ventricular tachycardia ecg characteristics

Patient does not provide medical advice, diagnosis or treatment. Download figureDownload PowerPointFigure 3. We used the 2 morphology criteria and adjusted interval criteria that were able to achieve a high specificity of ≥95% with a sensitivity of at least 20% for identifying a paced QRS VT-like complex from the EPI. The sensitivity/specificity values (right box) for interval criteria using the reported cutoffs were poor for identifying VT site of origin. Our clinical information is certified to meet NHS England's Information Standard.Read more. The presence of a QWL1 is a marker of the initial rightward activation of the LV base from the EPI origin. The rest of the interval criteria measurements were not significantly different when comparing EPI and ENDO origin. ECG criteria for identifying an epicardial origin of ventricular tachycardia appear to be region and substrate specific. Patient Platform Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. Ventricular tachycardia (VT) or ventricular fibrillation (VF) is responsible for most of the sudden cardiac deaths in the United States, [] at an estimated rate of approximately 300,000 deaths per year. All patients were referred to the Hospital of the University of Pennsylvania for electrophysiological evaluation and catheter ablation. Local Info These variations are discussed separately. By continuing to browse this site you are agreeing to our use of cookies. A and B, Pace maps from superior basal and lateral basal ENDO LV, respectively. Registered number: 10004395 Registered office: Fulford Grange, Micklefield Lane, Rawdon, Leeds, LS19 6BA. This investigation focused only on patients who had NICM and only on the region of the LV that most frequently demonstrates the substrate for VT, that is, the basal anterior, antero-lateral, and lateral LV ENDO and EPI.7 We did this to enhance the power of the investigative effort and to facilitate the collection of ENDO versus EPI comparative data in areas that typically demonstrate substrate voltage abnormalities. The results unequivocally show that the morphological criteria (presence of a q wave in lead I and absence of q waves in the inferior leads) appear to be the most specific criteria and in the case of presence of a QWL1 also a very sensitive criterion for identifying an EPI site of origin of all prior published criteria. Contact Us, Correspondence to Francis Marchlinski, MD, 9 Founders Pavilion, Hospital of University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104. However, the sensitivity/specificity values (right box) using the reported cutoffs for interval criteria were limited. Admittedly, a very small portion of our mapped VTs (29%) and even smaller portion of mapped VTs with a right bundle-branch block morphology (22%) originated from other anatomic sites such as the basal inferior LV. Can you prevent breakthrough bleeding on the pill? Ventricular tachycardia (VT) is a cardiac arrhythmia characterized by a pulse rate of more than 100 beats per minute, with at least three irregular heartbeats in a row. Capture beats - occasionally ventricular depolarisation occurs along the normal conduction system with a resulting early, narrow QRS complex. However, given the frequency of VTs from the basal anterior and lateral LV in patients with NICM and the ability of the ECG precordial transition to readily identify the basal LV VTs to which the criteria should apply, our data should have significant clinical merit. Published ECG criteria for identifying an epicardial (EPI) origin of ventricular tachycardia (VT) include interval slowing in the initial portion of QRS and morphological criteria identifying the presence of an unanticipated change in the initial QRS vector. This is known as the R-R interval. Both morphology criteria showed a very high sensitivity, and the presence of a q wave in lead I was also seen to be a specific criterion for identifying the VT site of origin. Which rhythm strip finding is a sign of ventricular tachycardia? Torsades de pointes tachycardia - this is a subgroup of polymorphic VT associated with prolongation of the QT interval; the cardiac axis rotates over 5-20 beats first in one direction and then the other; it has a variety of causes and the arrhythmia is often not sustained; anti-arrhythmic drugs can aggravate this rhythm. flutter waves seen at II, III, aVF - usually more prominent and broad in V1. This is an important consideration because many ventricular tachycardias associated with nonischemic cardiomyopathy are epicardial in origin and most of them originate from substrate-based abnormalities near the superior and lateral mitral valve region. A diagnosis of VT is made more reliable by finding evidence of atrial activity independent of ventricular contractions, such as: P waves dissociated from the QRS complex and usually present at a slower rate. Therefore, some of these criteria did not reach a high sensitivity and specificity when evaluating pace maps from the described basal superior and lateral locations. Bradycardias (<60 bpm) are usually caused by diseases affecting the sinoatrial or atrioventricular (AV) nodes or the conducting tissues of the heart (although these may also cause some tachyarrhythmias). Location in the EPI or in the ENDO was considered as a fixed effect predictor in each analyses, and each patient was considered as a random effect predictor, using a compound symmetrical variance. Ventricular rate at 150bpm if at 1:1 block. The rate will be 120-200 bpm. Previously seen q waves in inferior leads are not observed and lead I shows q waves. In these patients, as with the first group of patients, a decision was made to undergo an EPI ablation because of an unsuccessful ENDO LV ablation before or at the time of the EPI mapping ablation procedure. After performing mixed-effects model analyses, significant differences remained (P<0.001) in morphological criteria, strengthening the observations noted. Fusion beats - occur when a normal AV node beat fuses with a beat arising in the ventricles, causing a QRS complex halfway between normal and abnormal beat. Sensitivity and specificity were determined for each ECG feature that reached statistical significance in the comparison of ENDO and EPI pace map QRS complexes. A through E, ECG tracings show 5 VTs arising from different EPI superior and lateral basal origins. Red arrows show q waves in lead I with EPI pacing. Figure 2. A and B, Pace maps from superior basal and lateral basal ENDO LV, respectively. We then applied this algorithm to the entire series of pace maps and VTs to determine the ability of the algorithm to identify the EPI versus ENDO origin. The American Heart Association is qualified 501(c)(3) tax-exempt When the sensitivity and/or specificity was identified as being <75% for any interval measurement from the pace map analysis for identifying an EPI or ENDO site of origin, we reanalyzed the interval data. The following ECG features were assessed in each pace map and VT: (1) QRS duration (QRSd); (2) pseudo-delta wave (PdW), intrinsicoid deflection time (IDT), shortest RS complex (SRS), and maximum deflection index (MDI); and (3) presence of q waves in lead I (QWL1) and presence of q wave in inferior leads (Figure 2). Background. Pace mapping focused on the basal superior and lateral segments of the left ventricle (Josephson sites 8, 10 and 12; Figure 1), in the distribution of confluent scar (Figure 1). E-mail. © Patient Platform Limited. Conclusions— Morphological ECG features that describe the initial QRS vector can help identify basal-superior/lateral EPI VTs in nonischemic cardiomyopathy. Endocardial (ENDO) and EPI basal left ventricle fibrosis characterizes the VT substrate. The VT was defined as originating from the ENDO or EPI region if concealed entrainment with the return cycle length equal to the VT cycle length or a 12 of 12-ECG lead pace map match was observed, and VT was eliminated with catheter ablation. Polymorphic VT - there are the same ECG characteristics as monomorphic VT but there are repeated progressive changes in the QRS axis, so that the complexes appear to twist about the ECG baseline. When interpreting the timing of events on an ECG, one should count the number of squares over which the event in question occurs in order to obtain an accurate reading of how long it has taken.

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