From the Division of Cardiology, Department of Internal Medicine,
National Cardiovascular Center, Osaka, Japan (S.K., W.S., K.M., A.T., K.
Suyama, T.K., N.A.); the Department of Cardiology, Okayama University School
of Medicine, Okayama, Japan (T.O.); and Izumisano Municipal Hospital, Osaka,
Japan (K. Shimomura).
Correspondence to Shiro Kamakura, MD, Department of Internal Medicine, National Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka, 565-8565, Japan. E-mail kamakura{at}hsp.ncvc.go.jp
Background—Idiopathic
ventricular tachycardia (VT) is known to arise
from the right ventricular (RV) and left
ventricular outflow tracts (LVOT). However, reliable
noninvasive methods to localize the optimum ablation site for VT have
not been reported.
Methods and Results—Body surface maps (BSM) and 12-lead ECGs were
investigated in 35 VTs from the RVOT and 5 VTs from the LVOT in which
the origin was confirmed during the ablation procedure. The RVOT was
classified into 8 subdivisions with the use of a 3-dimensional anatomic
relation: anterior (A)–posterior (P), right (R)–left (L), and
superior (S)–inferior (I). On the BSM, the following 3
indexes differentiated each location of the origin, with a
diagnostic accuracy of 88% (A-P), 92% (R-L), and 77%
(S-I): (1) the location of the minimum at the early-to-mid QRS (right,
A; left, P), (2) the isopotential distribution in the left shoulder
area after 30 ms of QRS (positive, R; negative, L), and (3) the
downward moving time of the minimum at the early-to-mid QRS (
Conclusions—The origin or the optimum ablation site of idiopathic
VT from RVOT and LVOT can be localized with the use of indexes obtained
with a BSM or 12-lead ECG.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Localization of Optimal Ablation Site of Idiopathic Ventricular Tachycardia from Right and Left Ventricular Outflow Tract by Body Surface ECG
50 ms,
S; <50 ms, I). On the 12-lead ECG, (1) the QRS duration (>140 ms, A;
140 ms, P) and the R-wave pattern in leads II and III (RR' or Rr',
A, R, P), (2) the QS wave amplitude in aVR and aVL (aVRaVL, R;
aVR<aVL, L), and (3) the r-wave amplitude in V1 and
V2 (high, S; low, I) localized the origin with 80%, 86%
(A-P), 80% (R-L), and 66% (S-I) accuracy. R/S1 in lead
V3 was an index suggesting the LVOT origin.
Key Words: tachycardia • mapping • electrocardiography • ablation
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