心臓と肺のリハビリテーションのジャーナル

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Predictive Values of Different ECG Algorithms in Differentiating Left Ventricular Outflow Tract from Right Ventricular Outflow Tract Premature Ventricular Beats Origin

Mustafa Abdelmonaem, Amira Nour Eldin

Background: Premature ventricular beats (PVBs) are early myocardial electrical oscillations, which are not life threatening in patients with normal cardiac architecture, however causing annoying morbidity; radiofrequency catheter ablation became a curative tool for elimination of this arrhythmia.

Methods: This study was held on 80 symptomatic patients with PVBs of same morphology provided being of significant burden, these patients were eligible for PVB electrophysiological study and catheter ablation in EP unit, Ain Shams University. Detailed history, comprehensive general and local examination was fulfilled. Trans-thoracic echocardiographic study and Holter ECG monitoring was offered for the studied population. Different algorithms for PVB origin identification were utilized in all patients before electrophysiological localization and radiofrequency ablation was done.

Results: Mean age of studied population was 39.9 ± 12.97 years, encompassing 44 (59.4%) males, admitted to our centre for EP study and ablation. PVB origin was unleashed initially via various algorhythms, which matched precise intra-cardiac origin in 78 cases; patients with PVBs originating from LVOT showed earlier transition, narrowed QRS complex, higher V2 transition ratio and R wave duration index as compared to those with PVBs originating from RT side. With multivariate logistic regression, the only significant independent predictor for RVOT origin was R wave duration index utilizing a cut off value of ˂0.3 (P=0.0057).

Conclusion: Accurate localization of PVB origin is feasible using surface ECG with positive impact on acute procedural success as well as reducing procedural time.