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Hourly Variability in Outflow Tract Ectopy as a Predictor of its Site of Origin
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  • Michael Waight,
  • Anthony Li,
  • Lisa Leung,
  • Benedict Wiles,
  • Gareth Thomas,
  • Mark Gallagher,
  • Elijah Behr,
  • Manav Sohal,
  • Alejandro Jimenez,
  • Magdi Saba
Michael Waight
St George's University of London

Corresponding Author:[email protected]

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Anthony Li
St. George's University of London
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Lisa Leung
St. George's Hospital NHS Foundation Trust
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Benedict Wiles
St. George's Hospital NHS Foundation Trust
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Gareth Thomas
St. George's Hospital NHS Foundation Trust
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Mark Gallagher
St George's Hospital
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Elijah Behr
St. George's University of London
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Manav Sohal
St. George's University Hospitals NHS Foundation Trust
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Alejandro Jimenez
UM Baltimore
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Magdi Saba
St George's Hospital
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Abstract

Introduction: Prior to ablation, predicting the site of origin (SOO) of outflow tract ventricular arrhythmia (OTVA), can inform patient consent and facilitate appropriate procedural planning. We set out to determine if OTVA variability can accurately predict SOO. Methods: Consecutive patients with a clear SOO identified at OTVA ablation had their prior 24-hour ambulatory ECGs retrospectively analysed (derivation cohort). Percentage ventricular ectopic (VE) burden, hourly VE values, episodes of trigeminy/bigeminy, and the variability in these parameters were evaluated for their ability to distinguish right from left sided SOO. Effective parameters were then prospectively tested on a validation cohort of consecutive patients undergoing their first OTVA ablation. Results: High VE variability (coefficient of variation ≥ 0.7) and the presence of any hour with < 50 VE, were found to accurately predict RVOT SOO in a derivation cohort of 40 patients. In a validation cohort of 29 patients, the correct SOO was prospectively identified in 23/29 patients (79.3%) using CoV, and 26/29 patients (89.7%) using VE < 50. Including current ECG algorithms, VE < 50 had the highest Youden Index (78), the highest positive predictive value (95.0%) and the highest negative predictive value (77.8%). Conclusion: VE variability and the presence of a single hour where VE < 50 can be used to accurately predict SOO in patients with OTVA. Accuracy of these parameters compares favourably to existing ECG algorithms.
12 Aug 2021Submitted to Journal of Cardiovascular Electrophysiology
16 Aug 2021Submission Checks Completed
16 Aug 2021Assigned to Editor
16 Aug 2021Reviewer(s) Assigned
09 Sep 2021Review(s) Completed, Editorial Evaluation Pending
11 Sep 2021Editorial Decision: Revise Minor
17 Sep 20211st Revision Received
24 Sep 2021Submission Checks Completed
24 Sep 2021Assigned to Editor
24 Sep 2021Reviewer(s) Assigned
14 Oct 2021Review(s) Completed, Editorial Evaluation Pending
17 Oct 2021Editorial Decision: Accept
25 Nov 2021Published in Journal of Cardiovascular Electrophysiology. 10.1111/jce.15295