We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Lead I R‐wave amplitude to differentiate idiopathic ventricular arrhythmias with left bundle branch block right inferior axis originating from the left versus right ventricular outflow tract.
- Authors
Xie, Shuanglun; Kubala, Maciej; Liang, Jackson J.; Hayashi, Tatsuya; Park, Jaeseok; Padros, Irene Lucena; Garcia, Fermin C.; Santangeli, Pasquale; Supple, Gregory E.; Frankel, David S.; Zado, Erica S.; Lin, David; Schaller, Robert D.; Dixit, Sanjay; Callans, David J.; Nazarian, Saman; Marchlinski, Francis E.
- Abstract
Introduction: Differentiation of right versus left ventricular outflow tract (RVOT vs. LVOT) arrhythmia origin with left bundle branch block right inferior axis (LBRI) morphology is relevant to ablation planning and risk discussion. Our aim was to determine if lead I R‐wave amplitude is useful for differentiation of RVOT from LVOT arrhythmias with LBRI morphology. Methods: The R‐wave amplitude in lead I was measured in a retrospective cohort of 75 consecutive patients with LBRI pattern ventricular arrhythmias (VAs) successfully ablated from the RVOT (n = 54), LVOT (n = 16), or the anterior interventricular vein (AIV; n = 5). The optimal R‐wave threshold was identified and diagnostic indices were compared with the previously reported transitional zone (TZ) index and V2S/V3R index. Results: An R‐wave amplitude greater than or equal to 0.1 mV predicted LVOT origin with 75% sensitivity and 98.2% specificity. In comparison, the TZ and V2S/V3R indices had 50% and 68.8% sensitivity, and 75.9% and 88.9% specificity, respectively, for predicting LVOT origin. The area under the curve (AUC) was 0.85 for lead I R‐wave amplitude, 0.87 for V2S/V3R, and 0.72 for the TZ index. Of 36 cases with QS in lead I, 30 (83.3%) were from the anterior RVOT, three (8.3%) from the LVOT, and three (8.3%) from the AIV. Conclusion: The presence of R‐wave amplitude in lead I (≥0.1 mV) is a simple and useful criterion to identify LVOT cusp or endocardium focus in LBRI arrhythmias. A QS pattern in lead I suggests an origin in the anterior RVOT, or less commonly the adjacent LV summit.
- Subjects
BUNDLE-branch block; ELECTRODES; ENDOCARDIUM; LEFT heart ventricle; RIGHT heart ventricle; HEART conduction system; LONGITUDINAL method; RETROSPECTIVE studies; ABLATION techniques; DIAGNOSIS; VENTRICULAR arrhythmia
- Publication
Journal of Cardiovascular Electrophysiology, 2018, Vol 29, Issue 11, p1515
- ISSN
1045-3873
- Publication type
Article
- DOI
10.1111/jce.13747