Abstract：
BACKGROUND:The origin of outflow tract ventricular tachycardia (OTVT) can be predicted from a surface electrocardiogram: indexes of R-wave amplitudes in leads V(1) and V(2) are used to differentiate a right origin from a left origin, while the axis of lead I differentiates an anterior origin from a posterior origin. Incorrect electrode placement is clinically common and may alter predictability of OTVTs. OBJECTIVE:To explore the influence of vertical deviation in leads V(1) and V(2) and arm lead position on the QRS morphology of OTVTs. METHODS:Vertical deviation of leads V(1) and V(2) was studied in 18 patients with OTVTs. Ventricular premature depolarization beats were recorded in the standard position, superior position, and inferior position. The effect of arm lead position was studied in a separate cohort of 16 patients: ventricular premature depolarizations were recorded with limb leads positioned over the shoulders and over the chest. The origin of tachycardia was determined by using activation mapping and confirmed by successful ablation. RESULTS:Superior displacement of leads V(1) and V(2) reduced the R-wave amplitude and led to a decreased R/S ratio (0.11 ± 0.09 vs 0.17 ± 0.1; P <.01), while inferior displacement of leads V(1) and V(2) resulted in an increased R-wave amplitude and led to an increased R/S ratio (0.46 ± 0.35 vs 0.17 ± 0.1; P <.01). Anterior displacement of the arm leads from shoulders to chest resulted in the reduction in the R-wave amplitude in lead I (0.25 ± 0.30 mV vs 0.04 ± 0.43 mV; P <.05). CONCLUSIONS:Small changes in electrocardiographic electrode placement markedly alter the QRS morphology of OTVTs and thus alter the predictability of OTVT origin. These deviations are well within the range of clinical application and have the potential to misdirect ablation procedures.
journal_name
Heart Rhythmjournal_title
Heart rhythmauthors
Anter E,Frankel DS,Marchlinski FE,Dixit Sdoi
10.1016/j.hrthm.2011.12.007subject
Has Abstractpub_date
2012-05-01 00:00:00pages
697-703issue
5eissn
1547-5271issn
1556-3871pii
S1547-5271(11)01462-7journal_volume
9pub_type
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