Newer Diagnostic Criteria for Identification of Epicardial Origin of Ventricular tachycardia/premature Ventricular Complex

Lay abstract

Heart can have extra beats or a run of extra beats from lower chambers. These beats can come either from inside or outside of the lower chamber. Prior to going inside the heart to treat these extra beats by burning the sites of origin it is imperative to know where these beats are coming from. This helps in planning the procedure and reducing the risk. We examined a duration that would help us to differentiate the origin of these extra beats. This duration is defined with the use of normal ECG and a small electrical signal that we see when we put electrical cables in heart in a specific region knows as His region.

Aim: The study defines criteria for localization of ventricular arrhythmias. Materials & methods: Data from 40 premature ventricular complex (PVC)/ventricular tachycardia (VT) were studied. The interval from PVC QRS onset to His potential and ratio of this interval to PVC/VT QRS duration was analyzed. Patients were divided into epicardial and endocardial groups based on mapping/successful ablation site. Results: The interval from PVC QRS onset to His potential in the epicardial versus endocardial group was 99 ± 21 ms and 64 ± 37 ms (p = 0.002). A cut off of 88 ms had a sensitivity of 73% and specificity of 76%. A cut off of 0.50 for the ratio had a sensitivity of 82% and specificity of 72%. Conclusion: Two new parameters can help localization of PVC/VTs origin.

Keywords:

• endocardial
• epicardial
• premature ventricular complex
• ventricular tachycardia

Supplementary data

To view the supplementary data that accompany this paper please visit the journal website at:www.tandfonline.com/doi/full/10.2217/fca-2020-0155

Acknowledgments

This material is the result of work supported with resources and the use of facilities at the Richard L. Roudebush, VAMC, Indianapolis, IN, USA.

Financial & competing interests disclosure

JM Miller is a consultant for: Biosense-Webster, MediLynx and BioSig, Inc.; he gives lectures sponsored by: Biosense-Webster, Medtronic, Inc., Abbott Electrophysiology, Boston Scientific Corp. and Biotronik, Inc.; he has received fellowship training grants from Biosense-Webster, Medtronic, Inc., Boston Scientific Corp. and Biotronik, Inc. R Jain has given lectures sponsored by Biosense Webster but none in the last 2 years. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Disclaimer

The contents do not represent the views of the US Department of Veterans Affairs or the US Government.

Ethical conduct of research

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of Indiana University approved this study.