Why the study?
Using a 12-lead ECG to localize LV summit idiopathic ventricular arrhythmias ablatable from the dGCV is valuable for ablation planning, but specific ECG identifiers required determination.
Do specific ECG features predict successful ablation of idiopathic ventricular arrhythmias from the distal great cardiac vein?
Observational (n=120)
Yes
Do specific ECG features predict successful ablation of idiopathic ventricular arrhythmias from the distal great cardiac vein?
Effect estimate: Sensitivity 94.4%, Specificity 96.1%
A combination of a 'w' wave in lead I, an early precordial pattern break, and an MDI ≥ 0.5 provides high sensitivity and specificity for localizing ventricular arrhythmias to the distal great cardiac vein for ablation planning.
BACKGROUND: Idiopathic ventricular arrhythmias (IVAs) from the left ventricular (LV) summit may be successfully ablated from the distal great cardiac vein (dGCV). Using a 12-lead electrocardiogram (ECG) to localize IVAs that can be ablated from the dGCV is valuable for ablation planning. OBJECTIVE: To determine if a "w" wave, a notch in the Q wave in lead I, and other ECG features can identify IVAs that can be successfully ablated from the dGCV. METHODS: We reviewed outflow tract premature ventricular contraction (PVC) ablations performed at two centers between September 2010 and June 2018. Successful PVC ablations, in which the PVCs were mapped from the right ventricular outflow tract, coronary cusps, commissures, endocardial LV, and the coronary venous system including the dGCV were included. ECG characteristics were compared between patients with successful ablations in the dGCV and non-dGCV sites. RESULTS: Of the 120 patients (age 56.8 ± 13.8 years, 45% female) that met the inclusion criteria, the dGCV was the successful ablation site in 18 patients (15%). Multivariate analysis with binary logistic regression showed that a "w" in lead I in combination with an early precordial pattern break and a maximum deflection index (MDI) ≥ 0.5 had sensitivity and specificity for a successful ablation in the dGCV of 94.4% and 96.1%, respectively. CONCLUSION: Combining a "w" wave in lead I with an early precordial pattern break and an MDI ≥ 0.5 is highly sensitive and specific for identifying the dGCV as a successful ablation site for PVCs.
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Chang et al. (2020) conducted an observational in Idiopathic ventricular arrhythmias / Premature ventricular contractions (n=120). ECG criteria ('w' wave in lead I, early precordial pattern break, MDI ≥ 0.5) was evaluated on Successful ablation in the distal great cardiac vein (dGCV) (Sensitivity 94.4%, Specificity 96.1%).
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