Utility of Conventional Electrocardiographic Criteria in Patients With Idiopathic Ventricular Tachycardia

Anil V. Yadav, Babak Nazer, Barbara J. Drew, John M. Miller, Hicham El Masry, William J. Groh, Andrea Natale, Nassir Marrouche, Nitish Badhwar, Yanfei Yang, Melvin M. Scheinman

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objectives: This study sought to determine the ability of conventional electrocardiographic (ECG) criteria to correctly differentiate idiopathic ventricular tachycardia (VT) from supraventricular tachycardia (SVT) with aberrancy. Background: Previously reported VT ECG criteria were developed from cohorts of patients with structural heart disease and have not been applied to patients with idiopathic VT. Methods: ECGs of 115 idiopathic VTs, 101 post-myocardial infarction (MI) VTs, and 111 wide QRS SVTs were analyzed using standard criteria. VT was diagnosed in patients when at least 1 criterion was met, SVT when no criteria were met, and indeterminate when there were conflicting criteria. Results: Standard ECG criteria more frequently diagnosed VT in the post-MI group than the idiopathic group (95% vs. 82%, respectively; p < 0.01). Diagnosis in only 12 of the 111 SVT patients (11%) met the criterial for VT. All patients in the idiopathic VT group with right branch bundle block morphology who did not meet VT criteria demonstrated an rsR' pattern in V1 (consistent with SVT). Among idiopathic VT patients, Purkinje-associated VT had the lowest sensitivity for correct VT diagnosis in 13 of 23 patients (57%), septal sites of origin were correctly diagnosed in only 56 of 76 patients (74%), whereas nonseptal sites had a high sensitivity in 35 of 35 patients (100%; p < 0.005). Conclusions: Conventional ECG criteria have reduced sensitivity to distinguish VT from SVT with aberrancy in patients with idiopathic VT. This is most pronounced in VT originating from septal sites, particularly Purkinje sites and the septal outflow tract regions. Clinicians should be aware that application of conventional ECG criteria in idiopathic VT may underdiagnose VT.

Original languageEnglish (US)
JournalJACC: Clinical Electrophysiology
DOIs
StateAccepted/In press - Jul 25 2016

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Ventricular Tachycardia
Supraventricular Tachycardia
Myocardial Infarction
Bundle-Branch Block
Heart Diseases

Keywords

  • Catheter ablation
  • Electrocardiogram
  • Idiopathic ventricular tachycardia
  • Wide complex tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Utility of Conventional Electrocardiographic Criteria in Patients With Idiopathic Ventricular Tachycardia. / Yadav, Anil V.; Nazer, Babak; Drew, Barbara J.; Miller, John M.; El Masry, Hicham; Groh, William J.; Natale, Andrea; Marrouche, Nassir; Badhwar, Nitish; Yang, Yanfei; Scheinman, Melvin M.

In: JACC: Clinical Electrophysiology, 25.07.2016.

Research output: Contribution to journalArticle

Yadav, AV, Nazer, B, Drew, BJ, Miller, JM, El Masry, H, Groh, WJ, Natale, A, Marrouche, N, Badhwar, N, Yang, Y & Scheinman, MM 2016, 'Utility of Conventional Electrocardiographic Criteria in Patients With Idiopathic Ventricular Tachycardia', JACC: Clinical Electrophysiology. https://doi.org/10.1016/j.jacep.2017.01.010
Yadav, Anil V. ; Nazer, Babak ; Drew, Barbara J. ; Miller, John M. ; El Masry, Hicham ; Groh, William J. ; Natale, Andrea ; Marrouche, Nassir ; Badhwar, Nitish ; Yang, Yanfei ; Scheinman, Melvin M. / Utility of Conventional Electrocardiographic Criteria in Patients With Idiopathic Ventricular Tachycardia. In: JACC: Clinical Electrophysiology. 2016.
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abstract = "Objectives: This study sought to determine the ability of conventional electrocardiographic (ECG) criteria to correctly differentiate idiopathic ventricular tachycardia (VT) from supraventricular tachycardia (SVT) with aberrancy. Background: Previously reported VT ECG criteria were developed from cohorts of patients with structural heart disease and have not been applied to patients with idiopathic VT. Methods: ECGs of 115 idiopathic VTs, 101 post-myocardial infarction (MI) VTs, and 111 wide QRS SVTs were analyzed using standard criteria. VT was diagnosed in patients when at least 1 criterion was met, SVT when no criteria were met, and indeterminate when there were conflicting criteria. Results: Standard ECG criteria more frequently diagnosed VT in the post-MI group than the idiopathic group (95{\%} vs. 82{\%}, respectively; p < 0.01). Diagnosis in only 12 of the 111 SVT patients (11{\%}) met the criterial for VT. All patients in the idiopathic VT group with right branch bundle block morphology who did not meet VT criteria demonstrated an rsR' pattern in V1 (consistent with SVT). Among idiopathic VT patients, Purkinje-associated VT had the lowest sensitivity for correct VT diagnosis in 13 of 23 patients (57{\%}), septal sites of origin were correctly diagnosed in only 56 of 76 patients (74{\%}), whereas nonseptal sites had a high sensitivity in 35 of 35 patients (100{\%}; p < 0.005). Conclusions: Conventional ECG criteria have reduced sensitivity to distinguish VT from SVT with aberrancy in patients with idiopathic VT. This is most pronounced in VT originating from septal sites, particularly Purkinje sites and the septal outflow tract regions. Clinicians should be aware that application of conventional ECG criteria in idiopathic VT may underdiagnose VT.",
keywords = "Catheter ablation, Electrocardiogram, Idiopathic ventricular tachycardia, Wide complex tachycardia",
author = "Yadav, {Anil V.} and Babak Nazer and Drew, {Barbara J.} and Miller, {John M.} and {El Masry}, Hicham and Groh, {William J.} and Andrea Natale and Nassir Marrouche and Nitish Badhwar and Yanfei Yang and Scheinman, {Melvin M.}",
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T1 - Utility of Conventional Electrocardiographic Criteria in Patients With Idiopathic Ventricular Tachycardia

AU - Yadav, Anil V.

AU - Nazer, Babak

AU - Drew, Barbara J.

AU - Miller, John M.

AU - El Masry, Hicham

AU - Groh, William J.

AU - Natale, Andrea

AU - Marrouche, Nassir

AU - Badhwar, Nitish

AU - Yang, Yanfei

AU - Scheinman, Melvin M.

PY - 2016/7/25

Y1 - 2016/7/25

N2 - Objectives: This study sought to determine the ability of conventional electrocardiographic (ECG) criteria to correctly differentiate idiopathic ventricular tachycardia (VT) from supraventricular tachycardia (SVT) with aberrancy. Background: Previously reported VT ECG criteria were developed from cohorts of patients with structural heart disease and have not been applied to patients with idiopathic VT. Methods: ECGs of 115 idiopathic VTs, 101 post-myocardial infarction (MI) VTs, and 111 wide QRS SVTs were analyzed using standard criteria. VT was diagnosed in patients when at least 1 criterion was met, SVT when no criteria were met, and indeterminate when there were conflicting criteria. Results: Standard ECG criteria more frequently diagnosed VT in the post-MI group than the idiopathic group (95% vs. 82%, respectively; p < 0.01). Diagnosis in only 12 of the 111 SVT patients (11%) met the criterial for VT. All patients in the idiopathic VT group with right branch bundle block morphology who did not meet VT criteria demonstrated an rsR' pattern in V1 (consistent with SVT). Among idiopathic VT patients, Purkinje-associated VT had the lowest sensitivity for correct VT diagnosis in 13 of 23 patients (57%), septal sites of origin were correctly diagnosed in only 56 of 76 patients (74%), whereas nonseptal sites had a high sensitivity in 35 of 35 patients (100%; p < 0.005). Conclusions: Conventional ECG criteria have reduced sensitivity to distinguish VT from SVT with aberrancy in patients with idiopathic VT. This is most pronounced in VT originating from septal sites, particularly Purkinje sites and the septal outflow tract regions. Clinicians should be aware that application of conventional ECG criteria in idiopathic VT may underdiagnose VT.

AB - Objectives: This study sought to determine the ability of conventional electrocardiographic (ECG) criteria to correctly differentiate idiopathic ventricular tachycardia (VT) from supraventricular tachycardia (SVT) with aberrancy. Background: Previously reported VT ECG criteria were developed from cohorts of patients with structural heart disease and have not been applied to patients with idiopathic VT. Methods: ECGs of 115 idiopathic VTs, 101 post-myocardial infarction (MI) VTs, and 111 wide QRS SVTs were analyzed using standard criteria. VT was diagnosed in patients when at least 1 criterion was met, SVT when no criteria were met, and indeterminate when there were conflicting criteria. Results: Standard ECG criteria more frequently diagnosed VT in the post-MI group than the idiopathic group (95% vs. 82%, respectively; p < 0.01). Diagnosis in only 12 of the 111 SVT patients (11%) met the criterial for VT. All patients in the idiopathic VT group with right branch bundle block morphology who did not meet VT criteria demonstrated an rsR' pattern in V1 (consistent with SVT). Among idiopathic VT patients, Purkinje-associated VT had the lowest sensitivity for correct VT diagnosis in 13 of 23 patients (57%), septal sites of origin were correctly diagnosed in only 56 of 76 patients (74%), whereas nonseptal sites had a high sensitivity in 35 of 35 patients (100%; p < 0.005). Conclusions: Conventional ECG criteria have reduced sensitivity to distinguish VT from SVT with aberrancy in patients with idiopathic VT. This is most pronounced in VT originating from septal sites, particularly Purkinje sites and the septal outflow tract regions. Clinicians should be aware that application of conventional ECG criteria in idiopathic VT may underdiagnose VT.

KW - Catheter ablation

KW - Electrocardiogram

KW - Idiopathic ventricular tachycardia

KW - Wide complex tachycardia

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