Published Online
on April 12, 2004

A more recent version of this article appeared on April 20, 2004

This Article Full Text (PDF) All Versions of this Article: 109/15/1842    most recent 01.CIR.0000125525.04081.4Bv1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Berruezo, A. Articles by Brugada, J. Search for Related Content PubMed PubMed Citation Articles by Berruezo, A. Articles by Brugada, J. Related Collections Electrophysiology Arrhythmias, clinical electrophysiology, drugs

Submitted on July 18, 2003
Revised on January 27, 2004
Accepted on February 2, 2004

Electrocardiographic Recognition of the Epicardial Origin of Ventricular Tachycardias

Antonio Berruezo MD, Lluis Mont MD, Santiago Nava MD, Enrique Chueca MD, Eduardo Bartholomay MD, and Josep Brugada MD, PhD^*

From the Arrhythmia Section, Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain.

^* To whom correspondence should be addressed. E-mail: jbrugada{at}clinic.ub.es.

Background--Some ventricular tachycardias (VTs) originating from the epicardium are not suitable for endocardial radiofrequency ablation and require an epicardial approach. The aim of this study was to define the ECG characteristics that may identify an epicardial origin of VTs.

Methods and Results--We analyzed the 12-lead ECG recordings during epicardial and endocardial left ventricular pacing in 9 patients to verify the hypothesis that the epicardial origin of the ventricular activation widens the initial part of the QRS complex. Then, we analyzed the ECG pattern in 14 VTs successfully ablated from the epicardium after a failed endocardial approach (group A), in 27 VTs successfully ablated from the endocardium (group B), and in 28 additional VTs that could not be ablated from the endocardium (group C). Four distinct intervals of ventricular activation were defined and measured: (1) the pseudodelta wave, (2) the intrinsicoid deflection time in V2, (3) the shortest RS complex, and (4) the QRS complex. VTs from groups A and C showed a significantly longer pseudodelta wave, intrinsicoid deflection time, and RS complex duration compared with VTs of group B. There was no difference between groups A and C. A pseudodelta wave of 34 ms has a sensitivity of 83% and a specificity of 95%, an intrinsicoid deflection time of 85 ms has a sensitivity of 87% and a specificity of 90%, and an RS complex duration of 121 ms has a sensitivity of 76% and a specificity of 85% in identifying an epicardial origin of the VTs.

Conclusions--ECG suggests VTs originating from the epicardium and those with an unsuccessful radiofrequency ablation from the endocardium.

Key words: electrocardiography • pericardium • tachycardia, ventricular

This article has been cited by other articles:

				O. Cano, M. Hutchinson, D. Lin, F. Garcia, E. Zado, R. Bala, M. Riley, J. Cooper, S. Dixit, E. Gerstenfeld, et al. Electroanatomic substrate and ablation outcome for suspected epicardial ventricular tachycardia in left ventricular nonischemic cardiomyopathy. J. Am. Coll. Cardiol., August 25, 2009; 54(9): 799 - 808. [Abstract] [Full Text] [PDF]

				E. M. Aliot, W. G. Stevenson, J. M. Almendral-Garrote, F. Bogun, C. H. Calkins, E. Delacretaz, P. D. Bella, G. Hindricks, P. Jais, M. E. Josephson, et al. EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias: Developed in a partnership with the European Heart Rhythm Association (EHRA), a Registered Branch of the European Society of Cardiology (ESC), and the Heart Rhythm Society (HRS); in collaboration with the American College of Cardiology (ACC) and the American Heart Association (AHA) Europace, June 1, 2009; 11(6): 771 - 817. [Full Text] [PDF]

				H. J. Wellens Forty Years of Invasive Clinical Electrophysiology: 1967-2007 Circ Arrhythm Electrophysiol, April 1, 2008; 1(1): 49 - 53. [Full Text] [PDF]

				J. Najjar, A. Bortone, S. Boveda, and J.-P. Albenque Radiofrequency ablation of an epicardial ventricular tachycardia through the great cardiac vein in a patient with mitro-aortic mechanical prostheses Europace, November 1, 2007; 9(11): 1069 - 1072. [Abstract] [Full Text] [PDF]

				R. E. Eckart, T. W. Hruczkowski, U. B. Tedrow, B. A. Koplan, L. M. Epstein, and W. G. Stevenson Sustained Ventricular Tachycardia Associated With Corrective Valve Surgery Circulation, October 30, 2007; 116(18): 2005 - 2011. [Abstract] [Full Text] [PDF]

				W. G. Stevenson and K. Soejima Catheter Ablation for Ventricular Tachycardia Circulation, May 29, 2007; 115(21): 2750 - 2760. [Full Text] [PDF]

				D. V. Daniels, Y.-Y. Lu, J. B. Morton, P. A. Santucci, J. G. Akar, A. Green, and D. J. Wilber Idiopathic Epicardial Left Ventricular Tachycardia Originating Remote From the Sinus of Valsalva: Electrophysiological Characteristics, Catheter Ablation, and Identification From the 12-Lead Electrocardiogram Circulation, April 4, 2006; 113(13): 1659 - 1666. [Abstract] [Full Text] [PDF]

				A. Berruezo, L. Cano, L. Mont, and J. Brugada Epicardial ablation of syncopal ventricular tachycardia. Utility of the electrocardiogram. Europace, January 1, 2006; 8(5): 338 - 340. [Abstract] [Full Text] [PDF]