Modified Precordial Lead R-Wave Deflection Interval Predicts Left- and Right-Sided Idiopathic Outflow Tract Ventricular Arrhythmias

• Published in: JACC. Clinical electrophysiology 2020-10, Vol.6 (11), p.1405-1419
• Main Authors: Anderson, Robert D., Kumar, Saurabh, Binny, Simon, Prabhu, Mukund, Al-Kaisey, Ahmed, Parameswaran, Ramanathan, Sugumar, Hariharan, Chieng, David, Hawson, Joshua, Campbell, Timothy, Joshi, Subodh, Lui, Elaine, Sparks, Paul B., Joseph, Stephen A., Morton, Joseph B., McLellan, Alex, Lipton, Jonathan, Pathik, Bhupesh, Kistler, Peter M., Kalman, Jonathan, Lee, Geoffrey
• Format: Article
• Language: English
• Subjects: algorithms; electrocardiograms; outflow tract; premature ventricular complex; ventricular tachycardia
• ISSN: 2405-500X; 2405-5018
• DOI: 10.1016/j.jacep.2020.07.011

This study evaluated if modifying electrocardiographic (ECG) precordial leads to a higher intercostal position improved the accuracy of outflow tract ventricular arrhythmia (OTVA) localization. Precordial ECG prediction algorithms that use a standard lead configuration localize OTVA with variable accuracy. Patients who underwent OTVA ablation were prospectively enrolled to have a standard and modified (high) precordial ECG. R- and S-wave amplitudes and intervals were measured to develop an algorithm that differentiated the right ventricular outflow tract (RVOT) and the left ventricular outflow tract (LVOT) with high accuracy—the modified lead R-wave deflection interval (RWDI). This interval was defined from the earliest QRS onset (using all modified leads) to the lead with longest R-wave deflection. The RWDI was compared with all other ECG algorithms. A total of 50 patients (38 women; mean age 51 ± 17 years) had successful catheter ablation for OTVA (RVOT 60%, LVOT 40%). The modified lead RWDI was significantly shorter in the RVOT group (18.5 ms, interquartile range 25th to 75th percentile [IQR25−75]: 0 to 29.5 ms) compared with the LVOT group (67.5 ms, IQR25−75: 56.5 to 77 ms; p