Key result
Five 12-lead ECG algorithms show similar moderate diagnostic accuracy for predicting RVOT arrhythmia origins.
Why the study?
The study aimed to compare the predictive accuracy of five ECG algorithms for determining the origin of right ventricular outflow tract arrhythmias against successful ablation sites verified by 3D electroanatomical mapping.
Do five different 12-lead ECG algorithms accurately predict the sublocalisation of right ventricular outflow tract arrhythmia origin compared to 3D electroanatomical mapping in patients with idiopathic PVCs?
Observational (n=28)
No
Do five different 12-lead ECG algorithms accurately predict the sublocalisation of right ventricular outflow tract arrhythmia origin compared to 3D electroanatomical mapping in patients with idiopathic PVCs?
p-value: p=0.99
The evaluated 12-lead ECG algorithms, particularly the Pytkowski scheme, provide moderate accuracy and good interobserver agreement for pre-procedural sublocalization of right ventricular outflow tract arrhythmias.
Moderate accuracy of ECG algorithms for RVOT origin prediction warrants clinical caution; leaves open need for superior tools in prospective studies.
CĂl: Srovnat predikÄnĂ pĹesnost pÄti rĹŻznĂ˝ch algoritmĹŻ, ovÄĹenĂ˝ch ĂşspÄĹĄnou ablacĂ s pouĹžitĂm 3D elektroanatomickĂŠho bezkontaktnĂho mapovĂĄnĂ, u pacientĹŻ se symptomatickĂ˝mi i asymptomatickĂ˝mi tachykardiemi vĂ˝tokovĂŠho traktu pravĂŠ komory (right ventricular outflow tract, RVOT) a vysoce zatĂĹženĂ˝ch tÄmito aryt- miemi. Metody: Do studie bylo zaĹazeno 28 po sobÄ nĂĄsledujĂcĂch pacientĹŻ pĹijatĂ˝ch pro radiofrekvenÄnĂ katetrizaÄnĂ ablaci pro symptomatickĂŠ, pĹĂpadnÄ asymptomatickĂŠ, idiopatickĂŠ pĹedÄasnĂŠ komorovĂŠ stahy (premature ventricular contractions, PVC) znamenajĂcĂ vysokou zĂĄtÄĹž pro srdeÄnĂ komory. VĹĄichni pacienti jiĹž dĹĂve absolvovali neĂşspÄĹĄnou terapii beta-blokĂĄtory a/nebo alespoĹ jednĂm antiarytmikem tĹĂdy IC (pĹĂpadnÄ takovou lĂŠÄbu nesnĂĄĹĄeli); mÄli normĂĄlnĂ ejekÄnĂ frakci levĂŠ komory. U vĹĄech pacientĹŻ byly prokĂĄzĂĄny monomorfnĂ PVC s morfologiĂ blokĂĄdy levĂŠho Tawarova ramĂŠnka s prĹŻbÄhem vĂ˝slednĂŠho vektoru smÄrem dolĹŻ inferior axis. NĂĄslednÄ se hodnotila shoda mezi mĂstem vzniku arytmie podle EKG algoritmu a mĂsta urÄenĂŠho pomocĂ 3D mapovĂĄnĂ. Z pÄti algoritmĹŻ byly pro srovnĂĄnĂ pouĹžity dva pro snadnost pouĹžitĂ a zapamatovatelnost (Dixit, Joshi) a tĹi sloĹžitÄjĹĄĂ a pĹesnÄjĹĄĂ (Ito, Zhang, Pytkowski). VĂ˝sledky: PosouzenĂ diagnostickĂŠ pĹesnosti prokĂĄzalo pouze stĹednÄ kvalitnĂ pĹesnost vĹĄech algoritmĹŻ, pĹiÄemĹž nejpĹesnÄjĹĄĂ byl podle kardiologĹŻ algoritmus navrĹženĂ˝ PytkowskĂ˝m a pĹi hodnocenĂ elektrofyziologem algoritmy navrĹženĂŠ Dixitem a PytkowskĂ˝m. PĹi srovnĂĄnĂ jejich pĹesnosti, specificity a senzitivity nicmĂŠnÄ nebyly nalezeny ŞådnĂŠ vĂ˝znamnĂŠ rozdĂly (p = 0,99). ZĂĄvÄry: VĹĄech pÄt publikovanĂ˝ch algoritmĹŻ pro urÄenĂ mĂsta RVOT pomocĂ 12svodovĂŠho EKG zĂĄznamu bylo z hlediska diagnostickĂŠ pĹesnosti, specificity a senzitivity podobnĂ˝ch. V naĹĄĂ studii vykĂĄzal nejvÄtĹĄĂ pĹesnost a specificitu v predikci mĂsta algoritmus PytkowskĂŠho, pokud jej hodnotili elektrofyziologovĂŠ a/nebo kardio- logovĂŠ. © 2022, ÄKS.
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Prisecaru et al. (2022) conducted an observational in Right ventricular outflow tract arrhythmia (RVOTA) / Premature ventricular contractions (PVC) (n=28). Five 12-lead ECG algorithms (Ito, Dixit, Joshi, Zhang, Pytkowski) vs. 3D electroanatomical non-contact mapping was evaluated on Diagnostic accuracy of the algorithms in predicting the sublocalisation of RVOTA origin (p=0.99). Five 12-lead ECG algorithms for predicting the origin of right ventricular outflow tract arrhythmias showed similar moderate diagnostic accuracy with no significant differences between them.
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