These tools will no longer be maintained as of December 31, 2024. Archived website can be found here. PubMed4Hh GitHub repository can be found here. Contact NLM Customer Service if you have questions.


Pubmed for Handhelds

PUBMED FOR HANDHELDS

Search MEDLINE/PubMed

  • Title: Modified Precordial Lead R-Wave Deflection Interval Predicts Left- and Right-Sided Idiopathic Outflow Tract Ventricular Arrhythmias.
    Author: Anderson RD, Kumar S, Binny S, Prabhu M, Al-Kaisey A, Parameswaran R, Sugumar H, Chieng D, Hawson J, Campbell T, Joshi S, Lui E, Sparks PB, Joseph SA, Morton JB, McLellan A, Lipton J, Pathik B, Kistler PM, Kalman J, Lee G.
    Journal: JACC Clin Electrophysiol; 2020 Oct 26; 6(11):1405-1419. PubMed ID: 33121670.
    Abstract:
    OBJECTIVES: This study evaluated if modifying electrocardiographic (ECG) precordial leads to a higher intercostal position improved the accuracy of outflow tract ventricular arrhythmia (OTVA) localization. BACKGROUND: Precordial ECG prediction algorithms that use a standard lead configuration localize OTVA with variable accuracy. METHODS: Patients who underwent OTVA ablation were prospectively enrolled to have a standard and modified (high) precordial ECG. R- and S-wave amplitudes and intervals were measured to develop an algorithm that differentiated the right ventricular outflow tract (RVOT) and the left ventricular outflow tract (LVOT) with high accuracy-the modified lead R-wave deflection interval (RWDI). This interval was defined from the earliest QRS onset (using all modified leads) to the lead with longest R-wave deflection. The RWDI was compared with all other ECG algorithms. RESULTS: A total of 50 patients (38 women; mean age 51 ± 17 years) had successful catheter ablation for OTVA (RVOT 60%, LVOT 40%). The modified lead RWDI was significantly shorter in the RVOT group (18.5 ms, interquartile range 25th to 75th percentile [IQR25-75]: 0 to 29.5 ms) compared with the LVOT group (67.5 ms, IQR25-75: 56.5 to 77 ms; p < 0.05). Using a RWDI ≤40 ms to predict an RVOT focus, the sensitivity and specificity of the modified lead RWDI were 100% and 95%, respectively; the area under the receiver-operating characteristic curve was 0.96. This was superior to all previously developed algorithms. In a computed tomography analysis (n = 50), the modified leads were significantly closer to the outflow tracts compared with the standard precordial leads. CONCLUSIONS: The modified lead RWDI is a simple, easily interpretable algorithm that can potentially differentiate a right- or left-sided origin of OTVA with high accuracy.
    [Abstract] [Full Text] [Related] [New Search]