Electrocardiographic Characteristics of Ventricular Arrhythmias Originating from Different Areas Adjacent to the Mitral Annulus

• Published in: Journal of cardiovascular development and disease 2023-08, Vol.10 (8), p.334
• Main Authors: Lin, Yi-Fan, Xu, Que, Zheng, Cheng, Shao, Jia-Meng, Shen, Bing, He, Rui-Lin, Lin, Jia-Feng, Chen, Yan-Ru
• Format: Article
• Language: English
• Subjects: Ablation; Ablation (Surgery); Arrhythmia; Cardiac arrhythmia; Catheters; Electrocardiogram; Electrocardiography; electrophysiology; Hospitals; Medical imaging; Medical research; Medicine, Experimental; mitral annulus; Patients; radiofrequency catheter ablation; Success; Variables; ventricular arrhythmia
• ISSN: 2308-3425; 2308-3425
• DOI: 10.3390/jcdd10080334

Background: This study aimed to explore the electrocardiographic (ECG) characteristics of ventricular arrhythmias (VAs) arising from epicardial and endocardial areas adjacent to the mitral annulus (MA). Methods: This study involved 283 patients with MA-VAs who received radiofrequency catheter ablation at the center. The ECG characteristics of these patients were analyzed retrospectively. Results: The origin of MA-VAs was judged based on the ECG variables. Among all MA-VAs, intrinsicoid deflection time (IDT) > 77 ms or maximum deflection index (MDI) > 0.505 predicted the VAs arising from the epicardium (sensitivity of 70.20% and 73.51%, specificity of 94.70% and 82.58%, positive predictive value (PPV) of 93.81% and 82.84%, and negative predictive value (NPV) of 73.53% and 73.15%). Among all epicardial MA-VAs, the RV1/RV2 ratio > 0.87 predicted the VAs originating from the epicardial anteroseptal wall adjacent to the MA. It had a sensitivity, specificity, PPV, and NPV of 62.86%, 98.06%, 91.67%, and 88.60%, respectively. Among all endocardial MA-VAs, Q(q)R(r) morphology in lead V1 predicted the VAs arising from the endocardial septal wall adjacent to the MA. It had a sensitivity, specificity, PPV, and NPV of 92.98%, 100%, 100%, and 94.94%, respectively. Among all endocardial septal MA-VAs, a predominant positive wave in lead II and a predominant negative wave in lead III predicted the VAs arising from the endocardial midseptal portion adjacent to the MA. It had a sensitivity, specificity, PPV, and NPV of 86.04%, 100%, 100%, and 70.00%, respectively. Conclusion: the ECG characteristics of VAs from the different sites adjacent to the MA can enable judging the arrhythmia’s origin and designing the ablation plan accordingly.