The value of precordial transition in the differential diagnosis of ventricular arrhythmias in the right ventricular outflow tract
WANG Qiaoqiao1, LIN Jiaxuan2, LI Jin2, LI Yuechun2, LIN Jiafeng2.
1.Department of Electrocardiogram, the Affiliated Hospital of Wenzhou Integrated Traditional Chinese and Western Medicine, Wenzhou 325000, China; 2.Department of Cardiology, the Second Affiliated Hospital & Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325027, China
WANG Qiaoqiao,LIN Jiaxuan,LI Jin, et al. The value of precordial transition in the differential diagnosis of ventricular arrhythmias in the right ventricular outflow tract[J]. JOURNAL OF WEZHOU MEDICAL UNIVERSITY, 2019, 49(3): 219-221,225.
Abstract：Objective: To explore the diagnostic value of precordial transition in the ventricular arrhythmia of right ventricular outflow tract. Methods: Retrospectively study was made of ECG data from 295 patients with ventricular arrhythmias originating from the right ventricular outflow tract and 77 cases originating from left ventricular outflow tracts who were successfully treated with catheter radiofrequency ablation (gold standard). Precordial transition in the left and right ventricular outflow tracts and in different parts of the right ventricular outflow tract was observed. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of ventricular arrhythmia in the diagnosis of right ventricular outflow tract with the precordial transition ≥V3 were compared with the precordial transitional zone index ≥0 and a comparison was also made in diagnostic sensitivity of early ventricular outflow tract in different parts of the right ventricle with the Precordial transition ≥V3. Results: The migration score and transition zone index of the left ventricular outflow tract and right ventricular outflow tract were 1.71±0.78, 4.22±0.67, −1.48±1.31, 0.56±0.72 respecitively. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of arrhythmia in the diagnosis of the right ventricular outflow tract with the precordial transition ≥V3 were 76.95%, 93.51%, 80.38%, 97.84%, 51.43% respectively, and 93.56%, 90.91%, 93.01%, 97.53%, 78.65% in the precordial transitional zone index≥0. The thoracic leads in the posterior, medial, anterior, and free wall regions of the right ventricular outflow tract were 3.65±0.82, 3.76±0.54, 4.53±0.65, and 4.75±0.66, respectively. The sensitivity of the precordial transition ≥V3 to the diagnosis of the right posterior ventricular outflow tract in the posterior, middle, anterior, and free wall areas was 56.52%, 66.67%, 89.11%, and 91.18%, respectively. Conclusion: The precordial transition of the left ventricular outflow tract is more delayed than that of the right ventricular outflow tract and is often present in v3 and later leads. The precordial transitional zone index ≥0 improves the positive identification rate. It is particularly applicable to such standards as the free wall area and the front partition wall located in the front of the right ventricular outflow tract.
[1] RILLIG A, LIN T, OUYANG F F, et al. Which is the appropriate arrhythmia burden to offer RF ablation for RVOT tachycardia’s?[J]. J Atr Fibrillation, 2014, 7(4): 41-49.
[2] MOTOKI K, KURITA T, YASUOKA R, et al. Simultaneous existence of sustained doublechamber tachycardias riginating from the aortic sinus of Valsalva[J]. J Cardiovasc Electrophysiol, 2012, 23(4): 436-439.
[3] LAMBA J, REDFEARN D P, MICHAEL K A, et al. Radiofrequency catheter ablation for the treatment of idiopathic premature ventricular contractions originating from the right ventricular outflow tract: a systematic review and meta-analysis[J]. PACE, 2014, 37(1): 73-78.
[4] LING Z, LIU Z, SU L, et al. Radiofrequency ablation versus antiarrhythmic medication for treatment of ventricular premature beats from the right ventricular outflow tract: prospective randomized study[J]. Cire Arrhythm Electrophysiol, 2014, 7(2): 237-243.
[5] 林加锋, 林佳选, 季亢挺, 等. 单导管射频消融治疗右心室心律失常的疗效与安全性[J]. 中华急诊医学杂志, 2008, 17(12): 1308-1313.
[6] YOSHIDA N, INDEN Y, UCHIKAWA T, et al. Novel transitional zone index allows more accurate differentiation between idiopathic right ventricular outflow tract and aortic sinus cusp ventricular arrhythmias[J]. Heart Rhythm, 2011, 8(3): 349-356.
[7] KAMAKURA S, SHIMIZU W, MATSUO K, et al. Localization of optimal ablation site of idiopathic ventricular tachycardia from right and left ventricular outflow tract by body surface ecg[J]. Circulation, 1998, 98(15): 1525-1533.
[8] ARYA A, HUO Y, FROGNER F, et al. Effect of limb lead electrodes location on ecg and localization of idiopathic outflow tract tachycardia: A prospective study[J]. J Cardiovasc Electrophysiol, 2011, 22(8): 886-891.
