Electrocardiographic recognition of the epicardial origin of ventricular tachycardias
Some ventricular tachycardias (VTs) originating from the epicardium are not suitable for endocardial radiofrequency ablation and require an epicardial approach. The aim of this study was to define the ECG characteristics that may identify an epicardial origin of VTs. We analyzed the 12-lead ECG reco...
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| Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 2004-04, Vol.109 (15), p.1842-1847 |
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| container_title | Circulation (New York, N.Y.) |
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| creator | BERRUEZO, Antonio MONT, Lluis NAVA, Santiago CHUECA, Enrique BARTHOLOMAY, Eduardo BRUGADA, Josep |
| description | Some ventricular tachycardias (VTs) originating from the epicardium are not suitable for endocardial radiofrequency ablation and require an epicardial approach. The aim of this study was to define the ECG characteristics that may identify an epicardial origin of VTs.
We analyzed the 12-lead ECG recordings during epicardial and endocardial left ventricular pacing in 9 patients to verify the hypothesis that the epicardial origin of the ventricular activation widens the initial part of the QRS complex. Then, we analyzed the ECG pattern in 14 VTs successfully ablated from the epicardium after a failed endocardial approach (group A), in 27 VTs successfully ablated from the endocardium (group B), and in 28 additional VTs that could not be ablated from the endocardium (group C). Four distinct intervals of ventricular activation were defined and measured: (1) the pseudodelta wave, (2) the intrinsicoid deflection time in V2, (3) the shortest RS complex, and (4) the QRS complex. VTs from groups A and C showed a significantly longer pseudodelta wave, intrinsicoid deflection time, and RS complex duration compared with VTs of group B. There was no difference between groups A and C. A pseudodelta wave of > or =34 ms has a sensitivity of 83% and a specificity of 95%, an intrinsicoid deflection time of > or =85 ms has a sensitivity of 87% and a specificity of 90%, and an RS complex duration of > or =121 ms has a sensitivity of 76% and a specificity of 85% in identifying an epicardial origin of the VTs.
ECG suggests VTs originating from the epicardium and those with an unsuccessful radiofrequency ablation from the endocardium. |
| doi_str_mv | 10.1161/01.CIR.0000125525.04081.4B |
| format | Article |
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We analyzed the 12-lead ECG recordings during epicardial and endocardial left ventricular pacing in 9 patients to verify the hypothesis that the epicardial origin of the ventricular activation widens the initial part of the QRS complex. Then, we analyzed the ECG pattern in 14 VTs successfully ablated from the epicardium after a failed endocardial approach (group A), in 27 VTs successfully ablated from the endocardium (group B), and in 28 additional VTs that could not be ablated from the endocardium (group C). Four distinct intervals of ventricular activation were defined and measured: (1) the pseudodelta wave, (2) the intrinsicoid deflection time in V2, (3) the shortest RS complex, and (4) the QRS complex. VTs from groups A and C showed a significantly longer pseudodelta wave, intrinsicoid deflection time, and RS complex duration compared with VTs of group B. There was no difference between groups A and C. A pseudodelta wave of > or =34 ms has a sensitivity of 83% and a specificity of 95%, an intrinsicoid deflection time of > or =85 ms has a sensitivity of 87% and a specificity of 90%, and an RS complex duration of > or =121 ms has a sensitivity of 76% and a specificity of 85% in identifying an epicardial origin of the VTs.
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We analyzed the 12-lead ECG recordings during epicardial and endocardial left ventricular pacing in 9 patients to verify the hypothesis that the epicardial origin of the ventricular activation widens the initial part of the QRS complex. Then, we analyzed the ECG pattern in 14 VTs successfully ablated from the epicardium after a failed endocardial approach (group A), in 27 VTs successfully ablated from the endocardium (group B), and in 28 additional VTs that could not be ablated from the endocardium (group C). Four distinct intervals of ventricular activation were defined and measured: (1) the pseudodelta wave, (2) the intrinsicoid deflection time in V2, (3) the shortest RS complex, and (4) the QRS complex. VTs from groups A and C showed a significantly longer pseudodelta wave, intrinsicoid deflection time, and RS complex duration compared with VTs of group B. There was no difference between groups A and C. A pseudodelta wave of > or =34 ms has a sensitivity of 83% and a specificity of 95%, an intrinsicoid deflection time of > or =85 ms has a sensitivity of 87% and a specificity of 90%, and an RS complex duration of > or =121 ms has a sensitivity of 76% and a specificity of 85% in identifying an epicardial origin of the VTs.
ECG suggests VTs originating from the epicardium and those with an unsuccessful radiofrequency ablation from the endocardium.</description><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Cardiac Pacing, Artificial</subject><subject>Cardiology. Vascular system</subject><subject>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</subject><subject>Electrocardiography</subject><subject>Humans</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Pericardium - physiopathology</subject><subject>Radiography</subject><subject>Tachycardia, Ventricular - diagnostic imaging</subject><subject>Tachycardia, Ventricular - etiology</subject><subject>Tachycardia, Ventricular - physiopathology</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpNkN9LwzAQgIMobk7_BSmCvrUmTdK0vrkxdTAQZD6H2zXdIl0zk07Yf2-3FfRejuO--8FHyB2jCWMZe6Qsmcw-EtoFS6VMZUIFzVkixmdkyGQqYiF5cU6GHVDEiqfpgFyF8NWVGVfykgyYpCpXBR-Sz2ltsPUOwZfWrTxs1xYjb9CtGtta10Suitq1iczWHhmoI-ftyh4bP6ZpvcVdDT5qAdf7ExKuyUUFdTA3fR6Rxct0MXmL5--vs8nzPEZJszYuBCwpzSvMAZRIFVJTckRW5DwX3XtZrjgIpRALjnRpOKtSMBQ4lksmgI_Iw2nt1rvvnQmt3tiApq6hMW4XtGK5KFimOvDpBKJ3IXhT6a23G_B7zag-ONWU6c6p_nOqj061GHfDt_2V3XJjyr_RXmIH3PcABIS68tCgDf-47MBJ_gvB-oFH</recordid><startdate>20040420</startdate><enddate>20040420</enddate><creator>BERRUEZO, Antonio</creator><creator>MONT, Lluis</creator><creator>NAVA, Santiago</creator><creator>CHUECA, Enrique</creator><creator>BARTHOLOMAY, Eduardo</creator><creator>BRUGADA, Josep</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20040420</creationdate><title>Electrocardiographic recognition of the epicardial origin of ventricular tachycardias</title><author>BERRUEZO, Antonio ; MONT, Lluis ; NAVA, Santiago ; CHUECA, Enrique ; BARTHOLOMAY, Eduardo ; BRUGADA, Josep</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c506t-94ab008fc8aa7427c0ed3cc1983847936873a477cc93c0be31f2ae0a3cdb14a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2004</creationdate><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Cardiac Pacing, Artificial</topic><topic>Cardiology. Vascular system</topic><topic>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</topic><topic>Electrocardiography</topic><topic>Humans</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Pericardium - physiopathology</topic><topic>Radiography</topic><topic>Tachycardia, Ventricular - diagnostic imaging</topic><topic>Tachycardia, Ventricular - etiology</topic><topic>Tachycardia, Ventricular - physiopathology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>BERRUEZO, Antonio</creatorcontrib><creatorcontrib>MONT, Lluis</creatorcontrib><creatorcontrib>NAVA, Santiago</creatorcontrib><creatorcontrib>CHUECA, Enrique</creatorcontrib><creatorcontrib>BARTHOLOMAY, Eduardo</creatorcontrib><creatorcontrib>BRUGADA, Josep</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>BERRUEZO, Antonio</au><au>MONT, Lluis</au><au>NAVA, Santiago</au><au>CHUECA, Enrique</au><au>BARTHOLOMAY, Eduardo</au><au>BRUGADA, Josep</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Electrocardiographic recognition of the epicardial origin of ventricular tachycardias</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>2004-04-20</date><risdate>2004</risdate><volume>109</volume><issue>15</issue><spage>1842</spage><epage>1847</epage><pages>1842-1847</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><coden>CIRCAZ</coden><abstract>Some ventricular tachycardias (VTs) originating from the epicardium are not suitable for endocardial radiofrequency ablation and require an epicardial approach. The aim of this study was to define the ECG characteristics that may identify an epicardial origin of VTs.
We analyzed the 12-lead ECG recordings during epicardial and endocardial left ventricular pacing in 9 patients to verify the hypothesis that the epicardial origin of the ventricular activation widens the initial part of the QRS complex. Then, we analyzed the ECG pattern in 14 VTs successfully ablated from the epicardium after a failed endocardial approach (group A), in 27 VTs successfully ablated from the endocardium (group B), and in 28 additional VTs that could not be ablated from the endocardium (group C). Four distinct intervals of ventricular activation were defined and measured: (1) the pseudodelta wave, (2) the intrinsicoid deflection time in V2, (3) the shortest RS complex, and (4) the QRS complex. VTs from groups A and C showed a significantly longer pseudodelta wave, intrinsicoid deflection time, and RS complex duration compared with VTs of group B. There was no difference between groups A and C. A pseudodelta wave of > or =34 ms has a sensitivity of 83% and a specificity of 95%, an intrinsicoid deflection time of > or =85 ms has a sensitivity of 87% and a specificity of 90%, and an RS complex duration of > or =121 ms has a sensitivity of 76% and a specificity of 85% in identifying an epicardial origin of the VTs.
ECG suggests VTs originating from the epicardium and those with an unsuccessful radiofrequency ablation from the endocardium.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>15078793</pmid><doi>10.1161/01.CIR.0000125525.04081.4B</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Biological and medical sciences Blood and lymphatic vessels Cardiac Pacing, Artificial Cardiology. Vascular system Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous Electrocardiography Humans Medical sciences Middle Aged Pericardium - physiopathology Radiography Tachycardia, Ventricular - diagnostic imaging Tachycardia, Ventricular - etiology Tachycardia, Ventricular - physiopathology |
| title | Electrocardiographic recognition of the epicardial origin of ventricular tachycardias |
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