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Differentiation of the right versus left outflow tract ventricular arrhythmias using local activation time at the His bundle electrogram

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Authors
Choe, Won-Seok; Lee, So-Ryoung; Cha, Myung-Jin; Choi, Eue-Keun; Oh, Seil
Issue Date
2020-09-29
Publisher
BMC
Citation
International Journal of Arrhythmia. 2020 Sep 29;21(1):15
Keywords
Idiopathic ventricular tachycardiaPremature ventricular contractionRight ventricular outfow tractLeft ventricular outfow tractRadiofrequency catheter ablatio
Abstract
Background
Although multiple algorithms based on surface electrocardiographic criteria have been introduced to localize idiopathic ventricular arrhythmia (VA) origins from the outflow tract (OT), their diagnostic accuracy and clinical usefulness remain limited. We evaluated whether local activation time of the His bundle region could differentiate left and right ventricular OT VA origins in the early stage of electrophysiology study.

Methods
We studied 30 patients who underwent catheter ablation for OT VAs with a left bundle branch block pattern and inferior axis QRS morphology. The interval between the local V signal on the mapping catheter placed in the RVOT and His bundle region (V(RVOT)-V(HB) interval) and the interval from QRS complex onset to the local V signal on the His bundle region (QRS-V(HB) interval) were measured during VAs.

Results
The V(RVOT)-V(HB) and QRS-V(HB) intervals were significantly shorter in patients with LVOT VAs. The area under the curve (AUC) for the V(RVOT)-V(HB) interval by receiver operating characteristic analysis was 0.865. A cutoff value of ≤ 50 ms predicted an LVOT origin of VA with sensitivity, specificity, and positive and negative predictive values of 100%, 62.5%, 40%, and 100%, respectively. The QRS-V(HB) interval showed similar diagnostic accuracy (AUC, 0.840), and a cutoff value of ≤ 15 ms predicted an LVOT origin of VA with a sensitivity, specificity, and positive and negative predictive values of 100%, 70.8%, 45.2%, and 100%, respectively.

Conclusion
The V(RVOT)-V(HB) and QRS-V(HB) intervals could differentiate left from right OT origins of VA with high sensitivity and negative predictive values.
ISSN
2466-1171
Language
English
URI
http://hdl.handle.net/10371/171191
DOI
doi.org/10.1186/s42444-020-00023-7
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College of Medicine/School of Medicine (의과대학/대학원)Internal Medicine (내과학전공)Journal Papers (저널논문_내과학전공)
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