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 language | English (US) |
|---|---|
| Pages (from-to) | 1351-1358 |
| Number of pages | 8 |
| Journal | Journal of Cardiovascular Electrophysiology |
| Volume | 22 |
| Issue number | 12 |
| DOIs | |
| State | Published - Dec 2011 |
| Externally published | Yes |
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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 journal › Article
}
TY - JOUR
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
UR - http://www.scopus.com/inward/record.url?scp=83655163898&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=83655163898&partnerID=8YFLogxK
U2 - 10.1111/j.1540-8167.2011.02129.x
DO - 10.1111/j.1540-8167.2011.02129.x
M3 - Article
C2 - 21736660
AN - SCOPUS:83655163898
VL - 22
SP - 1351
EP - 1358
JO - Journal of Cardiovascular Electrophysiology
JF - Journal of Cardiovascular Electrophysiology
SN - 1045-3873
IS - 12
ER -