Harilaos Bogossian1, Gerrit Frommeyer2, Ilias Ninios3, Fuad Hasan3, Quy Suu Nguyen3, Zana Karosiene3, Dejan Mijic3, Dirk Bandorski3, Melchior Seyfarth4, Johannes Friemann5, Bernd Lemke3, Lars Eckardt2, Markus Zarse6. 1. Märkische Kliniken GmbH, Department of Cardiology and Angiology, Klinikum Lüdenscheid, Lüdenscheid, Germany; Department of Cardiology, University Witten/Herdecke, Witten, Germany. Electronic address: Harilaos.bogossian@klinikum-luedenscheid.de. 2. Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Münster, Germany. 3. Märkische Kliniken GmbH, Department of Cardiology and Angiology, Klinikum Lüdenscheid, Lüdenscheid, Germany. 4. Department of Cardiology, Helios Klinikum Wuppertal, Wuppertal, Germany; Department of Cardiology, University Witten/Herdecke, Witten, Germany. 5. Märkische Kliniken GmbH, Institute of Pathology, Klinikum Lüdenscheid, Lüdenscheid, Germany. 6. Märkische Kliniken GmbH, Department of Cardiology and Angiology, Klinikum Lüdenscheid, Lüdenscheid, Germany; Department of Cardiology, University Witten/Herdecke, Witten, Germany.
Abstract
BACKGROUND: The present literature holds an enormous variation concerning origin and ablation site of idiopathic ventricular arrhythmias (VA), ranging from 2.5 to 15% for the origin within the coronary venous system (CVS). The aim of the study was to detect positive predictive ECG morphology patterns to discriminate VA stemming from the CVS. METHODS: 110 consecutive patients (P) with 111 premature ventricular capture beat (PVC) morphologies undergoing successful ablation for VA were retrospectively analyzed concerning their ECG patterns. RESULTS: 20/110 P (18%) displayed their VA origin in the CVS with anterior/anterolateral left ventricular inflow tract (LVIT) (epicardial/GCV) in 16 P (14%), anterior/anterolateral LVIT (endo- and epicardial/GCV) in 3 P (3%), and anterior interventricular vein (AIV) 1 P (<1%). ECG morphology of all GCV cases demonstrated an inferior axis and concordant R-pattern in all precordial leads resulting in 100% sensitivity. One VA demonstrating this pattern was ablated outside at the LVOT resulting in 95% specificity for origin in the anterior/anterolateral LVIT. 3/20 P that were ablated in the CVS required additional endocardial ablation from the anterior/anterolateral LVIT resulting in 80% specificity for sole successful ablation in the CVS. CONCLUSION: An inferior axis and concordant R-pattern in all precordial leads serve as diagnostic markers for an LVIT origin in the surface ECG and suggest a high primary ablation success via the GCV.
BACKGROUND: The present literature holds an enormous variation concerning origin and ablation site of idiopathic ventricular arrhythmias (VA), ranging from 2.5 to 15% for the origin within the coronary venous system (CVS). The aim of the study was to detect positive predictive ECG morphology patterns to discriminate VA stemming from the CVS. METHODS: 110 consecutive patients (P) with 111 premature ventricular capture beat (PVC) morphologies undergoing successful ablation for VA were retrospectively analyzed concerning their ECG patterns. RESULTS: 20/110 P (18%) displayed their VA origin in the CVS with anterior/anterolateral left ventricular inflow tract (LVIT) (epicardial/GCV) in 16 P (14%), anterior/anterolateral LVIT (endo- and epicardial/GCV) in 3 P (3%), and anterior interventricular vein (AIV) 1 P (<1%). ECG morphology of all GCV cases demonstrated an inferior axis and concordant R-pattern in all precordial leads resulting in 100% sensitivity. One VA demonstrating this pattern was ablated outside at the LVOT resulting in 95% specificity for origin in the anterior/anterolateral LVIT. 3/20 P that were ablated in the CVS required additional endocardial ablation from the anterior/anterolateral LVIT resulting in 80% specificity for sole successful ablation in the CVS. CONCLUSION: An inferior axis and concordant R-pattern in all precordial leads serve as diagnostic markers for an LVIT origin in the surface ECG and suggest a high primary ablation success via the GCV.