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Review
. 2021 Apr;10(1):10-16.
doi: 10.15420/aer.2020.10.

Electrocardiographic Criteria for Differentiating Left from Right Idiopathic Outflow Tract Ventricular Arrhythmias

Marco V Mariani  1 , Agostino Piro  1 , Domenico G Della Rocca  2 , Giovanni B Forleo  3 , Naga Venkata Pothineni  4 , Jorge Romero  5 , Luigi Di Biase  5 , Francesco Fedele  1 , Carlo Lavalle  1
Affiliations
Review

Electrocardiographic Criteria for Differentiating Left from Right Idiopathic Outflow Tract Ventricular Arrhythmias

Marco V Mariani et al. Arrhythm Electrophysiol Rev. 2021 Apr.

Abstract

Idiopathic ventricular arrhythmias are ventricular tachycardias or premature ventricular contractions presumably not related to myocardial scar or disorders of ion channels. Of the ventricular arrhythmias (VAs) without underlying structural heart disease, those arising from the ventricular outflow tracts (OTs) are the most common. The right ventricular outflow tract (RVOT) is the most common site of origin for OT-VAs, but these arrhythmias can, less frequently, originate from the left ventricular outflow tract (LVOT). OT-VAs are focal and have characteristic ECG features based on their anatomical origin. Radiofrequency catheter ablation (RFCA) is an effective and safe treatment strategy for OT-VAs. Prediction of the OT-VA origin according to ECG features is an essential part of the preprocedural planning for RFCA procedures. Several ECG criteria have been proposed for differentiating OT site of origin. Unfortunately, the ECG features of RVOT-VAs and LVOT-VAs are similar and could possibly lead to misdiagnosis. The authors review the ECG criteria used in clinical practice to differentiate RVOT-VAs from LVOT-VAs.

Keywords: Idiopathic ventricular arrhythmia; catheter ablation; electrocardiogram; ventricular outflow tract.

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Conflict of interest statement

Disclosure: The authors have no conflicts of interest to declare.

Figures

Figure 1:
Figure 1:. Activation Map of Ventricular Arrhythmias Originating from the Posteroseptal Right Ventricular Outflow Tract Site
Figure 2:
Figure 2:. Intracardiac Echocardiography Showing the Relationship Between the Right Coronary Cusp and Right Ventricular Outflow Tract
Figure 3:
Figure 3:. 12-lead ECG of Ventricular Arrhythmias Arising from Right Ventricular Outflow Tract Anterior, Middle and Posterior Sites
Figure 4:
Figure 4:. 12-lead ECG of Ventricular Arrhythmias Arising from Different Left Ventricular Outflow Tract Sites
See this image and copyright information in PMC

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