ECG Criteria to Identify Epicardial Ventricular Tachycardia in Nonischemic Cardiomyopathy (original) (raw)
2010, Circulation-arrhythmia and Electrophysiology
a, Pe Pe e e e e enn nn nn nn nnsy sy sy sy sy sy sylv lv lv lv lv lv van an an an an an ania ia i ia ia ia ia.1 Abstract Background: ECG criteria identifying epicardial (EPI) origin for ventricular tachycardia (VT) in non-ischemic cardiomyopathy (NICM) have not been determined. Endocardial (ENDO) and EPI basal left ventricle fibrosis characterizes the VT substrate. Methods and Results: We assessed the QRS from 102 basal-superior/lateral EPI and 67 comparable ENDO pacemaps (PM) in 14 patients with NICM. Pacemapping focused on low bipolar voltage areas. Published morphology: q wave in lead I (QWL1), no q waves in inferior leads and interval criteria: pseudo-delta wave (PdW) 34ms, intrinsicoid deflection time 85ms, shortest RS complex 121ms and maximum deflection index (MDI) 0.55 were assessed for ability to identify EPI origin. Sixteen EPI and 8 ENDO of the 34 mapped VTs (71%) in the study population and 14 EPI and 7 ENDO VTs from an 11 patient validation cohort were localized to basal-superior/lateral left ventricle and corroborated pacing data. A QWL1 was seen in EPI but not ENDO PMs (91% vs 4%; p<0.001), identified 14/16 EPI VTs (sensitivity 88%) and was seen in 1/8 ENDO VT's (specificity 88%). None of the remaining criteria achieved similar sensitivity without specificity <50%. We identified 4 criteria (q waves in inferior leads, PdW 75 ms, MDI 0.59 and QWL1) having 95% specificity and 20% sensitivity in identifying EPI/ENDO origin for PMs. This four-step algorithm identified the origin in 109/115 PMs (95%), 21/24 VTs (88%) in study population and 19/21 VTs (90%) in validation cohort. Conclusion: Morphologic ECG features that describe the initial QRS vector can help identify basal-superior/lateral EPI VTs in NICM. or or or or or or or a a a a a a abi bi bi bi bi bi bili li li li li li lity ty ty ty ty ty ty t t t t t t to o o o o o o id id id id id id ide e e e e e e %) in n n n n n n t t t t t t the he he he he he he s s s s s s stu tu tu tu tu tu tudy dy dy dy dy dy dy p a c o not ENDO PMs (91% vs 4%; p<0.001), identified 14/16 8 o it i hi d i il iti it ith t ifi it <5 and 7 ENDO VTs from an 11 patient validation cohort were loc or/lateral left ventricle and corroborated pacing data. A QWL1 not ENDO PMs (91% vs 4%; p<0.001), identified 14/16 88%) and was seen in 1/8 ENDO VT's (specificity 88%). No it i hi d i il iti it ith t ifi it <5 by guest on October 3, 2016 http://circep.ahajournals.org/ Downloaded from Fourteen patients with NICM undergoing ENDO and EPI catheter mapping and ablation for drug refractory ventricular arrhythmias were included in the study.
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