Positive QRS Complex in Lead I as a Malignant Sign in Right Ventricular Outflow Tract Tachycardia

Kurosaki, Kenji; Nogami, Akihiko; Shirai, Yoshio; Kowase, Shinya

doi:10.1253/circj.cj-12-0864

Cited by 19 publications

(24 citation statements)

References 15 publications

(7 reference statements)

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“…[22] In contrast, the "malignant" PA-VT in this study appeared to be provoked by the catecholaminergic / tachycardia -dependent mechanism, because the preceding R-R interval was markedly abbreviated (Table 2). Based on these studies [12,13,18,20] and ours, there might be at least two types of idiopathic polymorphic VT / VF arising from RVOT area.…”

Section: Discussionsupporting

confidence: 53%

“…[16,17] In contrast, it has been reported that a small number of patients develop polymorphic VT and /or VF, thereby suggesting the malignant entity. [12,13,[18][19][20] There are several studies attempting to differentiate such a malignant form of RVOT-VT from a benign one. Viskin et al reported that the malignant type had short-coupled premature extrasystoles which initiated the polymorphic VT and / or VF.…”

Section: Discussionmentioning

confidence: 99%

“…A recent study reported that an initial PVC with positive QRS complex in lead I was observed in about 70 % (10 out of 14) of patients with idiopathic polymorphic VT / VF arising from RVOT. [13] The authors proposed the positive QRS complex in lead I as a malignant sign in RVOT-VT. The incidence of positive QRS complex in lead I in PA-VT group was 50 % (2 out of 4), that was comparable to that in RVOT-VT group in the present study (Table 3).…”

Section: Discussionmentioning

confidence: 99%

“…However, there were no significant differences in the ECG characteristics such as QRS duration, R/S ratio and R-wave duration index in lead V2, aVL/aVR of Q-wave amplitude, and the incidence of positive QRS wave in lead I [4,13,14] (Table 3). 2B).…”

Section: Patient Characteristicsmentioning

confidence: 94%

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Characteristics of idiopathic ventricular tachycardia originating above the pulmonary valve

et al. 2015

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AbstractsPanoptic studies of ventricular tachycardia (VT) originating above the pulmonary valve are scarce. The purpose of this study is to clarify the characteristic of idiopathic VT arising above pulmonary valve. We analyzed 15 consecutive patients with idiopathic VT that was successfully abolished by catheter ablation at the right ventricular outflow tract (RVOT-VT, n = 11) and above the pulmonary valve (PA-VT, n = 4). Incidence of syncope was higher in PA-VT than RVOT-VT (100 % vs 27 %, P < 0.05) and polymorphic VT was also more prevalent in PA-VT (75 % vs 0 %, P < 0.05). The coupling interval (315 ± 29 ms vs 449 ± 32 ms, mean ± SE) at the onset of VT and minimum cycle length (CL) (192 ± 13 ms vs 344 ± 37 ms) during VT were shorter in PA-VT (both P < 0.05). Among 12-lead ECG parameters, only R-wave amplitude in lead II was different between groups (2.05 ± 0.17 mV in PA-VT vs 1.44 ± 0.05 mV in RVOT-VT, P < 0.005). At the successful ablation site, the activation time from the onset of QRS complex did not differ between groups ( -37 ± 3 ms vs -31 ± 4 ms, P = 0.405), whereas the amplitude of intracardiac electrograms was significantly lower in PA-VT (0.83 ± 0.38 mV vs 2.39 ± 0.36 mV, P < 0.05). Although the number of patients in this study is limited, VT originating above the pulmonary valve demonstrated rapid excitation and often degenerated into polymorphic VT, suggesting its malignant electrophysiological characteristics.

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Section: Discussionsupporting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Patient Characteristicsmentioning

confidence: 94%

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Characteristics of idiopathic ventricular tachycardia originating above the pulmonary valve

et al. 2015

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“…However, previous studies have reported that malignant arrhythmias, such as spontaneous ventricular fibrillation (VF) and polymorphic ventricular tachycardia, are occasionally initiated by ventricular extrasystoles arising from RVOT (2,3). Generally, the majority of PVCs and VTs originating from RVOT can be effectively eliminated by catheter radiofrequency ablation (RFA) (4) targeting the initiating ventricular extrasystole.…”

Section: Introductionmentioning

confidence: 99%

Radiofrequency ablation of metastatic chondrosarcoma-associated refractory ventricular tachycardia originating from the right ventricular outflow tract: A case report and literature review

Shi¹,

Liang²,

Li³

et al. 2016

Experimental and Therapeutic Medicine

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Abstract. Ventricular tachycardia (VT) and premature contraction originating from the right ventricular outflow tract (RVOT) usually appear in healthy individuals. Radiofrequency ablation (RFA) is highly effective at resolving this type of arrhythmia. Refractory VT of RVOT is uncommon and occasionally results from cardiac metastasis of extraskeletal mesenchymal chondrosarcomas (ESMC). ESMC is a rare malignant tumor arising from soft tissues. The current study presents the case of a 25-year-old male with severe VT arising from RVOT due to metastasis of an ESMC that originally occurred in the retroperitoneum. The diagnosis was confirmed following echocardiography and cardiac magnetic resonance. VT was eventually eliminated by RFA, and during the 8-month follow-up period the patient did not complain of any palpitations. Holter monitoring confirmed the absence of recurrence.

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JCS/JHRS 2019 guideline on non‐pharmacotherapy of cardiac arrhythmias

Nogami¹,

Kurita²,

Abe³

et al. 2021

Journal of Arrhythmia

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104

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Positive QRS Complex in Lead I as a Malignant Sign in Right Ventricular Outflow Tract Tachycardia

Cited by 19 publications

References 15 publications

Characteristics of idiopathic ventricular tachycardia originating above the pulmonary valve

Characteristics of idiopathic ventricular tachycardia originating above the pulmonary valve

Radiofrequency ablation of metastatic chondrosarcoma-associated refractory ventricular tachycardia originating from the right ventricular outflow tract: A case report and literature review

JCS/JHRS 2019 guideline on non‐pharmacotherapy of cardiac arrhythmias

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