Background
The relevance of the temporal relationship between a unipolar electrogram (UEGM) and
a bipolar electrogram (BEGM) in determining the site of origin (SOO) of focal arrhythmias
has been largely demonstrated.
Objective
We sought to demonstrate that a negative concordance in the initial forces of these
EGMs is also helpful in predicting the SOO of premature ventricular contractions (PVCs).
Methods
Mapping and radiofrequency (RF) ablation were performed in 41 patients with symptomatic
PVCs in the absence of structural heart disease. Simultaneous recordings of the minimally
filtered (0.5–500 Hz) UEGM and filtered BEGM (30–500 Hz) were analyzed at 247 mapping
sites, where RF was attempted. EGMs of 63 mechanically induced PVCs were separately
analyzed as a validation group. All ablation sites had a QS pattern in the UEGM. Acute
PVC suppression was defined as a complete disappearance of ventricular ectopic beats
after a 60-second pulse of RF.
Results
RF ablation obtained PVC suppression (RF+) in 33 of 247 sites (13.3%). A negative
concordance pattern (NCP) during the initial 20 ms of both UEGM and BEGM was observed
in 31 of 33 (94%) RF+ sites compared with 10 of 214 (4%)RF− sites (P < .0001). The NCP criterion demonstrated to be an additional powerful predictor of
acute RF success with sensitivity, specificity, positive predictive value, and negative
predictive value of 94%, 95%, 76%, and 99%, respectively. Similarly to RF+ sites,
the NCP was observed in 60 of 63 sites (95.2%) in the mechanical PVC group.
Conclusion
An NCP in both UEGM and BEGM may be an additional criterion that helps to localize
the SOO of focal ventricular arrhythmias.
Abbreviations:
BEGM (bipolar electrogram), Bip (first peak (positive or negative) of the bipolar electrogram), ECG (electrocardiogram/electrocardiographic), NCP (negative concordance pattern), NPV (negative predictive value), PPV (positive predictive value), PVC (premature ventricular contraction), RF (points where radiofrequency was delivered without suppression of PVC's), RF+ (radiofrequency-induced complete premature ventricular contraction suppression), ROC (receiver operating characteristic), SOO (site of origin), UEGM (unipolar electrogram), UNIon (onset of the unipolar electrogram), UNIS (rapid negative deflection of the unipolar electrogram)Keywords
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Article info
Publication history
Published online: November 06, 2015
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© 2016 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
