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Electrocardiographic morphology of multiple ventricular arrhythmias originating from the right ventricular outflow tract: inverse correlation of the amplitude in the inferior leads and anatomic height of the origin.

Abstract：

:It is unclear whether the electrocardiogram amplitude in the inferior leads (Amp-I) can always predict the height of the origin of right ventricular outflow tract arrhythmias (RVOT-VAs). We analyzed patients who received catheter ablation of multiple RVOT-VAs in the same session in our hospital from 2011 to 2016. Two distinguished RVOT-VAs, those with anatomically higher origins (HOs) and lower origins (LOs), were identified and compared to measure the longitudinal distance. Amp-I was uniquely determined for each OTVA as the highest amplitude in leads II, III, and aVF and compared between the HO-VAs and LO-VAs. In total, out of 187 patients who underwent catheter ablation of RVOT-VAs, 9 (4.8%) had multiple right OTVAs successfully treated. Four cases (Group A) had HO-VAs (10.8 ± 5.3 mm from an LO) with a lower Amp-I (1.28 ± 0.46 mV) than the LO-VAs (1.81 ± 0.59 mV), whereas the other 4 patients (Group B) had HO-VAs with a higher Amp-I (1.91 ± 0.23 mV) than the LO-VAs (1.26 ± 0.35 mV). In Group A, all HO-VAs originated from the lateral free wall and had notched R waves in the inferior leads, whereas all LOs with higher Amp-Is were located on the septum. In one patient, the HO and LO were at almost the same height, while a VA from a lateral origin had lower notched R waves in the inferior leads. A divided excitation from high lateral origins may result in not only QRS notching, but also a reduction in the QRS amplitude. In patients harboring multiple RVOT-VAs, VAs arising from the high lateral free wall could have lower Amp-Is than VAs from low septal origins.

journal_name

Heart Vessels

journal_title

Heart and vessels

authors

Kajiyama T,Hachiya H,Kusa S,Watanabe T,Hamaya R,Yamao K,Miyazaki S,Igarashi M,Nakamura H,Iesaka Y

doi

10.1007/s00380-018-1235-0

subject

Has Abstract

pub_date

2019-02-01 00:00:00

pages

324-330

issue

eissn

0910-8327

issn

1615-2573

pii

10.1007/s00380-018-1235-0

journal_volume

pub_type

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Electrocardiographic morphology of multiple ventricular arrhythmias originating from the right ventricular outflow tract: inverse correlation of the amplitude in the inferior leads and anatomic height of the origin.