Key result
Hourly variability of ventricular arrhythmic events correctly predicted a right-sided site of origin for outflow tract ectopy in a patient with cardiac rotation, whereas standard morphological criteria failed.
Why the study?
The accuracy of validated 12-lead ECG criteria used to predict the site of origin for outflow tract ventricular arrhythmias may be reduced by variations in body habitus and cardiac orientation.
Case Report (n=1)
No
Hourly variability of ventricular arrhythmic events on a 24-hour Holter monitor can accurately predict the site of origin of outflow tract ventricular arrhythmias, overcoming limitations of morphological criteria in patients with cardiac rotation.
Hourly variability criteria may improve OTVA localization when morphology is confounded by rotation; leaves open need for prospective validation.
Outflow tract ventricular arrhythmias (OTVA) are the most common form of idiopathic ventricular arrhythmias encountered in clinical practice. The 12-lead electrocardiogram (ECG) is a vitally important tool that allows rapid and non-invasive localization of the most likely site of origin (SOO) when planning ablation procedures. Different ECG criteria have been validated for this purpose.1 However, their accuracy may be reduced by variations in body habitus and cardiac orientation.2
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Caixal et al. (2023) conducted a case report in Outflow tract ventricular arrhythmias (OTVA) (n=1). Hourly variability of arrhythmic events (24-hour Holter) vs. ECG morphological criteria was evaluated on Prediction of the site of origin (SOO) of ventricular outflow tract ectopy. Hourly variability of ventricular arrhythmic events correctly predicted a right-sided site of origin for outflow tract ectopy in a patient with cardiac rotation, whereas standard morphological criteria failed.
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