A novel electrocardiographic criterion for differentiating a left from right ventricular outflow tract tachycardia origin: The V2s/V3R index

Naoki Yoshida, Takumi Yamada, H. Thomas McElderry, Yasuya Inden, Masayuki Shimano, Toyoaki Murohara, Vineet Kumar, Harish Doppalapudi, Vance J. Plumb, G. Neal Kay

Research output: Contribution to journalArticlepeer-review

67 Scopus citations

Abstract

V2S/V3R Index Distinguishes LVOT from RVOT Origins Introduction Although several ECG criteria have been proposed for differentiating between left and right origins of idiopathic ventricular arrhythmias (VA) originating from the outflow tract (OT-VA), their accuracy and usefulness remain limited. This study was undertaken to develop a more accurate and useful ECG criterion for differentiating between left and right OT-VA origins. Methods and Results We studied OT-VAs with a left bundle branch block pattern and inferior axis QRS morphology in 207 patients who underwent successful catheter ablation in the right (RVOT; n = 154) or left ventricular outflow tract (LVOT; n = 53). The surface ECGs during the OT-VAs and during sinus beats were analyzed with an electronic caliper. The V2S/V3R index was defined as the S-wave amplitude in lead V2 divided by the R-wave amplitude in lead V3 during the OT-VA. The V2S/V3R index was significantly smaller for LVOT origins than RVOT origins (P < 0.001). The area under the curve (AUC) for the V2S/V3R index by a receiver operating characteristic analysis was 0.964, with a cut-off value of ≤1.5 predicting an LVOT origin with an 89% sensitivity and 94% specificity. In the AUC and accuracy, the V2S/V3R index was superior to any previously proposed ECG criteria in an analysis of all OT-VAs. This advantage of the V2S/V3R index over the V2 transition ratio and other indices also held true for a subanalysis of 77 OT-VAs with a lead V3 precordial transition. Conclusion The V2S/V3R index outperformed other ECG criteria to differentiate left from right OT-VA origins independent of the site of the precordial transition.

Original languageEnglish (US)
Pages (from-to)747-753
Number of pages7
JournalJournal of cardiovascular electrophysiology
Volume25
Issue number7
DOIs
StatePublished - Jul 2014
Externally publishedYes

Keywords

  • catheter ablation
  • electrocardiogram
  • premature ventricular contraction
  • ventricular outflow tract
  • ventricular tachycardia

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