S‐R difference in V1‐V2 is a novel criterion for differentiating the left from right ventricular outflow tract arrhythmias

Kaypaklı, Onur; Koca, Hasan; Şahin, Durmuş Yıldıray; Karataş, Fadime; Özbiçer, Süleyman; Koç, Mevlüt

doi:10.1111/anec.12516

Cited by 20 publications

(21 citation statements)

References 23 publications

(36 reference statements)

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“…Kaypakli et al proposed the S-R difference in leads V1 and V2 (V1–2 SRd), calculated using this formula on the 12-lead surface ECG: (V1S amplitude + V2S amplitude) – (V1R amplitude + V2R amplitude). [ 22 ] Owing to its anterior position, the RVOT is closer to leads V1 and V2 than the LVOT, and therefore RVOT VAs will produce a deeper S wave and smaller R wave in these leads; conversely, the LVOT is further from leads V1 and V2 relative to the RVOT, and therefore LVOT VAs will give rise to a higher R wave and smaller S wave in these leads. Thus, V1-2 SRd is lower in LVOT sites of origin than in RVOT sites of origin, and the cut-off proposed by Kaypakli et al is 1.625 mV (sensitivity, 95.1%; specificity, 85.5%).…”

Section: Current Ecg Criteria For Differentiating Lvot From Rvot Originmentioning

confidence: 99%

Electrocardiographic Criteria for Differentiating Left from Right Idiopathic Outflow Tract Ventricular Arrhythmias

Mariani

Piro

Rocca

et al. 2021

Arrhythm Electrophysiol Rev

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Idiopathic ventricular arrhythmias are ventricular tachycardias or premature ventricular contractions presumably not related to myocardial scar or disorders of ion channels. Of the ventricular arrhythmias (VAs) without underlying structural heart disease, those arising from the ventricular outflow tracts (OTs) are the most common. The right ventricular outflow tract (RVOT) is the most common site of origin for OT-VAs, but these arrhythmias can, less frequently, originate from the left ventricular outflow tract (LVOT). OT-VAs are focal and have characteristic ECG features based on their anatomical origin. Radiofrequency catheter ablation (RFCA) is an effective and safe treatment strategy for OT-VAs. Prediction of the OT-VA origin according to ECG features is an essential part of the preprocedural planning for RFCA procedures. Several ECG criteria have been proposed for differentiating OT site of origin. Unfortunately, the ECG features of RVOT-VAs and LVOT-VAs are similar and could possibly lead to misdiagnosis. The authors review the ECG criteria used in clinical practice to differentiate RVOT-VAs from LVOT-VAs.

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Section: Current Ecg Criteria For Differentiating Lvot From Rvot Originmentioning

confidence: 99%

Electrocardiographic Criteria for Differentiating Left from Right Idiopathic Outflow Tract Ventricular Arrhythmias

Mariani

Piro

Rocca

et al. 2021

Arrhythm Electrophysiol Rev

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“…So it is challenging to recognize the origin of the PVCs. Different ECG algorithms have been proposed for differentiation of left and right sided PVCs (7)(8)(9)(10)(11)(12). Their accuracy and usefulness remain limited especially when the transition in the precordial leads occurs in V3 (10).…”

Section: Discussionmentioning

confidence: 99%

“…In these patients, a 3.5-mm irrigated-tip catheter (NaviStar, Biosense Webster) was used for mapping and ablation. Target ablation sites were chosen with the combination of activation mapping and pace mapping as described previously (12). If radiofrequency application was successful, it was maintained for 60 seconds in RVOT and for 30-45 seconds in aortic root.…”

Section: Ablation Protocolmentioning

confidence: 99%

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An easy measurement to predict the left vs. right premature ventricular contractions: CS distal delay interval

Kaypaklı

Bekler

ARDIÇ

et al. 2022

Preprint

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Aim: We aimed to detect the predictive value of CS distal delay interval for differentiating the left from right sided PVCs. Methods: We included 137 patients with symptomatic frequent premature ventricular contractions (PVCs) who underwent successful catheter ablation retrospectively (67 male, 70 female; mean age 46.0 ± 16.2 years). Patients were classified into two groups as left sided and right sided PVCs. Decapolar catheters were placed in the coronary sinus before the procedure. CS distal delay interval (Q-CSd) was measured as the interval from onset of earliest QRS complex of premature ventricular contractions in 12 lead ECG to distal CS EGM signal. Results: CS distal delay interval was found to be significantly lower in left sided PVCs. The cutoff value of CS distal delay interval obtained by ROC curve analysis was 48,5 ms for prediction of right sided origin (sensitivity: 91,5%, specificity: 85.9%). The area under the curve (AUC) was 0.911 (p<0.001). Conclusion: CS distal delay interval is a novel and simple measurement for accurately differentiating the left from right sided PVCs. The use of this simple measurement could be beneficial for decreasing ablation duration, radiation exposure and the number of arterial or venous punctures.

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“…Several ECG methods have been proposed for distinguishing RVOT from LVOT [4,[10][11][12][13][14][15][16][17]. However, the accuracy and effectiveness of these algorithms have some shortcomings, which may account for the heterogenous QRS morphology of OT-VAs.…”

Section: Introductionmentioning

confidence: 99%

A Simplified Two-Stepwise Electrocardiographic Algorithm to Distinguish Left from Right Ventricular Outflow Tract Tachycardia Origin

Yu¹,

Li²,

Zhang³

et al. 2020

Cardiology

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Background: There are several electrocardiographic algorithms to predict the origin of idiopathic outflow tract ventricular arrhythmias (OT-VAs). This study aimed to develop a more accurate and efficient stepwise electrocardiographic algorithm to discriminate left ventricular outflow tract (LVOT) from right ventricular outflow tract (RVOT) origin. Methods and Results: We analyzed 12-lead electrocardiographic characteristics of 173 consecutive OT-VAs patients who underwent successful radiofrequency catheter ablation in the RVOT (n = 124) or LVOT (n = 49). Based on the areas under the receiver operating characteristic curves, the combination of transitional zone (TZ) index <0 and V2S/V3R index ≤1.5 exhibited 93.5% sensitivity, 85.9% specificity, and 87.3% accuracy. A further analysis was performed in the 71 OT-VAs with a V3-lead precordial transition. The sensitivity, specificity, and accuracy of the integration of V2S/V3R index ≤1.5 and R-wave deflection interval in lead V3 >80 ms were 91.7, 83.1, and 85.9%, respectively. In the prospective evaluation, the combination of TZ index and V2S/V3R index could identify the correct origin sites with 91.2% accuracy in the overall analysis, and the integration of V2S/V3R index ≤1.5 and R-wave deflection interval in lead V3 >80 ms exhibited 94% accuracy in V3-lead precordial transition. Conclusions: The combination of TZ index <0 and V2S/V3R index ≤1.5 is a simple and efficient stepwise electrocardiographic algorithm for predicting LVOT origin. For the OT-VAs with a V3-lead precordial transition, the integration of V2S/V3R index ≤1.5 and R-wave deflection interval in lead V3 >80 ms would be a better choice.

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S‐R difference in V1‐V2 is a novel criterion for differentiating the left from right ventricular outflow tract arrhythmias

Cited by 20 publications

References 23 publications

Electrocardiographic Criteria for Differentiating Left from Right Idiopathic Outflow Tract Ventricular Arrhythmias

Electrocardiographic Criteria for Differentiating Left from Right Idiopathic Outflow Tract Ventricular Arrhythmias

An easy measurement to predict the left vs. right premature ventricular contractions: CS distal delay interval

A Simplified Two-Stepwise Electrocardiographic Algorithm to Distinguish Left from Right Ventricular Outflow Tract Tachycardia Origin

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