A novel electrocardiography algorithm to differentiate between
ventricular arrhythmia and right ventricular outflow tract versus left
ventricular outflow tract
Abstract
Aim: To evaluate the accuracy of the diagnostic criteria for
determining the origin of outflow tract ventricular arrhythmia (OTVA)
and develop an electrocardiography (ECG) algorithm to predict its
origin. Method: We analyzed the ECGs of 100 patients with OTVA
who underwent successful ablation. The QRS complex was measured during
sinus rhythm and ventricular arrhythmia (VA). After the ECG algorithm
was developed, it was validated in an additional 100 patients from two
different hospitals. Results: In this retrospective study,
among the parameters without restrictions in the transition lead, the
V2S/V3R index (AUC = 0.89) was significantly better in predicting VA
originating from the right ventricular outflow tract (RVOT). Further,
the larger ISA in V1 and V2 (AUC = 0.90) was significantly better in
predicting VAs originating from the left ventricular outflow tract
(LVOT). Among the parameters with the transition lead in V3, the V2S/V3R
index (AUC = 0.82) was significantly better in predicting VAs
originating from the RVOT. On the other hand, the V3 R-wave deflection
interval (AUC = 0.81) was significantly better in predicting VAs
originating from the LVOT. The algorithm combining the V2S/V3R index and
the larger ISA in V1 and V2 could predict OTVA origin with an accuracy
of 85.00%, a sensitivity of 75.68%, a specificity of 90.48%, a
positive predictive value (PPV) of 82.35%, and a negative predictive
value (NPV) of 86.36%. In the validation study, the algorithm exhibited
excellent accuracy (95.00%) and AUC (AUC = 0.95), with a sensitivity of
94.12%, a specificity of 95.45%, a PPV of 91.43%, and an NPV of
96.92%. Conclusion: Our developed algorithm can reliably
predict OTVA origin without restrictions in the transition lead.