Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jan;33(1):7-16.
doi: 10.1111/jce.15295. Epub 2021 Nov 25.

Hourly variability in outflow tract ectopy as a predictor of its site of origin

Michael C Waight  1 , Anthony C Li  1   2 , Lisa W Leung  1 , Benedict M Wiles  2 , Gareth R Thomas  2 , Mark M Gallagher  2 , Elijah R Behr  1   2 , Manav Sohal  2 , Alejandro J Restrepo  3 , Magdi M Saba  1   2
Affiliations

Hourly variability in outflow tract ectopy as a predictor of its site of origin

Michael C Waight et al. J Cardiovasc Electrophysiol. 2022 Jan.

Abstract

Introduction: Before ablation, predicting the site of origin (SOO) of outflow tract ventricular arrhythmia (OTVA), can inform patient consent and facilitate appropriate procedural planning. We set out to determine if OTVA variability can accurately predict SOO.

Methods: Consecutive patients with a clear SOO identified at OTVA ablation had their prior 24-h ambulatory ECGs retrospectively analysed (derivation cohort). Percentage ventricular ectopic (VE) burden, hourly VE values, episodes of trigeminy/bigeminy, and the variability in these parameters were evaluated for their ability to distinguish right from left-sided SOO. Effective parameters were then prospectively tested on a validation cohort of consecutive patients undergoing their first OTVA ablation.

Results: High VE variability (coefficient of variation ≥0.7) and the presence of any hour with <50 VE, were found to accurately predict RVOT SOO in a derivation cohort of 40 patients. In a validation cohort of 29 patients, the correct SOO was prospectively identified in 23/29 patients (79.3%) using CoV, and 26/29 patients (89.7%) using VE < 50. Including current ECG algorithms, VE < 50 had the highest Youden Index (78), the highest positive predictive value (95.0%) and the highest negative predictive value (77.8%).

Conclusion: VE variability and the presence of a single hour where VE < 50 can be used to accurately predict SOO in patients with OTVA. Accuracy of these parameters compares favorably to existing ECG algorithms.

Keywords: LVOT (left ventricular outflow tract) ectopy; RVOT (right ventricular outflow tract) ectopy; outflow tract ventricular arrhythmia; radiofrequency ablation.

PubMed Disclaimer

Comment in

References

REFERENCES

    1. Kim RJ, Iwai S, Markowitz SM, Shah BK, Stein KM, Lerman BB. Clinical and electrophysiological spectrum of idiopathic ventricular outflow tract arrhythmias. J Am Coll Cardiol. 2007;49:2035-2043.
    1. Baman TS, Lange DC, Ilg KJ, et al. Relationship between burden of premature ventricular complexes and left ventricular function. Heart Rhythm. 2010;7:865-869.
    1. Anderson RD, Kumar S, Parameswaran R, et al. Differentiating right- and left-sided outflow tract ventricular arrhythmias. Circ Arrhythmia Electrophysiol. 2019;12:7392.
    1. Bas HD, Baser K, Hoyt J, et al. Effect of circadian variability in frequency of premature ventricular complexes on left ventricular function. Heart Rhythm. 2016;13:98-102.
    1. 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.

Publication types

LinkOut - more resources