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How to use the 12-lead ECG to predict the site of origin of idiopathic ventricular arrhythmias

      Idiopathic ventricular arrhythmias may arise from anywhere in the heart, and the majority of them can be effectively treated with catheter ablation. The 12-lead electrocardiogram (ECG) is the initial mapping tool to predict the most likely site of origin and is valuable to choose the appropriate ablation strategy. Crucial to ECG interpretation is understanding the attitudinal orientation of the heart within the chest and the relationship between the different cardiac structures. In this review, we provide a stepwise anatomical approach for the localization of idiopathic ventricular arrhythmias based on sequential analysis of the most relevant ECG features.

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      References

        • McAlpine W.A.
        Heart and Coronary Arteries.
        Springer-Verlag, New York1975
        • Yamada T.
        • Litovsky S.H.
        • Kay G.N.
        The left ventricular ostium: an anatomic concept relevant to idiopathic ventricular arrhythmias.
        Circ Arrhythm Electrophysiol. 2008; 1: 396-404
        • Enriquez A.
        • Malavassi F.
        • Saenz L.C.
        • et al.
        How to map and ablate left ventricular summit arrhythmias.
        Heart Rhythm. 2017; 14: 141-148
        • Jamil-Copley S.
        • Bokan R.
        • Kojodjojo P.
        • et al.
        Noninvasive electrocardiographic mapping to guide ablation of outflow tract ventricular arrhythmias.
        Heart Rhythm. 2014; 11: 587-594
        • Hutchinson M.D.
        • Garcia F.C.
        An organized approach to the localization, mapping, and ablation of outflow tract ventricular arrhythmias.
        J Cardiovasc Electrophysiol. 2013; 24: 1189-1197
        • Bala R.
        • Garcia F.C.
        • Hutchinson M.D.
        • et al.
        Electrocardiographic and electrophysiologic features of ventricular arrhythmias originating from the right/left coronary cusp commissure.
        Heart Rhythm. 2010; 7: 312-322
        • Yamauchi Y.
        • Aonuma K.
        • Takahashi A.
        • et al.
        Electrocardiographic characteristics of repetitive monomorphic right ventricular tachycardia originating near the His-bundle.
        J Cardiovasc Electrophysiol. 2005; 16: 1041-1048
        • Tada H.
        • Tadokoro K.
        • Ito S.
        • et al.
        Idiopathic ventricular arrhythmias originating from the tricuspid annulus: prevalence, electrocardiographic characteristics, and results of radiofrequency catheter ablation.
        Heart Rhythm. 2007; 4: 7-16
        • Betensky B.P.
        • Park R.E.
        • Marchlinski F.E.
        • et al.
        The V2 transition ratio: a new electrocardiographic criterion for distinguishing left from right ventricular outflow tract tachycardia origin.
        J Am Coll Cardiol. 2011; 57: 2255-2262
        • Yoshida N.
        • Yamada T.
        • McElderry H.T.
        • et al.
        A novel electrocardiographic criterion for differentiating a left from right ventricular outflow tract tachycardia origin: the V2S/V3R index.
        J Cardiovasc Electrophysiol. 2014; 25: 747-753
        • Ouyang F.
        • Fotuhi P.
        • Ho S.Y.
        • et al.
        Repetitive monomorphic ventricular tachycardia originating from the aortic sinus cusp: electrocardiographic characterization for guiding catheter ablation.
        J Am Coll Cardiol. 2002; 39: 500-508
        • Cheng D.
        • Ju W.
        • Zhu L.
        • et al.
        V3R/V7 index.
        Circ Arrhythm Electrophysiol. 2018; 11: e006243
        • Zhang F.
        • Hamon D.
        • Fang Z.
        • et al.
        Value of a posterior electrocardiographic lead for localization of ventricular outflow tract arrhythmias: the V4/V8 ratio.
        JACC Clin Electrophysiol. 2017; 3: 678-686
        • Yamada T.
        • McElderry H.T.
        • Doppalapudi H.
        • et al.
        Idiopathic ventricular arrhythmias originating from the left ventricular summit: anatomic concepts relevant to ablation.
        Circ Arrhythm Electrophysiol. 2010; 3: 616-623
        • Santangeli P.
        • Marchlinski F.E.
        • Zado E.S.
        • et al.
        Percutaneous epicardial ablation of ventricular arrhythmias arising from the left ventricular summit: outcomes and electrocardiogram correlates of success.
        Circ Arrhythm Electrophysiol. 2015; 8: 337-343
        • Hayashi T.
        • Santangeli P.
        • Pathak R.K.
        • et al.
        Outcomes of catheter ablation of idiopathic outflow tract ventricular arrhythmias with an R wave pattern break in lead V2: a distinct clinical entity.
        J Cardiovasc Electrophysiol. 2017; 28: 504-514
        • Sadek M.M.
        • Benhayon D.
        • Sureddi R.
        • et al.
        Idiopathic ventricular arrhythmias originating from the moderator band: electrocardiographic characteristics and treatment by catheter ablation.
        Heart Rhythm. 2015; 12: 67-75
        • Kawamura M.
        • Gerstenfeld E.P.
        • Vedantham V.
        • et al.
        Idiopathic ventricular arrhythmia originating from the cardiac crux or inferior septum: epicardial idiopathic ventricular arrhythmia.
        Circ Arrhythm Electrophysiol. 2014; 7: 1152-1158
        • Al’Aref S.J.
        • Ip J.E.
        • Markowitz S.M.
        • et al.
        Differentiation of papillary muscle from fascicular and mitral annular ventricular arrhythmias in patients with and without structural heart disease.
        Circ Arrhythm Electrophysiol. 2015; 8: 616-624
        • Enriquez A.
        • Pathak R.K.
        • Santangeli P.
        • et al.
        Inferior lead discordance in ventricular arrhythmias: a specific marker for certain arrhythmia locations.
        J Cardiovasc Electrophysiol. 2017; 28: 1179-1186