A simplified two-stepwise electrocardiographic algorithm of body surface electrocardiogram index to distinguish left from right ventricular outflow tract tachycardia origin
Objective There are several electrocardiographic algorithms to predict the origin of idiopathic outflow tract ven-tricular arrhythmias (OT-VAs ),this study was aimed to develop a more accurate and efficient stepwise electrocardiographic al-gorithm to discriminate left ventricular outflow tract (LVOT)from right ventricular outflow tract (RVOT)origin. Methods We analyzed 12-lead electrocardiographic characteristics of 172 consecutive OT-VAs patients underwent successful radiofre-quency catheter ablation.Based on the results of the receiver operating characteristic curve analysis,different types of indicators with the largest area under the curve were used to predict the origin of ventricular arrhythmias. Results Based on the areas under the receiver operating characteristic curves,the combination of transitional zone (TZ)index<0 and SV2/RV3 index≤ 1.5 exhibited 93.5％ sensitivity,85.9％ specificity,87.3％ accuracy.A further analysis was performed in the 72 OT-VAs with a V3-lead precordial transition,the sensitivity,specificity and accuracy of the integration of SV2/RV3 index≤ 1.5 and R-wave de-flection interval in lead V3>80 ms was 91.2％,83％ and 85.7％.In the prospective evaluation,the combination of TZ index and SV2/RV3 index could identify the correct origin sites with 91.5％accuracy in overall analysis,and the integration of SV2/RV3 index ≤ 1.5 and R-wave deflection interval in lead V3>80 ms exhibited 94％ accuracy in V3-lead precordial transition. Con-clusion The combination of TZ index<0 and SV2/RV3 index≤1.5 is a simple and efficient stepwise ECG algorithm for predic-ting LVOT origin.For the OT-VAs with a V3-lead precordial transition,the integration of SV2/RV3 index≤1.5 and R-wave deflection interval in lead V3>80 ms will be a better choice.
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