Frontiers in Cardiovascular Medicine (Oct 2022)

A novel and effective ECG method to differentiate right from left ventricular outflow tract arrhythmias: Angle-corrected V2S

  • Shifeng Qiu,
  • Shifeng Qiu,
  • Shifeng Qiu,
  • Zhuhua Sun,
  • Xinzhong Li,
  • Xinzhong Li,
  • Xinzhong Li,
  • Jianyong Li,
  • Jianyong Li,
  • Jianyong Li,
  • Xiaobo Huang,
  • Xiaobo Huang,
  • Xiaobo Huang,
  • Menghui Liu,
  • Menghui Liu,
  • Jianping Bin,
  • Jianping Bin,
  • Jianping Bin,
  • Yulin Liao,
  • Yulin Liao,
  • Yulin Liao,
  • Jiancheng Xiu,
  • Jiancheng Xiu,
  • Jiancheng Xiu,
  • Daogang Zha,
  • Daogang Zha,
  • Daogang Zha,
  • Yumei Xue,
  • Yumei Xue,
  • Lichun Wang,
  • Lichun Wang,
  • Yuegang Wang,
  • Yuegang Wang,
  • Yuegang Wang

DOI
https://doi.org/10.3389/fcvm.2022.868634
Journal volume & issue
Vol. 9

Abstract

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Background and aimsStandard 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.MethodsThis 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).ResultsPatients 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).ConclusionV2S 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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