Validation of a clinical model for predicting left versus right ventricular outflow tract origin of idiopathic ventricular arrhythmias.
ablation
outflow tract tachycardia
premature ventricular complex
ventricular tachycardia
Journal
Pacing and clinical electrophysiology : PACE
ISSN: 1540-8159
Titre abrégé: Pacing Clin Electrophysiol
Pays: United States
ID NLM: 7803944
Informations de publication
Date de publication:
Oct 2023
Oct 2023
Historique:
revised:
26
07
2023
received:
16
05
2022
accepted:
15
08
2023
pubmed:
24
8
2023
medline:
24
8
2023
entrez:
24
8
2023
Statut:
ppublish
Résumé
Prediction of the chamber of origin in patients with outflow tract ventricular arrhythmias (OTVA) remains challenging. A clinical risk score based on age, sex and presence of hypertension was associated with a left ventricular outflow tract (LVOT) origin. We aimed to validate this clinical score to predict an LVOT origin in patients with OTVA. In a two-center observational cohort study, unselected patients undergoing catheter ablation (CA) for OTVA were enrolled. All procedures were performed using an electroanatomical mapping system. Successful ablation was defined as a ≥80% reduction of the initial overall PVC burden after 3 months of follow-up. Patients with unsuccessful ablation were excluded from this analysis. We included 187 consecutive patients with successful CA of idiopathic OTVA. Mean age was 52 ± 15 years, 102 patients (55%) were female, and 74 (40%) suffered from hypertension. A LVOT origin was found in 64 patients (34%). A score incorporating age, sex and presence of hypertension reached 73% sensitivity and 67% specificity for a low (0-1) and high (2-3) score, to predict an LVOT origin. The combination of one ECG algorithm (V The published clinical score yielded a lower sensitivity and specificity in our cohort. However, for PVCs with R/S transition at V
Sections du résumé
BACKGROUND
BACKGROUND
Prediction of the chamber of origin in patients with outflow tract ventricular arrhythmias (OTVA) remains challenging. A clinical risk score based on age, sex and presence of hypertension was associated with a left ventricular outflow tract (LVOT) origin. We aimed to validate this clinical score to predict an LVOT origin in patients with OTVA.
METHODS
METHODS
In a two-center observational cohort study, unselected patients undergoing catheter ablation (CA) for OTVA were enrolled. All procedures were performed using an electroanatomical mapping system. Successful ablation was defined as a ≥80% reduction of the initial overall PVC burden after 3 months of follow-up. Patients with unsuccessful ablation were excluded from this analysis.
RESULTS
RESULTS
We included 187 consecutive patients with successful CA of idiopathic OTVA. Mean age was 52 ± 15 years, 102 patients (55%) were female, and 74 (40%) suffered from hypertension. A LVOT origin was found in 64 patients (34%). A score incorporating age, sex and presence of hypertension reached 73% sensitivity and 67% specificity for a low (0-1) and high (2-3) score, to predict an LVOT origin. The combination of one ECG algorithm (V
CONCLUSION
CONCLUSIONS
The published clinical score yielded a lower sensitivity and specificity in our cohort. However, for PVCs with R/S transition at V
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1186-1196Informations de copyright
© 2023 The Authors. Pacing and Clinical Electrophysiology published by Wiley Periodicals LLC.
Références
Takemoto M, Yoshimura H, Ohba Y, et al. Radiofrequency catheter ablation of premature ventricular complexes from right ventricular outflow tract improves left ventricular dilation and clinical status in patients without structural heart disease. J Am Coll Cardiol. 2005;45:1259-1265. doi:10.1016/j.jacc.2004.12.073
Chugh SS, Shen W-K, Luria DM, Smith HC. First evidence of premature ventricular complex-induced cardiomyopathy: a potentially reversible cause of heart failure. J Cardiovasc Electrophysiol. 2000;11:328-329. doi:10.1111/j.1540-8167.2000.tb01802.x
Noda T, Shimizu W, Taguchi A, et al. Malignant entity of idiopathic ventricular fibrillation and polymorphic ventricular tachycardia initiated by premature extrasystoles originating from the right ventricular outflow tract. J Am Coll Cardiol. 2005;46:1288-1294. doi:10.1016/j.jacc.2005.05.077
Van Herendael H, Zado ES, Haqqani H, et al. Catheter ablation of ventricular fibrillation: importance of left ventricular outflow tract and papillary muscle triggers. Heart Rhythm. 2014;11:566-573. doi:10.1016/j.hrthm.2013.12.030
Ling Z, Liu Z, Su L, et al. Radiofrequency ablation versus antiarrhythmic medication for treatment of ventricular premature beats from the right ventricular outflow tract: prospective randomized study. Circ Arrhythm Electrophysiol. 2014;7:237-243. doi:10.1161/CIRCEP.113.000805
Lamba J, Redfearn DP, Michael KA, Simpson CS, Abdollah H, Baranchuk A. Radiofrequency catheter ablation for the treatment of idiopathic premature ventricular contractions originating from the right ventricular outflow tract: a systematic review and meta-analysis. Pacing Clin Electrophysiol. 2014;37:73-78. doi:10.1111/pace.12243
Zhong L, Lee YH, Huang XM, et al. Relative efficacy of catheter ablation vs antiarrhythmic drugs in treating premature ventricular contractions: a single-center retrospective study. Heart Rhythm. 2014;11:187-193. doi:10.1016/j.hrthm.2013.10.033
Cronin EM, Bogun FM, Maury P, et al. 2019 HRS/EHRA/APHRS/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias: executive summary. J Arrhythm. 2020;36:1-58. doi:10.1002/joa3.12264
Cheung JW, Anderson RH, Markowitz SM, Lerman BB. Catheter ablation of arrhythmias originating from the left ventricular outflow tract. JACC: Clin Electrophysiol. 2019;5:1-12.
Ouyang F, Mathew S, Wu S, et al. Ventricular arrhythmias arising from the left ventricular outflow tract below the aortic sinus cusps: mapping and catheter ablation via transseptal approach and electrocardiographic characteristics. Circ Arrhythm Electrophysiol. 2014;7:445-455. doi:10.1161/CIRCEP.114.001690
Bohnen M, Stevenson WG, Tedrow UB, et al. Incidence and predictors of major complications from contemporary catheter ablation to treat cardiac arrhythmias. Heart Rhythm. 2011;8:1661-1666. doi:10.1016/j.hrthm.2011.05.017
Roberts-Thomson KC, Steven D, Seiler J, et al. Coronary artery injury due to catheter ablation in adults. Circulation. 2009;120:1465-1473.
Chung FP, Lin CY, Shirai Y, et al. Outcomes of catheter ablation of ventricular arrhythmia originating from the left ventricular summit: a multicenter study. Heart Rhythm. 2020;17:1077-1083. doi:10.1016/j.hrthm.2020.02.027
Yue-Chun L, Jia-Feng L, Xue-Qiang G, Peng C. Chronic left coronary artery stenosis after radiofrequency ablation of idiopathic premature ventricular contraction originating from left coronary sinus cusp. Circ Arrhythm Electrophysiol. 2016;9:e004353. doi:10.1161/CIRCEP.116.004353
Whitman IR, Gladstone RA, Badhwar N, et al. Brain emboli after left ventricular endocardial ablation. Circulation. 2017;135:867-877. doi:10.1161/CIRCULATIONAHA.116.025546
Latchamsetty R, Yokokawa M, Morady F, et al. Multicenter outcomes for catheter ablation of idiopathic premature ventricular complexes. JACC Clin Electrophysiol. 2015;1:116-123. doi:10.1016/j.jacep.2015.04.005
Anderson RD, Kumar S, Parameswaran R, et al. Differentiating right- and left-sided outflow tract ventricular arrhythmias. Circ Arrhyth Electrophysiol. 2019;12:e007392. doi:10.1161/CIRCEP.119.007392
Park K-M, Kim Y-H, Marchlinski FE. Using the surface electrocardiogram to localize the origin of idiopathic ventricular tachycardia. Pac Clin Electrophysiol. 2012;35:1516-1527. doi:10.1111/j.1540-8159.2012.03488.x
Betensky BP, Park RE, Marchlinski FE, et al. The V(2) transition ratio: a new electrocardiographic criterion for distinguishing left from right ventricular outflow tract tachycardia origin. J Am Coll Cardiol. 2011;57:2255-2262. doi:10.1016/j.jacc.2011.01.035
Yoshida N, Yamada T, Mcelderry HT, et al. A novel electrocardiographic criterion for differentiating a left from right ventricular outflow tract tachycardia origin: the V2S/V3R index. J Cardiovasc Electrophysiol. 2014;25:747-753. doi:10.1111/jce.12392
Yoshida N, Inden Y, Uchikawa T, et al. Novel transitional zone index allows more accurate differentiation between idiopathic right ventricular outflow tract and aortic sinus cusp ventricular arrhythmias. Heart Rhythm. 2011;8:349-356. doi:10.1016/j.hrthm.2010.11.023
He Z, Liu M, Yu M, et al. An electrocardiographic diagnostic model for differentiating left from right ventricular outflow tract tachycardia origin. J Cardiovasc Electrophysiol. 2018;29:908-915. doi:10.1111/jce.13493
Ludwik B, Deutsch K, Mazij M, et al. Electrocardiographic algorithms to guide the management strategy of idiopathic outflow tract ventricular arrhythmias. Pol Arch Intern Med. 2017;127:749-757. doi:10.20452/pamw.4097
Penela D, De Riva M, Herczku C, et al. An easy-to-use, operator-independent, clinical model to predict the left vs. right ventricular outflow tract origin of ventricular arrhythmias. Europace. 2015;17:1122-1128. doi:10.1093/europace/euu373
Cheng Z, Cheng K, Deng H, et al. The R-wave deflection interval in lead V3 combining with R-wave amplitude index in lead V1: a new surface ECG algorithm for distinguishing left from right ventricular outflow tract tachycardia origin in patients with transitional lead at V3. Int J Cardiol. 2013;168:1342-1348. doi:10.1016/j.ijcard.2012.12.013
Nikoo MH, Taheri S, Attar A. A novel ECG criterion to differentiate left from right ventricular outflow tract premature complex. Scand Cardiovasc J. 2019;54:139-145. doi:10.1080/14017431.2019.1693616
Xie S, Kubala M, Liang JJ, et al. Lead I R-wave amplitude to differentiate idiopathic ventricular arrhythmias with left bundle branch block right inferior axis originating from the left versus right ventricular outflow tract. J Cardiovasc Electrophysiol. 2018;29:1515-1522. doi:10.1111/jce.13747
Celikyurt U, Agir A, Karauzum I, Karauzum K, Sahin T, Vural A. Predicting value of coupling interval variability in determining the origin of ventricular premature contractions with V3 transition. J Interv Card Electrophysiol. 2018;53:169-174. doi:10.1007/s10840-018-0381-8
Hayashi T, Liang JJ, Shirai Y, et al. Trends in successful ablation sites and outcomes of ablation for idiopathic outflow tract ventricular arrhythmias. JACC Clin Electrophysiol. 2020;6:221-230. doi:10.1016/j.jacep.2019.10.004
Haqqani HM, Tschabrunn CM, Tzou WS, et al. Isolated septal substrate for ventricular tachycardia in nonischemic dilated cardiomyopathy: incidence, characterization, and implications. Heart Rhythm. 2011;8:1169-1176. doi:10.1016/j.hrthm.2011.03.008
Frangogiannis NG. Cardiac fibrosis: cell biological mechanisms, molecular pathways and therapeutic opportunities. Mol Aspects Med. 2019;65:70-99. doi:10.1016/j.mam.2018.07.001
Shirakabe A, Ikeda Y, Sciarretta S, Zablocki DK, Sadoshima J. Aging and autophagy in the heart. Circ Res. 2016;118:1563-1576. doi:10.1161/CIRCRESAHA.116.307474
Schillaci G, Verdecchia P, Borgioni C, et al. Association between persistent pressure overload and ventricular arrhythmias in essential hypertension. Hypertension. 1996;28:284-289. doi:10.1161/01.hyp.28.2.284
Messerli FH, Ventura HO, Elizardi DJ, Dunn FG, Frohlich ED. Hypertension and sudden death. Increased ventricular ectopic activity in left ventricular hypertrophy. Am J Med. 1984;77:18-22. doi:10.1016/0002-9343(84)90430-3
Gami AS, Noheria A, Lachman N, et al. Anatomical correlates relevant to ablation above the semilunar valves for the cardiac electrophysiologist: a study of 603 hearts. J Interv Card Electrophysiol. 2011;30:5-15. doi:10.1007/s10840-010-9523-3
Pavlovic N, Knecht S, Kuhne M, Sticherling C. Changing exits in ventricular outflow tract tachycardia. Heart Rhythm. 2014;11:1495-1496. doi:10.1016/j.hrthm.2013.11.027
Muser D, Santangeli P, Castro SA, et al. Risk stratification of patients with apparently idiopathic premature ventricular contractions: a multicenter international CMR registry. JACC: Clin Electrophysiol. 2020;6:722-735.
Nucifora G, Muser D, Masci PG, et al. Prevalence and prognostic value of concealed structural abnormalities in patients with apparently idiopathic ventricular arrhythmias of left versus right ventricular origin. Circ Arrhyth Electrophysiol. 2014;7:456-462. doi:10.1161/CIRCEP.113.001172
Reithmann C, Kling T, Herkommer B, Fiek M, Ulbrich M. Magnetic resonance imaging abnormalities in the basal interventricular septum of patients with left ventricular outflow tract arrhythmias. J Cardiovasc Electrophysiol. 2019;30:1042-1052. doi:10.1111/jce.13951