Twelve‐lead electrocardiographic localization of idiopathic premature ventricular contraction origins

Abstract

The major sites of origins of idiopathic ventricular arrhythmias have been elucidated. Idiopathic ventricular arrhythmias most often present as premature ventricular contractions (PVCs) with a focal mechanism, and commonly occur without structural heart disease. Idiopathic ventricular arrhythmias usually originate from specific anatomical structures, commonly endocardial but sometimes epicardial and exhibit characteristic electrocardiograms (ECGs) based on their anatomical background. There are general and specific ECG characteristics that can localize the site of idiopathic PVC origins. The general ECG characteristics include the bundle branch block pattern, axis, QRS polarity in lead V6, QRS duration, precordial transition, maximal deflection index, and so forth. They can roughly localize the site of idiopathic PVC origins. Several major sites of idiopathic PVC origins are located close to each other, and specific ECG characteristics are helpful for localizing the site of origins more accurately in those PVCs. Twelve‐lead surface ECG algorithms usually can localize the site of idiopathic PVC origins with a high accuracy, but their accuracy can be limited by the patients’ physique, heart rotation, specific conduction properties, presence of structural heart disease, and so forth. This review describes an overview of the approaches to the 12‐lead surface ECG localization of idiopathic PVCs, and also discusses their caveats and limitations.

A High-Precision Machine Learning Algorithm to Classify Left and Right Outflow Tract Ventricular Tachycardia

“…An accurate prediction of RVOT and LVOT origins of OTVT can optimize the CA strategy, reduce ablation duration, and avoid operative complications. Previous studies (Kamakura et al, 1998;Hachiya et al, 2000;Ito et al, 2003;Joshi and Wilber, 2005;Tanner et al, 2005;Haqqani et al, 2009;Zhang et al, 2009;Betensky et al, 2011;Yoshida et al, 2011Yoshida et al, , 2014Cheng et al, 2013Cheng et al, , 2018Nakano et al, 2014;Efimova et al, 2015;He et al, 2018;Xie et al, 2018;Di et al, 2019;Enriquez et al, 2019;Yamada, 2019) propose several criteria or models to estimate RVOT and LVOT origins. However, these results have been limited by sample size, scope of studies, ECG measurement efficiency, and generalizability of the models.…”

Earliest activation time is a good predictor of successful ablation of idiopathic outflow tract ventricular arrhythmias

“…Several studies revealed relatively high accuracy for differentiating right from left OT‐VA origin on 12‐lead ECG algorithm 12‐15 . However, the accuracy of prediction varies according to the patient population because there is considerable variability in lead positions, shape of the chest wall, heart rotation, and conduction properties from person to person 16,17 . In general, since the LVOT is posteriorly positioned compared with the RVOT, PVC originating from the LVOT tends to show a larger and wider R‐wave at lead V 1 and V 2 .…”

Premature ventricular complexes : Systematic review, evaluation and management

“…Relatively narrow QRS generally indicates septal origin or early entry to the preferential conduction fibres of the His-Purkinje system. Finally, signs of initial slow depolarisation would sug- gest an epicardial origin instead of the most common endocardial origin of the PVC (19). Globally, the most frequent location of PVCs is the RVOT, generally not related to any underlying cardiac disease.…”