Key result
Electrocardiographic criteria based on initial QRS components can help identify the epicardial origin of ventricular tachycardias, though these parameters are substrate-specific and have limitations.
Why the study?
What are the electrocardiographic criteria and other clinical information used to recognize the epicardial origin of ventricular tachycardias?
Electrocardiographic criteria and clinical information such as underlying heart disease and MRI findings are crucial for identifying epicardial ventricular tachycardias and planning ablation procedures.
May inform preprocedural VT ablation planning; extends prior criteria but leaves open substrate-specific validation.
Percutaneous pericardial access for epicardial mapping and ablation of ventricular arrhythmias has expanded considerably in recent years. After its description in patients with Chagas disease, the technique has provided relevant information on the arrhythmia substrate in other cardiomyopathies and has improved the results of ablation procedures in various clinical settings. Electrocardiographic criteria proposed for the recognition of the epicardial origin of ventricular tachycardias are mainly based on analysis of the first QRS components. Ventricular activation at the epicardium has a slow initial component reflecting the transmural activation and influenced by the absence of Purkinje system in the epicardium. Various parameters (pseudodelta wave, intrinsicoid deflection and shortest RS interval) of these initial intervals predict an epicardial origin in patients with scar-related ventricular tachycardias with right bundle branch block morphology. Using the same concept, the maximum deflection index was defined for the location of idiopathic epicardial tachycardias remote from the aortic root. Electrocardiogram criteria based on the morphology of the first component of the QRS (q wave in lead I) have been proposed in patients with nonischemic cardiomyopathy. All these criteria seem to be substrate-specific and have several limitations. Other information, including type of underlying heart disease, previous failed endocardial ablation, and evidence of epicardial scar on magnetic resonance imaging, can help to plan the ablation procedure and decide on an epicardial approach.
No takes yet. Share an insight, caveat, or question.
Fernández‐Armenta et al. (2014) conducted a review in Ventricular Tachycardias. Electrocardiographic criteria was evaluated. Electrocardiographic criteria based on initial QRS components can help identify the epicardial origin of ventricular tachycardias, though these parameters are substrate-specific and have limitations.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: