Christopher Reithmann1, Michael Fiek2, Zeinab Aynur2, Michael Ulbrich2. 1. Medizinische Klinik 1, HELIOS Klinikum München-West, Akademisches Lehrkrankenhaus der Universität München, Steinerweg 5, 81241, Munich, Germany. Christopher.Reithmann@helios-gesundheit.de. 2. Medizinische Klinik 1, HELIOS Klinikum München-West, Akademisches Lehrkrankenhaus der Universität München, Steinerweg 5, 81241, Munich, Germany.
Abstract
BACKGROUND: ECG criteria for identifying an epicardial origin of ventricular tachycardia (VT) have mainly been described for VTs with basal-superior and lateral origin. OBJECTIVE: The aim of this study was to determine ECG criteria for epicardial VTs with anterior origin as a guide for trans-pericardial ablation. RESULTS: Among 22 patients undergoing successful ablation of VTs from the anterior myocardial wall, 14 patients underwent endocardial ablation and 8 patients underwent epicardial ablation. VTs with anterior origin ablated epicardially had widened QS complexes in precordial leads with staircase-shaped notching and slowing of the descent to the nadir of S. In comparison, endocardial VTs with anterior origin usually had narrower QS complexes with a smooth and fast downstroke to the nadir of S. The duration of the negative pseudodelta wave was longer in epicardial VTs (55 ± 12 ms) compared to endocardial VTs (22 ± 12 ms). The interval "time to the nadir of S" in patients with anterior VT origin was longer in epicardial VTs (121 ± 16 ms) than in endocardial VTs (80 ± 22 ms). The QRS duration was also longer in patients with epicardial origin (212 ± 19 ms) than with endocardial VT origin (166 ± 30 ms). CONCLUSIONS: Epicardial origin of VTs arising from the anterior myocardial wall produces a slowing, widening and staircase-shaped notching in the initial VT-QS complex. Thus, the morphology of the initial part of the QS complex in precordial leads can be used as a guide for trans-pericardial ablation of VTs with anterior origin.
BACKGROUND: ECG criteria for identifying an epicardial origin of ventricular tachycardia (VT) have mainly been described for VTs with basal-superior and lateral origin. OBJECTIVE: The aim of this study was to determine ECG criteria for epicardial VTs with anterior origin as a guide for trans-pericardial ablation. RESULTS: Among 22 patients undergoing successful ablation of VTs from the anterior myocardial wall, 14 patients underwent endocardial ablation and 8 patients underwent epicardial ablation. VTs with anterior origin ablated epicardially had widened QS complexes in precordial leads with staircase-shaped notching and slowing of the descent to the nadir of S. In comparison, endocardial VTs with anterior origin usually had narrower QS complexes with a smooth and fast downstroke to the nadir of S. The duration of the negative pseudodelta wave was longer in epicardial VTs (55 ± 12 ms) compared to endocardial VTs (22 ± 12 ms). The interval "time to the nadir of S" in patients with anterior VT origin was longer in epicardial VTs (121 ± 16 ms) than in endocardial VTs (80 ± 22 ms). The QRS duration was also longer in patients with epicardial origin (212 ± 19 ms) than with endocardial VT origin (166 ± 30 ms). CONCLUSIONS: Epicardial origin of VTs arising from the anterior myocardial wall produces a slowing, widening and staircase-shaped notching in the initial VT-QS complex. Thus, the morphology of the initial part of the QS complex in precordial leads can be used as a guide for trans-pericardial ablation of VTs with anterior origin.
Authors: Shibu Mathew; Sebastian Feickert; Thomas Fink; Andreas Rillig; Bruno Reissmann; Laura Rottner; Naotaka Hashiguchi; Peter Wohlmuth; Tilman Maurer; Christine Lemes; Andreas Metzner; Karl-Heinz Kuck; Feifan Ouyang Journal: Clin Res Cardiol Date: 2020-07-27 Impact factor: 5.460