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Quantitative comparison of spontaneous and paced 12-lead electrocardiogram during right ventricular outflow tract ventricular tachycardia.

Abstract：

OBJECTIVES:The purpose of this study was to objectively quantify the similarity of 12-lead electrocardiogram (ECG) waveforms using two quantitative metrics, the correlation coefficient (CORR) and the mean absolute deviation (MAD). BACKGROUND:Comparison of the 12-lead ECG morphology between ventricular tachycardia (VT) and a pace-map is frequently performed; however, there are no objective criteria for quantifying the similarity between two waveform morphologies. METHODS:During ablation of right ventricular outflow tract (RVOT) VT, 12-lead ECG pace-maps were acquired from three superior septal sites, three superior free wall sites, and before each ablation attempt in 15 patients. The 12-lead ECG waveforms of the clinical tachycardia and pace-maps were compared using both MAD and CORR at each site. RESULTS:The MAD scores were lower (i.e., more closely matched) for septal compared with free wall sites (15.9 +/- 5.3% vs. 25.3 +/- 10.2%; p < 0.001). Successful ablation sites had a significantly lower MAD score compared with unsuccessful sites (9.5 +/- 2.8% vs. 13.3 +/- 5.6%; p = 0.01), whereas there was only a trend toward a higher CORR for successful ablation sites (98.2 +/- 1.2% vs. 96 +/- 4.7%; p = 0.07). A MAD score < or =12% was 93% sensitive and 75% specific for identifying a successful ablation site. There was an inverse correlation between MAD score and distance from the site of VT origin (r = 0.63, p < 0.001). CONCLUSIONS:A MAD score >12% between RVOT VT and a pace-map at any site suggests sufficient dissimilarity to dissuade ablation at that site. The MAD score can be used to standardize 12-lead ECG waveform morphology comparisons among different laboratories, and may be useful for guiding ablation of VT.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Gerstenfeld EP,Dixit S,Callans DJ,Rajawat Y,Rho R,Marchlinski FE

doi

10.1016/s0735-1097(03)00427-3

subject

Has Abstract

pub_date

2003-06-04 00:00:00

pages

2046-53

issue

eissn

0735-1097

issn

1558-3597

pii

S0735109703004273

journal_volume

pub_type

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Quantitative comparison of spontaneous and paced 12-lead electrocardiogram during right ventricular outflow tract ventricular tachycardia.