Newer diagnostic criteria for identification of epicardial origin of ventricular tachycardia/premature ventricular complex

• Published in: Future cardiology 2021-09, Vol.17 (6), p.1007-1115
• Main Authors: Jain, Rahul, Barmeda, Mamta, Devabahktuni, Subodh R, Gautam, Shruti, Jain, Rohit, Li, Xiaochun, Mar, Philip L, Miller, John M
• Format: Article
• Language: English
• Subjects: endocardial; epicardial; premature ventricular complex; ventricular tachycardia
• ISSN: 1479-6678; 1744-8298
• DOI: 10.2217/fca-2020-0155

The study defines criteria for localization of ventricular arrhythmias. Data from 40 premature ventricular complex (PVC)/ventricular tachycardia (VT) were studied. The interval from PVC QRS onset to His potential and ratio of this interval to PVC/VT QRS duration was analyzed. Patients were divided into epicardial and endocardial groups based on mapping/successful ablation site. The interval from PVC QRS onset to His potential in the epicardial versus endocardial group was 99 ± 21 ms and 64 ± 37 ms (p = 0.002). A cut off of 88 ms had a sensitivity of 73% and specificity of 76%. A cut off of 0.50 for the ratio had a sensitivity of 82% and specificity of 72%. Two new parameters can help localization of PVC/VTs origin. Heart can have extra beats or a run of extra beats from lower chambers. These beats can come either from inside or outside of the lower chamber. Prior to going inside the heart to treat these extra beats by burning the sites of origin it is imperative to know where these beats are coming from. This helps in planning the procedure and reducing the risk. We examined a duration that would help us to differentiate the origin of these extra beats. This duration is defined with the use of normal ECG and a small electrical signal that we see when we put electrical cables in heart in a specific region knows as His region.