Differentiation of arrhythmia originating from the right or left ventricular outflow tract based on the QRS morphology of premature ventricular beats and duration of repolarisation
| Autor: | Jarosław Kolasa, Anika Doruchowska, Jarosław Chmurawa, Andrzej Hoffmann, Iwona Woźniak-Skowerska, Seweryn Nowak, Beata Nowak-Jeż, Maria Trusz-Gluza, Anna Maria Wnuk-Wojnar, Krzysztof Szydło |
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| Rok vydání: | 2013 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Ectopic beat QT interval Ventricular Outflow Obstruction Electrocardiography QRS complex Heart Conduction System Internal medicine Heart rate medicine Humans Ventricular outflow tract Sinus rhythm cardiovascular diseases Interventricular septum Ejection fraction business.industry Arrhythmias Cardiac Middle Aged medicine.disease Ventricular Premature Complexes medicine.anatomical_structure Anesthesia Catheter Ablation cardiovascular system Cardiology Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Kardiologia Polska. 71:723-729 |
| ISSN: | 1897-4279 0022-9032 |
| DOI: | 10.5603/kp.2013.0160 |
| Popis: | Premature ventricular beats (PVBs) and monomorphic ventricular tachycardia originating from the right ventricular outflow tract (RVOT) are the most frequent forms of idiopathic ventricular arrhythmias, but arrhythmia originating from the left ventricular outflow tract (LVOT) may be found in about 10% of these patients.To compare electrocardiographic (ECG) patterns and duration of repolarisation after PVBs originating from the left and right superior part of the interventricular septum which were successfully treated with radiofrequency catheter ablation.We studied 62 patients who did not receive antiarrhythmic drug treatment before ablation, including 50 patients with RVOT arrhythmia (21 males, mean age 42 ± 14 years, left ventricular ejection fraction [LVEF] 61 ± 6%) and 12 patients with LVOT arrhythmia (3 males, mean age 41 ± 17 years, LVEF 59 ± 9%). Pre-ablation 24-h Holter ECG recordings were analysed for the total number of PVBs. In addition, we evaluated ectopic beat QRS duration, prematurity index and duration of repolarisation (QT interval, JT interval and TpeakTend values uncorrected for the heart rate) based on ten random daytime PVBs during a period of stable sinus rhythm at a rate of 60-70 bpm.The study groups did not differ by age, LVEF, heart rate and the number of PVBs. RVOT arrhythmia was characterised by a lower prematurity index (0.59 ± 0.11 vs. 0.72 ± 0.09, p = 0.001) and a lower R/S ratio in leads V1-V3 (p0.01 for each lead). QRS duration of right-sided PVBs was shorter compared to that of left-sided PVBs (147 ± 13 vs. 166 ± 13 ms, p = 0.002), QT and JT intervals were similar (QT: 422 ± 32 vs. 429 ± 27 ms, p = 0.35; JT: 272 ± 27 vs. 266 ± 27 ms, p = 0.31), and TpeakTend was shorter in RVOT arrhythmia (100 ± 10 vs. 110 ± 6 ms, p = 0.01). Combination of RS in lead V3 and TpeakTend-PVB110 ms identified LVOT arrhythmia with a sensitivity of 75% and specificity of 96%.Ventricular arrhythmias originating from the left or right superior part of the interventricular septum are not only characterised by different ECG patterns of ventricular ectopic beats but also show significant differences in the repolarisation phase. |
| Databáze: | OpenAIRE |
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