title: Electrocardiographic algorithm to identify the optimal target ablation site for idiopathic right ventricular outflow tract ventricular premature contraction.
abstract: OBJECTIVE
  Several electrocardiographic (ECG) algorithms have been developed to identify the site of origin of ventricular premature contractions (VPCs) from right ventricular outflow tract (RVOT) based on pacemapping; however, their accuracy remains unclear.
  
  
  RESULTS
  We evaluated the accuracy of these algorithms in 52 consecutive patients (31 female, mean age 42.6+/-14.6 years) with successful radiofrequency ablation of RVOT-VPC as guided by 3D electroanatomical non-contact mapping (Ensite, St Jude Medical, USA) and compared with a newly proposed ECG algorithm. As guided by 3D electroanatomical mapping, the successful ablation sites of RVOT-VPC were RVOT septum (n=31), RVOT free wall (n=19), and His region (n=2). Retrospective evaluation in the initial 39 patients shows that the overall positive prediction value to identify a successful ablation site of this newly proposed ECG algorithm is 77.3% and is higher than the 73.3% by Ito et al., 73.3% by Joshi et al., and 53.8% by Dixit et al. (P>0.05). Prospective evaluation in the subsequent 13 patients also demonstrate similar high overall sensitivity (79.0%), specificity (92.7%), and positive prediction value (88.2%) to identify a successful ablation site with this newly proposed ECG algorithm.
  
  
  CONCLUSIONS
  On the basis of detail 3D electroanatomical mapping of successful ablation sites, a newly proposed ECG algorithm was developed to improve the sensitivity, specificity, and positive prediction value in identification of targeted ablation sites for RVOT-VPC.
authors.affiliation: Cardiovascular Medical Center of Jiangsu, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
authors.forename: Fengxiang
authors.initials: F
authors.lastname: Zhang
authors.forename: Minglong
authors.initials: M
authors.lastname: Chen
authors.forename: Bing
authors.initials: B
authors.lastname: Yang
authors.forename: Weizhu
authors.initials: W
authors.lastname: Ju
authors.forename: Hongwu
authors.initials: H
authors.lastname: Chen
authors.forename: Jian
authors.initials: J
authors.lastname: Yu
authors.forename: Chu-Pak
authors.initials: CP
authors.lastname: Lau
authors.forename: Kejiang
authors.initials: K
authors.lastname: Cao
authors.forename: Hung-Fat
authors.initials: HF
authors.lastname: Tse
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D018780:Body Surface Potential Mapping / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography / Q000379:methods; D006329:Heart Conduction System / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D018879:Ventricular Premature Complexes / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D055815:Young Adult