Key result
V2S/V3R index ≤1.5 predicts LVOT origin of VAs with ~94% specificity, outperforming other ECG criteria.
Why the study?
Does the V2S/V3R index accurately differentiate left from right ventricular outflow tract tachycardia origins in patients with OT-VAs?
Observational (n=207)
Does the V2S/V3R index accurately differentiate left from right ventricular outflow tract tachycardia origins in patients with OT-VAs?
Effect estimate: AUC 0.964
p-value: p=<0.001
The V2S/V3R index is a highly accurate novel ECG criterion for differentiating left from right ventricular outflow tract tachycardia origins, outperforming previously proposed criteria.
May aid noninvasive OT-VA localization; leaves open prospective validation before changing practice.
INTRODUCTION: Although several ECG criteria have been proposed for differentiating between left and right origins of idiopathic ventricular arrhythmias (VA) originating from the outflow tract (OT-VA), their accuracy and usefulness remain limited. This study was undertaken to develop a more accurate and useful ECG criterion for differentiating between left and right OT-VA origins. METHODS AND RESULTS: We studied OT-VAs with a left bundle branch block pattern and inferior axis QRS morphology in 207 patients who underwent successful catheter ablation in the right (RVOT; n = 154) or left ventricular outflow tract (LVOT; n = 53). The surface ECGs during the OT-VAs and during sinus beats were analyzed with an electronic caliper. The V2S/V3R index was defined as the S-wave amplitude in lead V2 divided by the R-wave amplitude in lead V3 during the OT-VA. The V2S/V3R index was significantly smaller for LVOT origins than RVOT origins (P < 0.001). The area under the curve (AUC) for the V2S/V3R index by a receiver operating characteristic analysis was 0.964, with a cut-off value of ≤1.5 predicting an LVOT origin with an 89% sensitivity and 94% specificity. In the AUC and accuracy, the V2S/V3R index was superior to any previously proposed ECG criteria in an analysis of all OT-VAs. This advantage of the V2S/V3R index over the V2 transition ratio and other indices also held true for a subanalysis of 77 OT-VAs with a lead V3 precordial transition. CONCLUSION: The V2S/V3R index outperformed other ECG criteria to differentiate left from right OT-VA origins independent of the site of the precordial transition.
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Yoshida et al. (2014) conducted an observational in Idiopathic ventricular arrhythmias originating from the outflow tract (n=207). V2S/V3R index vs. Other ECG criteria was evaluated on Differentiating between left and right OT-VA origins (AUC 0.964, p=<0.001). The V2S/V3R index ≤1.5 predicted a left ventricular outflow tract origin for ventricular arrhythmias with 89% sensitivity and 94% specificity (AUC 0.964), outperforming other ECG criteria.
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