Key result
Distal great cardiac vein origins of epicardial outflow tract-ventricular arrhythmias exhibited a significantly greater R/S ratio in V1 (1.7 vs 0.2) and longer QRS duration (149 vs 123 ms) compared to anterior interventricular vein origins.
Why the study?
Do ECG characteristics such as R/S ratio in V1 and QRS duration differentiate between anterior interventricular vein and distal great cardiac vein origins in patients with epicardial outflow tract-ventricular arrhythmias?
Observational (n=13)
Yes
Do ECG characteristics such as R/S ratio in V1 and QRS duration differentiate between anterior interventricular vein and distal great cardiac vein origins in patients with epicardial outflow tract-ventricular arrhythmias?
Absolute Event Rate: 1.7% vs 0.2%
p-value: p=0.04
A low R/S ratio in V1 and shorter QRS duration can help identify the anterior interventricular vein as the site of origin for epicardial outflow tract-ventricular arrhythmias, differentiating it from the distal great cardiac vein.
May aid preprocedural localization of epicardial OT-VAs; leaves open prospective validation.
BACKGROUND: The aim of this study was to identify the ECG features that might differentiate between anterior interventricular vein (AIV) and distal great cardiac vein (d-GCV) outflow tract-ventricular arrhythmias (OT-VAs). METHODS AND RESULTS: Radiofrequency catheter ablation was performed in 13 of 375 patients (3.5%) for AIV or d-GCV OT-VAs. We grouped the 13 patients by the origin, d-GCV (n=9) or AIV (n=4), and compared their ECGs and electrophysiological data. The OT-VA ECGs had S waves in lead I in all 13 patients. The voltage in the inferior lead III and peak deflection index showed no significant between-group differences (2.3±0.7 vs. 2.5±0.3 mV and 0.65±0.04 vs. 0.68±0.04 mV, respectively) for the d-GCV and AIV groups. There were also no significant between-group differences in the QaVL/QaVR, where Q denotes the amplitude of the Q wave in the suffix lead. However, the R/S ratio in V1 (1.7±1.0 [n=5] vs. 0.2±0.05, P=0.04), and QRS duration (149±16.6 vs. 123±3.8 ms, P=0.012) were greater in the d-GCG group than in the AIV group. There were no significant between-group differences in the activation time or pace mapping score at the optimal ablation sites. CONCLUSIONS: A low R/S ratio in V1 and shorter QRS duration may help identify AIV sites of epicardial OT-VA origin.
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Hachiya et al. (2015) conducted an observational in Epicardial outflow tract-ventricular arrhythmias (n=13). Distal great cardiac vein (d-GCV) origin vs. Anterior interventricular vein (AIV) origin was evaluated on R/S ratio in V1 (p=0.04). Distal great cardiac vein origins of epicardial outflow tract-ventricular arrhythmias exhibited a significantly greater R/S ratio in V1 (1.7 vs 0.2) and longer QRS duration (149 vs 123 ms) compared to anterior interventricular vein origins.
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