Sinus rhythm ECG criteria associated with basal-lateral ventricular tachycardia substrate in patients with nonischemic cardiomyopathy

Wendy S. Tzou, Erica S. Zado, David Lin, David J. Callans, Sanjay Dixit, Joshua M. Cooper, Rupa Bala, Fermin Garcia, Mathew D. Hutchinson, Michael P. Riley, Rajat Deo, Edward P. Gerstenfeld, Francis E. Marchlinski

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Introduction: Patients with nonischemic cardiomyopathy (NICM) and ventricular tachycardia (VT) usually have basal-lateral scar in the left ventricle (LV). We sought to determine electrocardiogram (ECG) characteristics that may help identify NICM patients with basal-lateral scar and VT. Methods and Results: Phase I, study patients (n = 25) had NICM, VT, and endocardial/epicardial basal-lateral LV low voltage consistent with scar on detailed mapping. ECGs were compared to controls (n = 18) with NICM, and comparable age and gender without VT/known scar. All patients had either sinus or paced atrial rhythm ECGs without bundle-branch block or ventricular pacing. In phase II, criteria were evaluated prospectively, blinded to clinical data, using ECGs from 15 NICM patients, of which 7 patients had VT and endocardial/epicardial basal-lateral LV scar on detailed mapping. Of ECG characteristics studied, V1 R and R:S ratio, and V6 S and S:R ratio were univariately associated with basal-lateral-scar associated VT. Controlling for LVEF and multicollinearity in multivariate analyses, V1 R ≥ 0.15 mV (P = 0.001) and V6 S ≥ 0.15 mV (P <0.001), or V6 S:R ≥ 0.2 mV (P <0.001), best predicted presence of basal-lateral scar. In Phase II, the former criteria best identified those with NICM and VT because of basal-lateral scar, with sensitivity and specificity 0.86 and 0.88, respectively. Conclusions: Among patients with NICM, VT, and normal QRS duration, V1 R ≥ 0.15 mV and V6 S ≥ 0.15 mV predicted presence of basal-lateral LV areas of bipolar low voltage. This ECG information may have important value in defining presence of LV scar and possible risk for VT in NICM patients.

Original languageEnglish (US)
Pages (from-to)1351-1358
Number of pages8
JournalJournal of Cardiovascular Electrophysiology
Volume22
Issue number12
DOIs
StatePublished - Dec 2011
Externally publishedYes

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Ventricular Tachycardia
Cardiomyopathies
Cicatrix
Electrocardiography
Heart Ventricles
Lateral Ventricles
Bundle-Branch Block
Multivariate Analysis
Sensitivity and Specificity

Keywords

  • catheter ablation
  • electrocardiogram
  • mapping
  • nonischemic cardiomyopathy
  • ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Sinus rhythm ECG criteria associated with basal-lateral ventricular tachycardia substrate in patients with nonischemic cardiomyopathy. / Tzou, Wendy S.; Zado, Erica S.; Lin, David; Callans, David J.; Dixit, Sanjay; Cooper, Joshua M.; Bala, Rupa; Garcia, Fermin; Hutchinson, Mathew D.; Riley, Michael P.; Deo, Rajat; Gerstenfeld, Edward P.; Marchlinski, Francis E.

In: Journal of Cardiovascular Electrophysiology, Vol. 22, No. 12, 12.2011, p. 1351-1358.

Research output: Contribution to journalArticle

Tzou, WS, Zado, ES, Lin, D, Callans, DJ, Dixit, S, Cooper, JM, Bala, R, Garcia, F, Hutchinson, MD, Riley, MP, Deo, R, Gerstenfeld, EP & Marchlinski, FE 2011, 'Sinus rhythm ECG criteria associated with basal-lateral ventricular tachycardia substrate in patients with nonischemic cardiomyopathy', Journal of Cardiovascular Electrophysiology, vol. 22, no. 12, pp. 1351-1358. https://doi.org/10.1111/j.1540-8167.2011.02129.x
Tzou, Wendy S. ; Zado, Erica S. ; Lin, David ; Callans, David J. ; Dixit, Sanjay ; Cooper, Joshua M. ; Bala, Rupa ; Garcia, Fermin ; Hutchinson, Mathew D. ; Riley, Michael P. ; Deo, Rajat ; Gerstenfeld, Edward P. ; Marchlinski, Francis E. / Sinus rhythm ECG criteria associated with basal-lateral ventricular tachycardia substrate in patients with nonischemic cardiomyopathy. In: Journal of Cardiovascular Electrophysiology. 2011 ; Vol. 22, No. 12. pp. 1351-1358.
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abstract = "Introduction: Patients with nonischemic cardiomyopathy (NICM) and ventricular tachycardia (VT) usually have basal-lateral scar in the left ventricle (LV). We sought to determine electrocardiogram (ECG) characteristics that may help identify NICM patients with basal-lateral scar and VT. Methods and Results: Phase I, study patients (n = 25) had NICM, VT, and endocardial/epicardial basal-lateral LV low voltage consistent with scar on detailed mapping. ECGs were compared to controls (n = 18) with NICM, and comparable age and gender without VT/known scar. All patients had either sinus or paced atrial rhythm ECGs without bundle-branch block or ventricular pacing. In phase II, criteria were evaluated prospectively, blinded to clinical data, using ECGs from 15 NICM patients, of which 7 patients had VT and endocardial/epicardial basal-lateral LV scar on detailed mapping. Of ECG characteristics studied, V1 R and R:S ratio, and V6 S and S:R ratio were univariately associated with basal-lateral-scar associated VT. Controlling for LVEF and multicollinearity in multivariate analyses, V1 R ≥ 0.15 mV (P = 0.001) and V6 S ≥ 0.15 mV (P <0.001), or V6 S:R ≥ 0.2 mV (P <0.001), best predicted presence of basal-lateral scar. In Phase II, the former criteria best identified those with NICM and VT because of basal-lateral scar, with sensitivity and specificity 0.86 and 0.88, respectively. Conclusions: Among patients with NICM, VT, and normal QRS duration, V1 R ≥ 0.15 mV and V6 S ≥ 0.15 mV predicted presence of basal-lateral LV areas of bipolar low voltage. This ECG information may have important value in defining presence of LV scar and possible risk for VT in NICM patients.",
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T1 - Sinus rhythm ECG criteria associated with basal-lateral ventricular tachycardia substrate in patients with nonischemic cardiomyopathy

AU - Tzou, Wendy S.

AU - Zado, Erica S.

AU - Lin, David

AU - Callans, David J.

AU - Dixit, Sanjay

AU - Cooper, Joshua M.

AU - Bala, Rupa

AU - Garcia, Fermin

AU - Hutchinson, Mathew D.

AU - Riley, Michael P.

AU - Deo, Rajat

AU - Gerstenfeld, Edward P.

AU - Marchlinski, Francis E.

PY - 2011/12

Y1 - 2011/12

N2 - Introduction: Patients with nonischemic cardiomyopathy (NICM) and ventricular tachycardia (VT) usually have basal-lateral scar in the left ventricle (LV). We sought to determine electrocardiogram (ECG) characteristics that may help identify NICM patients with basal-lateral scar and VT. Methods and Results: Phase I, study patients (n = 25) had NICM, VT, and endocardial/epicardial basal-lateral LV low voltage consistent with scar on detailed mapping. ECGs were compared to controls (n = 18) with NICM, and comparable age and gender without VT/known scar. All patients had either sinus or paced atrial rhythm ECGs without bundle-branch block or ventricular pacing. In phase II, criteria were evaluated prospectively, blinded to clinical data, using ECGs from 15 NICM patients, of which 7 patients had VT and endocardial/epicardial basal-lateral LV scar on detailed mapping. Of ECG characteristics studied, V1 R and R:S ratio, and V6 S and S:R ratio were univariately associated with basal-lateral-scar associated VT. Controlling for LVEF and multicollinearity in multivariate analyses, V1 R ≥ 0.15 mV (P = 0.001) and V6 S ≥ 0.15 mV (P <0.001), or V6 S:R ≥ 0.2 mV (P <0.001), best predicted presence of basal-lateral scar. In Phase II, the former criteria best identified those with NICM and VT because of basal-lateral scar, with sensitivity and specificity 0.86 and 0.88, respectively. Conclusions: Among patients with NICM, VT, and normal QRS duration, V1 R ≥ 0.15 mV and V6 S ≥ 0.15 mV predicted presence of basal-lateral LV areas of bipolar low voltage. This ECG information may have important value in defining presence of LV scar and possible risk for VT in NICM patients.

AB - Introduction: Patients with nonischemic cardiomyopathy (NICM) and ventricular tachycardia (VT) usually have basal-lateral scar in the left ventricle (LV). We sought to determine electrocardiogram (ECG) characteristics that may help identify NICM patients with basal-lateral scar and VT. Methods and Results: Phase I, study patients (n = 25) had NICM, VT, and endocardial/epicardial basal-lateral LV low voltage consistent with scar on detailed mapping. ECGs were compared to controls (n = 18) with NICM, and comparable age and gender without VT/known scar. All patients had either sinus or paced atrial rhythm ECGs without bundle-branch block or ventricular pacing. In phase II, criteria were evaluated prospectively, blinded to clinical data, using ECGs from 15 NICM patients, of which 7 patients had VT and endocardial/epicardial basal-lateral LV scar on detailed mapping. Of ECG characteristics studied, V1 R and R:S ratio, and V6 S and S:R ratio were univariately associated with basal-lateral-scar associated VT. Controlling for LVEF and multicollinearity in multivariate analyses, V1 R ≥ 0.15 mV (P = 0.001) and V6 S ≥ 0.15 mV (P <0.001), or V6 S:R ≥ 0.2 mV (P <0.001), best predicted presence of basal-lateral scar. In Phase II, the former criteria best identified those with NICM and VT because of basal-lateral scar, with sensitivity and specificity 0.86 and 0.88, respectively. Conclusions: Among patients with NICM, VT, and normal QRS duration, V1 R ≥ 0.15 mV and V6 S ≥ 0.15 mV predicted presence of basal-lateral LV areas of bipolar low voltage. This ECG information may have important value in defining presence of LV scar and possible risk for VT in NICM patients.

KW - catheter ablation

KW - electrocardiogram

KW - mapping

KW - nonischemic cardiomyopathy

KW - ventricular tachycardia

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