A Novel Electrocardiographic Criterion for Differentiating a Left from Right Ventricular Outflow Tract Tachycardia Origin: The V2S/V3R Index

作者：Naoki Yoshida, Takumi Yamada, H. Thomas McElderry, Yasuya Inden, Masayuki Shimano, Toyoaki Murohara, Vineet Kumar, Harish Doppalapudi, Vance J. Plumb, George Neal Kay · 发表于：Journal of Cardiovascular Electrophysiology · 年份：2014 · DOI：10.1111/jce.12392 · 被引用次数：170 · 研究领域：Cardiac Arrhythmias and Treatments、Atrial Fibrillation Management and Outcomes、Cardiac electrophysiology and arrhythmias

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 o...