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Endocardial or epicardial ventricular tachycardia in nonischemic cardiomyopathy? The role of 12-lead ECG criteria in clinical practice.

Abstract：

BACKGROUND:Specific 12-lead ECG criteria have been reported to predict an epicardial site of origin (SoO) of induced ventricular tachycardias (VTs) in left ventricular nonischemic cardiomyopathy. OBJECTIVE:The purpose of this study was to (1) determine the value of ECG criteria to predict an epicardial SoO of clinically documented VTs, (2) analyze the effect of VT cycle length (CL) and antiarrhythmic drugs on the accuracy of ECG criteria, and (3) assess interobserver variability. METHODS:In 36 consecutive patients with nonischemic left ventricular cardiomyopathy (age 58 ± 16 years, 75% male) who underwent combined endocardial/epicardial VT ablation, all clinically documented and induced right bundle branch block VTs were analyzed for previously reported ECG criteria to determine the SoO, as defined by ≥11/12 pace-map, concealed entrainment, and/or VT termination during ablation. RESULTS:In 21 patients with clinically documented (25 mm/s) right bundle branch block VT, none of the ECG criteria differentiated between patients with and those without an epicardial SoO. In induced VTs (100 mm/s), 2 of 4 interval criteria differentiated between an endocardial and epicardial SoO for slow VTs (CL >350 ms) and 2 of 4 criteria in patients on amiodarone, but none for fast VTs (CL ≤350 ms) or patients off amiodarone. The Q wave in lead I was the most accurate criterion for an epicardial SoO (sensitivity 88%, specificity 80%). In both clinically documented and induced VTs, interobserver agreement was poor for pseudodelta wave and moderate for other criteria. CONCLUSION:When applied to clinically documented VTs, no ECG criterion could differentiate between patients with and those without an epicardial SoO. Published interval-based ECG criteria do not apply to fast VTs and patients off amiodarone.

journal_name

Heart Rhythm

journal_title

Heart rhythm

authors

Piers SR,Silva Mde R,Kapel GF,Trines SA,Schalij MJ,Zeppenfeld K

doi

10.1016/j.hrthm.2014.03.001

subject

Has Abstract

pub_date

2014-06-01 00:00:00

pages

1031-9

issue

eissn

1547-5271

issn

1556-3871

pii

S1547-5271(14)00234-3

journal_volume

pub_type

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Endocardial or epicardial ventricular tachycardia in nonischemic cardiomyopathy? The role of 12-lead ECG criteria in clinical practice.