BACKGROUND: An ECG predictor of ablation success has not been determined for difficult cases of outflow tract ventricular tachycardia/ventricular premature contractions (OT-VT/VPC). METHODS AND RESULTS: ECG analysis and radiofrequency catheter ablation (RFCA) were performed in 70 patients with OT-VT/VPC. The peak deflection index (PDI) was determined in the inferior lead presenting the tallest R wave by dividing the time from QRS onset to peak QRS deflection by total QRS duration. In 10 (14%) of the 70 patients, RFCA performed at a septal or epicardial site was unsuccessful (group 1), but was successful in the remaining 60 patients (group 2). Neither activation time (35+/-15 ms vs 40+/-12 ms, P=0.3) nor QRS duration (141+/-19 ms vs 137+/-19 ms, P=0.6) were significantly different between groups 1 and 2. However, PDI was significantly higher in group 1 than in group 2 (0.62+/-0.06 vs 0.55+/-0.06, P=0.002). A PDI >0.6 identified unsuccessful OT-VT/VPC with 80% sensitivity and 90% specificity, and may indicate that the origin of the OT-VT/VPC is deep within the ventricular septum or at an epicardial site. CONCLUSIONS: A PDI >0.6 is more likely to be associated with a higher rate of RFCA failure.
BACKGROUND: An ECG predictor of ablation success has not been determined for difficult cases of outflow tract ventricular tachycardia/ventricular premature contractions (OT-VT/VPC). METHODS AND RESULTS: ECG analysis and radiofrequency catheter ablation (RFCA) were performed in 70 patients with OT-VT/VPC. The peak deflection index (PDI) was determined in the inferior lead presenting the tallest R wave by dividing the time from QRS onset to peak QRS deflection by total QRS duration. In 10 (14%) of the 70 patients, RFCA performed at a septal or epicardial site was unsuccessful (group 1), but was successful in the remaining 60 patients (group 2). Neither activation time (35+/-15 ms vs 40+/-12 ms, P=0.3) nor QRS duration (141+/-19 ms vs 137+/-19 ms, P=0.6) were significantly different between groups 1 and 2. However, PDI was significantly higher in group 1 than in group 2 (0.62+/-0.06 vs 0.55+/-0.06, P=0.002). A PDI >0.6 identified unsuccessful OT-VT/VPC with 80% sensitivity and 90% specificity, and may indicate that the origin of the OT-VT/VPC is deep within the ventricular septum or at an epicardial site. CONCLUSIONS: A PDI >0.6 is more likely to be associated with a higher rate of RFCA failure.
Authors: Masashi Kamioka; Shibu Mathew; Tina Lin; Andreas Metzner; Andreas Rillig; Sebastian Deiss; Peter Rausch; Christine Lemes; Hisaki Makimoto; Hesheng Hu; Dongpo Liang; Erik Wissner; Roland Richard Tilz; Karl-Heinz Kuck; Feifan Ouyang Journal: Clin Res Cardiol Date: 2015-01-30 Impact factor: 5.460
Authors: Philipp Halbfaß; Karin Nentwich; Kai Sonne; Elena Ene; Franziska Fochler; Andreas Mügge; Bernhard Schieffer; Thomas Deneke Journal: Herzschrittmacherther Elektrophysiol Date: 2017-02-07
Authors: Michael Efremidis; Konstantinos Vlachos; Maria Kyriakopoulou; Panagiotis Mililis; Claire A Martin; George Bazoukis; Stylianos Dragasis; Athanasia Megarisiotou; Philippe Unger; Antonio Frontera; Giuseppe Mascia; Athanasios Saplaouras; Sotirios Xydonas; Kosmas Valkanas; Frédéric Sacher; Pierre Jaïs; Konstantinos P Letsas Journal: Heart Rhythm O2 Date: 2021-08-02