J, Ju W, Wang Z, Zou C, Yi F, Xiao F, Shen W, Li C, Shi L, Chen L, Ji Y, Wei Y, Gu K, Yang G, Chen H, Li M, Liu H, Chen M. RV1+RV3 Index to Differentiate Idiopathic Ventricular Arrhythmias Arising From Right Ventricular Outflow Tract and Aortic Sinus of Valsalva: A Multicenter Study. J Am Heart Assoc 2024; 13:e033779. [PMID: 38533964 PMCID: PMC11179762 DOI: 10.1161/jaha.123.033779] [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: 12/05/2023] [Accepted: 03/03/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND This study aimed to investigate the predictive value of parameters of every precordial lead and their combinations in differentiating between idiopathic ventricular arrhythmias (IVAs) from the right ventricular outflow tract and aortic sinus of Valsalva (ASV). METHODS AND RESULTS Between March 1, 2018, and December 1, 2021, consecutive patients receiving successful ablation of right ventricular outflow tract or ASV IVAs were enrolled. The amplitude and duration of the R wave and S wave were measured in every precordial lead during IVAs. These parameters were either summed, subtracted, multiplied, or divided to create different indexes. The index with the highest area under the curve to predict ASV IVAs was developed, compared with established indexes, and validated in an independent prospective multicenter cohort. A total of 150 patients (60 men; mean age, 45.3±16.4 years) were included in the derivation cohort. The RV1+RV3 index (summed R-wave amplitude in leads V1 and V3) had the highest area under the curve (0.942) among the established indexes. An RV1+RV3 index >1.3 mV could predict ASV IVAs with a sensitivity of 95% and a specificity of 83%. Its predictive performance was maintained in the validation cohort (N=109). In patients with V3 R/S transition, an RV1+RV3 index >1.3 mV could predict ASV IVAs, with an area under the curve of 0.892, 93% sensitivity, and 75% specificity. CONCLUSIONS The RV1+RV3 index is a simple and novel criterion that accurately differentiates between right ventricular outflow tract and ASV IVAs. Its performance outperformed established indexes, making it a valuable tool in clinical practice.
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Affiliation(s)
- Ning Chen
- The First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Lei Wang
- The First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Jincheng Jiao
- The First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Weizhu Ju
- The First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Zhe Wang
- The First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Cao Zou
- The First Affiliated Hospital of Soochow UniversitySoochowChina
| | - Fu Yi
- Xijing HospitalXi’anChina
| | - Fangyi Xiao
- The First Affiliated Hospital of Wenzhou Medical UniversityWenzhouChina
| | | | - Chengzong Li
- The Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Linsheng Shi
- The Second Affiliated Hospital of Nantong UniversityNantongChina
| | | | - Yuan Ji
- Changzhou No.2 People’s HospitalChangzhouChina
| | - Youquan Wei
- The First Affiliated Yijishan Hospital of Wannan Medical CollegeWuhuChina
| | - Kai Gu
- The First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Gang Yang
- The First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Hongwu Chen
- The First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Mingfang Li
- The First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Hailei Liu
- The First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Minglong Chen
- The First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
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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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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.
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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.)
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Bajaj S, Bennett MT, Rabkin SW. Identifying Premature Ventricular Complexes from Outflow Tracts Based on PVC Configuration: A Machine Learning Approach. J Clin Med 2023; 12:5558. [PMID: 37685626 PMCID: PMC10487978 DOI: 10.3390/jcm12175558] [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: 07/12/2023] [Revised: 07/30/2023] [Accepted: 08/01/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Current inferences about the site of origin (SOO) of premature ventricular complexes (PVC) from the surface ECG have not been subjected to newer data analytic techniques that identify signals that are not recognized by visual inspection. AIMS The objective of this study was to apply data analytics to PVC characteristics. METHODS PVCs from 12-lead ECGs of a consecutive series of 338 individuals were examined by unsupervised machine learning cluster analysis, and indexes were compared to a composite criterion for SOO. RESULTS Data analytics found that V1S plus V2S ≤ 9.25 of the PVC had a LVOT origin (sensitivity 95.4%; specificity 97.5%). V1R + V2R + V3R > 15.0 (a RBBB configuration) likely had a LVOT origin. PVCs with V1S plus V2S > 12.75 (LBBB configuration) likely had a RVOT origin. PVC with V1S plus V2S > 14.25 (LBBB configuration) and all inferior leads positive likely had a RVOT origin. CONCLUSION Newer data analytic techniques provide a non-invasive approach to identifying PVC SOO, which should be useful for the clinician evaluating a 12-lead ECG.
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Affiliation(s)
- Sargun Bajaj
- Faculty of Medicine, Vancouver Hospital Cardiology, Vancouver, BC V5Z 1M9, Canada; (S.B.)
| | - Matthew T. Bennett
- Faculty of Medicine, Vancouver Hospital Cardiology, Vancouver, BC V5Z 1M9, Canada; (S.B.)
- Department of Medicine (Cardiology), University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Simon W. Rabkin
- Faculty of Medicine, Vancouver Hospital Cardiology, Vancouver, BC V5Z 1M9, Canada; (S.B.)
- Department of Medicine (Cardiology), University of British Columbia, Vancouver, BC V5Z 1M9, Canada
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Caixal G, Waight M, Li A, Saba MM. Hourly variability versus ECG morphological criteria in predicting the site of origin of ventricular outflow tract ectopy. HeartRhythm Case Rep 2023; 9:227-231. [PMID: 37101669 PMCID: PMC10123941 DOI: 10.1016/j.hrcr.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Qiu S, Sun Z, Li X, Li J, Huang X, Liu M, Bin J, Liao Y, Xiu J, Zha D, Xue Y, Wang L, Wang Y. A novel and effective ECG method to differentiate right from left ventricular outflow tract arrhythmias: Angle-corrected V2S. Front Cardiovasc Med 2022; 9:868634. [PMID: 36312235 PMCID: PMC9606339 DOI: 10.3389/fcvm.2022.868634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 09/16/2022] [Indexed: 11/13/2022] Open
Abstract
Background and aims Standard 12-lead electrocardiogram (ECG) patterns combined with the anatomical cardiac long-axis angle revealed by chest X-ray can prevent the influence of cardiac rotation, physical shape, and lead position, so it may be an ideal means to predict the origin of the outflow tract (OT) ventricular arrhythmias (OTVAs) for ablation procedures. The study explores the value of this strategy in identifying the origin of OTVA. Methods This study was conducted using a retrospective cohort and a prospective cohort of consecutive patients at two centers. The anatomical cardiac long-axis angle was calculated by measuring the angle between the cardiac long-axis (a line joining the apex to the midpoint of the mitral annulus) and the horizontal plane on a chest X-ray. The V2S angle was calculated as the V2S amplitude times the angle. We ultimately enrolled 147 patients with symptomatic OTVAs who underwent successful radiofrequency catheter ablation (RFCA) (98 women (66.7%); mean age 46.9 ± 14.7 years; 126 right ventricular OT (RVOT) origins, 21 left ventricular OT (LVOT) origins) as a development cohort. The new algorithm was validated in 48 prospective patients (12 men (25.0%); mean age 48.0 ± 15.8 years; 36 RVOT, 12 LVOT origins). Results Patients with RVOT VAs had greater V2S, long-axis angle, and V2S angle than patients with LVOT VA (all P < 0.001). The cut-off V2S angle obtained by receiver operating characteristic (ROC) curve analysis was 58.28 mV° for the prediction of RVOT origin (sensitivity: 85.7%; specificity: 95.2%; positive predictive value: 99.1%; negative predictive value: 52.6%). The AUC achieved using the V2S angle was 0.888 (P < 0.001), which was the highest among all indexes (V2S/V3R: 0.887 (P < 0.016); TZ index: 0.858 (P < 0.001); V1-2 SRd: 0.876 (P < 0.001); V3 transition: 0.651 (P < 0.001)). In the prospective cohort, the V2S angle had a high overall accuracy of 93.8% and decreased the procedure time (P = 0.002). Conclusion V2S angle can be a novel measure that can be used to accurately differentiate RVOT from LVOT origins. It could help decrease ablation duration and radiation exposure.
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Affiliation(s)
- Shifeng Qiu
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China,Guangdong Provincial Key Laboratory of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China,State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhuhua Sun
- Department of Health Management, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Xinzhong Li
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China,Guangdong Provincial Key Laboratory of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China,State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jianyong Li
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China,Guangdong Provincial Key Laboratory of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China,State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaobo Huang
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China,Guangdong Provincial Key Laboratory of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China,State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Menghui Liu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China,Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
| | - Jianping Bin
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China,Guangdong Provincial Key Laboratory of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China,State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yulin Liao
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China,Guangdong Provincial Key Laboratory of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China,State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jiancheng Xiu
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China,Guangdong Provincial Key Laboratory of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China,State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Daogang Zha
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China,Guangdong Provincial Key Laboratory of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China,State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yumei Xue
- Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China,Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China,Yumei Xue,
| | - Lichun Wang
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China,Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China,Lichun Wang,
| | - Yuegang Wang
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China,Guangdong Provincial Key Laboratory of Shock and Microcirculation, Nanfang Hospital, Southern Medical University, Guangzhou, China,State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China,*Correspondence: Yuegang Wang,
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Zhao L, Li R, Zhang J, Xie R, Lu J, Liu J, Miao C, Cui W. The R-S difference index: A new electrocardiographic method for differentiating idiopathic premature ventricular contractions originating from the left and right ventricular outflow tracts presenting a left bundle branch block pattern. Front Physiol 2022; 13:1002926. [PMID: 36200051 PMCID: PMC9527274 DOI: 10.3389/fphys.2022.1002926] [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: 07/25/2022] [Accepted: 08/22/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction: Differentiating idiopathic premature ventricular contractions (PVCs) originating from the right and left ventricular outflow tracts with a left bundle branch block (LBBB) morphology is relevant to catheter ablation planning and important for lowering the risk of complications. This study established a novel electrocardiographic (ECG) criterion to discriminate PVCs originating from the septum of the right ventricular outflow tract (s-RVOT) and those originating from the aortic sinus cusp of the left ventricular outflow tract (LVOT-ASC). Methods: A total of 259 patients with idiopathic PVCs originating from ventricular outflow tract with a LBBB pattern who underwent successful catheter ablation were retrospectively included. Among them, the PVCs originated from the s-RVOT in 183 patients and from the LVOT-ASC in 76 patients. The surface ECGs of the PVCs and sinus beats were analyzed using an electronic caliper. The R-S difference index in the precordial leads was calculated as V2R + V3R + V4R − V1S. Results: PVCs originating from both the s-RVOT and LVOT-ASC displayed an inferior axis (dominant R waves in leads II, III, and aVF). Compared with the s-RVOT group, the R-wave amplitudes on leads II, III, and aVF were significantly larger in the LVOT-ASC group (p < 0.001, p < 0.003, and p < 0.001, respectively). Compared to the LVOT-ASC group, the s-RVOT group showed smaller R-wave amplitudes on leads V1–V6 (p = 0.021, p < 0.001, p < 0.001, p < 0.001, p < 0.001, and p < 0.001, respectively) and larger S-wave amplitudes on leads V1–V3 (p < 0.001, p < 0.001, and p < 0.001, respectively). Lead V3 was the most common transitional lead in both groups. Analysis of the receiver operating characteristic curve showed that the R-wave amplitude on lead V3 had the largest area under the curve (AUC) of 0.856 followed by the R-wave amplitudes on leads V4 (0.834) and V2 (0.806). The AUC of the R-S difference index was 0.867. An R-S difference index greater than 20.9 predicted an LVOT-ASC origin with 73.7% sensitivity and 86.3% specificity. This index is superior to previous criteria in differentiating PVCs with LBBB morphology and inferior axis originating from s-RVOT vs. LVOT-ASC. Conclusions: The R-S difference index in precordial leads is a useful new ECG criterion for distinguishing LVOT-PVCs from RVOT-PVCs with LBBB morphology.
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Affiliation(s)
- Lei Zhao
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ruibin Li
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jidong Zhang
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | | | - Jingchao Lu
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jinming Liu
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Chenglong Miao
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wei Cui
- The Second Hospital of Hebei Medical University, Shijiazhuang, China
- *Correspondence: Wei Cui,
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Zhu X, Chen S, Ma K, Chen Z, Chen C, Jiang Z. AInterventricular septum angle obtained from cardiac computed tomography for origin differentiation of outflow tract ventricular arrhythmia between left and right. Pacing Clin Electrophysiol 2022; 45:1279-1287. [DOI: 10.1111/pace.14593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Xiaomei Zhu
- Department of Radiology the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital) Nanjing China
| | - Shumin Chen
- Department of Cardiology the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital) Nanjing China
| | - Kefan Ma
- Department of Radiology the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital) Nanjing China
| | - Zenghong Chen
- Department of Cardiology the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital) Nanjing China
| | - Chun Chen
- Department of Cardiology the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital) Nanjing China
| | - Zhixin Jiang
- Department of Cardiology the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital) Nanjing China
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Doste R, Lozano M, Jimenez-Perez G, Mont L, Berruezo A, Penela D, Camara O, Sebastian R. Training machine learning models with synthetic data improves the prediction of ventricular origin in outflow tract ventricular arrhythmias. Front Physiol 2022; 13:909372. [PMID: 36035489 PMCID: PMC9412034 DOI: 10.3389/fphys.2022.909372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
In order to determine the site of origin (SOO) in outflow tract ventricular arrhythmias (OTVAs) before an ablation procedure, several algorithms based on manual identification of electrocardiogram (ECG) features, have been developed. However, the reported accuracy decreases when tested with different datasets. Machine learning algorithms can automatize the process and improve generalization, but their performance is hampered by the lack of large enough OTVA databases. We propose the use of detailed electrophysiological simulations of OTVAs to train a machine learning classification model to predict the ventricular origin of the SOO of ectopic beats. We generated a synthetic database of 12-lead ECGs (2,496 signals) by running multiple simulations from the most typical OTVA SOO in 16 patient-specific geometries. Two types of input data were considered in the classification, raw and feature ECG signals. From the simulated raw 12-lead ECG, we analyzed the contribution of each lead in the predictions, keeping the best ones for the training process. For feature-based analysis, we used entropy-based methods to rank the obtained features. A cross-validation process was included to evaluate the machine learning model. Following, two clinical OTVA databases from different hospitals, including ECGs from 365 patients, were used as test-sets to assess the generalization of the proposed approach. The results show that V2 was the best lead for classification. Prediction of the SOO in OTVA, using both raw signals or features for classification, presented high accuracy values (>0.96). Generalization of the network trained on simulated data was good for both patient datasets (accuracy of 0.86 and 0.84, respectively) and presented better values than using exclusively real ECGs for classification (accuracy of 0.84 and 0.76 for each dataset). The use of simulated ECG data for training machine learning-based classification algorithms is critical to obtain good SOO predictions in OTVA compared to real data alone. The fast implementation and generalization of the proposed methodology may contribute towards its application to a clinical routine.
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Affiliation(s)
- Ruben Doste
- Department of Computer Science, University of Oxford, Oxford, United Kingdom
- *Correspondence: Ruben Doste,
| | - Miguel Lozano
- Computational Multiscale Simulation Lab (CoMMLab), Department of Computer Science, Universitat de Valencia, Valencia, Spain
| | - Guillermo Jimenez-Perez
- Physense, BCN Medtech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Lluis Mont
- Arrhythmia Section, Cardiology Department, Cardiovascular Clinical Institute, Hospital Clínic, Universitat de Barcelona - IDIBAPS, Barcelona, Spain
| | - Antonio Berruezo
- Cardiology Department, Heart Institute, Teknon Medical Center, Barcelona, Spain
| | - Diego Penela
- Cardiology Department, Heart Institute, Teknon Medical Center, Barcelona, Spain
| | - Oscar Camara
- Physense, BCN Medtech, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
| | - Rafael Sebastian
- Computational Multiscale Simulation Lab (CoMMLab), Department of Computer Science, Universitat de Valencia, Valencia, Spain
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10
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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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11
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Zhao L, Li R, Zhang J, Xie R, Lu J, Liu J, Miao C, Liu S, Cui W. S-R index in V1/V3 serves as a novel criterion to discriminate idiopathic premature ventricular contractions originating from posteroseptal right ventricular outflow tract versus right coronary cusp. J Electrocardiol 2021; 70:7-12. [PMID: 34826636 DOI: 10.1016/j.jelectrocard.2021.11.030] [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: 09/28/2021] [Revised: 11/10/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
AIM The current study aimed to establish a novel electrocardiographic (ECG) criterion for discrimination of idiopathic premature ventricular contractions (PVCs) originating from posteroseptal right ventricular outflow tract (sRVOT-p) versus right coronary cusp (RCC). METHODS A total of 76 patients with idiopathic PVCs who underwent mapping and successful ablation were retrospectively included. Among them, 37 patients had PVCs from sRVOT-p origin and 39 patients from RCC origin. The surface ECGs during PVCs were recorded. S-R different index in V1/V3 was calculated with the following formula of 0.134*V3R-0.133*V1S. RESULTS ECG characteristics showed wider total QRS duration, smaller R-wave amplitude on lead V2-V5, and larger S-wave amplitude on lead V1-V3 in sRVOT-p origin than RCC origin. Lead V3 was the most common transitional lead in two groups. Receiver operating characteristic (ROC) curve analysis showed that S-wave amplitude on lead V1 exhibited the largest AUC of 0.772, followed by the AUC of R-wave amplitude on lead V3 of 0.771. Subsequently, 0.134*V3R-0.133*V1S index was obtained by multiplication, subtraction, sum, and division of these ECG measurements, which exhibited the largest AUC of 0.808. The optimal cut-off value was -0.26 for differentiating RCC from sRVOT-p origin, with the sensitivity of 78.4% and specificity of 77.8%. Moreover, 0.134*V3R-0.133*V1S index was superior to previous criteria in analysis of PVCs originating from sRVOT-p and RCC. CONCLUSIONS 0.134*V3R-0.133*V1S is a novel ECG criterion to discriminate sRVOT-p from RCC origin in patients with idiopathic PVCs, which may provide guidance for approach of radiofrequency catheter ablation.
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Affiliation(s)
- Lei Zhao
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ruibin Li
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jidong Zhang
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ruiqin Xie
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jingchao Lu
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jinming Liu
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Chenglong Miao
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Suyun Liu
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wei Cui
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
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12
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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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13
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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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14
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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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15
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Amplitude of QRS complex within initial 40 ms in V 2 (V 2QRS i40): Novel electrocardiographic criterion for predicting accurate localization of outflow tract ventricular arrhythmia origin. Heart Rhythm 2020; 17:2164-2171. [PMID: 32653429 DOI: 10.1016/j.hrthm.2020.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/17/2020] [Accepted: 07/07/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND The initial depolarization vector of outflow tract (OT) ventricular arrhythmia (VA) varies in different origins, which may help to predict OT-VA origin more accurately. OBJECTIVE The purpose of this study was to develop a more accurate electrocardiographic (ECG) criterion for differentiating between left and right OT-VA origins. METHODS We studied 275 patients with successful ablation in the right ventricular outflow tract (RVOT) (n = 207) or left ventricular outflow tract (LVOT) (n = 68) in the development cohort. Amplitude of the QRS complex within initial 40 ms (QRSi40) in precordial leads was measured. A novel criterion for identifying OT-VA origin was developed based on the development cohort. Predictive performance of novel criterion was further validated by comparing with previous ECG criteria (V2S/V3R index, V2 transition ratio, and transition zone index) in the validation cohort with 107 patients (RVOT 75; LVOT 32). RESULTS QRSi40 of identical precordial leads were significantly greater in the LVOT group than the RVOT group (P <.05). In the development cohort, QRSi40 of V2 (V2QRSi40) exhibited the greatest area under the curve of 0.950, with cutoff ≥0.52 mV predicting LVOT origin (sensitivity 86.0%; specificity 94.6%). In the validation cohort, V2QRSi40 ≥0.52 mV outperformed previous criteria in predictive performance (accuracy 90.7%; sensitivity 84.4%; specificity 93.3%). This advantage of V2QRSi40 over previous criteria also held true for subgroups of transition zone index = 0 and V3 R/S transition. CONCLUSION V2QRSi40 is a novel and accurate ECG criterion to predict OT-VA origin that outperforms previous criteria.
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16
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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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17
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Kaypakli O, Koca H, Sahin DY, Karataş F, Ozbicer S, Koç M. S-R difference in V1-V2 is a novel criterion for differentiating the left from right ventricular outflow tract arrhythmias. Ann Noninvasive Electrocardiol 2017; 23:e12516. [PMID: 29226502 DOI: 10.1111/anec.12516] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 10/17/2017] [Indexed: 01/19/2023] Open
Abstract
AIM The correct estimation of the VA origin as RVOT or LVOT results in reduced ablation duration reduced radiation exposure and decreased number of vascular access. In our study, we aimed to detect the predictive value of S-R difference in V1-V2 for differentiating the left from right ventricular outflow tract arrhythmias. METHODS We included 123 patients with symptomatic frequent premature ventricular outflow tract contractions who underwent successful catheter ablation (70 male, 53 female; mean age 46.2 ± 13.9 years, 61 RVOT, 62 LVOT origins). S-R difference in V1-V2 was calculated with this formula on the 12-lead surface ECG: (V1S + V2S) - (V1R + V2R). Conventional ablation was performed in 101 (82.1%) patients, CARTO electroanatomic mapping system was used in 22 (17.9%) patients. RESULTS V1-2 SRd was found to be significantly lower for LVOT origins than RVOT origins (p < .001). The cutoff value of V1-2 SRd obtained by ROC curve analysis was 1.625 mV for prediction of RVOT origin (sensitivity: 95.1%, specificity: 85.5%, positive predictive value: 86.5%, negative predictive value: 94.5%). The area under the curve (AUC) was 0.929 (p < .001). CONCLUSION S-R difference in V1-V2 is a novel and simple electrocardiographic criterion for accurately differentiating RVOT from LVOT sites of ventricular arrhythmia origins. The use of this simple ECG measurement could improve the accuracy of OTVA localization, could be beneficial for decreasing ablation duration and radiation exposure. Further studies with larger patient population are needed to verify the results of this study.
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Affiliation(s)
- Onur Kaypakli
- Department of Cardiology, Mustafa Kemal Universitesi Tayfur Ata Sokmen Tip Fakultesi, Hatay, Turkey
| | - Hasan Koca
- Department of Cardiology, Adana Numune Training and Research Hospital, Health Sciences University, Adana, Turkey
| | - Durmus Yıldıray Sahin
- Department of Cardiology, Adana Numune Training and Research Hospital, Health Sciences University, Adana, Turkey
| | - Fadime Karataş
- Department of Cardiology, Adana Numune Training and Research Hospital, Health Sciences University, Adana, Turkey
| | - Suleyman Ozbicer
- Department of Cardiology, Adana Numune Training and Research Hospital, Health Sciences University, Adana, Turkey
| | - Mevlüt Koç
- Department of Cardiology, Adana Numune Training and Research Hospital, Health Sciences University, Adana, Turkey
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