title: An easy-to-use, operator-independent, clinical model to predict the left vs. right ventricular outflow tract origin of ventricular arrhythmias.
abstract: OBJECTIVE
  To identify clinical characteristics able to predict a left ventricular outflow tract (LVOT) origin in outflow tract ventricular arrhythmias (OTVAs).
  
  
  RESULTS
  We included 117 consecutive patients (training sample) with successful radiofrequency ablation of OTVA in one centre. A predictive model for LVOT origin was obtained using clinical data. The model was prospectively validated in a second population (testing sample) of 143 patients from two additional centres. In training sample, mean age was 54 ± 17 years, 72 patients (61%) were male, and 63 (54%) had cardiovascular risk factors. Sixty (51%) patients had LVOT origin. Independent predictors for LVOT origin were the presence of hypertension [odds ratio (OR) 2.17, confidence interval (CI) 0.91-6.20, P = 0.09], male gender (OR 4.83, 95% CI 1.89-12.33, P < 0.001), and age >50 years (OR 4.46, 95% CI 1.57-12.7, P = 0.005). A simple score was constructed with these three variables to predict LVOT origin (mean predicted probability of 15% for score 0, 26% for score 1, 60% for score 2, and 87% for score 3, P < 0.001) and reached 80% sensitivity and 75% specificity. The score was validated in the testing sample and was not inferior to previously described electrocardiogram algorithms.
  
  
  CONCLUSIONS
  Patients currently referred for OTVA ablation are older, more frequently men, and with a higher probability for LVOT origin than previously described. A LVOT origin is associated with the presence of hypertension, male gender, and older age, and can be anticipated by using a simple clinical score.
authors: Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut D'Investigació Agustí Pi i Sunyer), C/ Villarroel 170 08036, Barcelona, Catalonia, Spain.
authors: Diego
authors: D
authors: Penela
authors: Leiden University Medical Center, Leiden, The Netherlands.
authors: Marta
authors: M
authors: De Riva
authors: Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut D'Investigació Agustí Pi i Sunyer), C/ Villarroel 170 08036, Barcelona, Catalonia, Spain.
authors: Csaba
authors: C
authors: Herczku
authors: Centro Cardiologico Monzino, Milan, Italy.
authors: Valentina
authors: V
authors: Catto
authors: Centro Cardiologico Monzino, Milan, Italy.
authors: Salvatore
authors: S
authors: Pala
authors: Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut D'Investigació Agustí Pi i Sunyer), C/ Villarroel 170 08036, Barcelona, Catalonia, Spain.
authors: Juan
authors: J
authors: Fernández-Armenta
authors: Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut D'Investigació Agustí Pi i Sunyer), C/ Villarroel 170 08036, Barcelona, Catalonia, Spain.
authors: Juan
authors: J
authors: Acosta
authors: Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut D'Investigació Agustí Pi i Sunyer), C/ Villarroel 170 08036, Barcelona, Catalonia, Spain.
authors: Laura
authors: L
authors: Cipolletta
authors: Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut D'Investigació Agustí Pi i Sunyer), C/ Villarroel 170 08036, Barcelona, Catalonia, Spain.
authors: David
authors: D
authors: Andreu
authors: Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut D'Investigació Agustí Pi i Sunyer), C/ Villarroel 170 08036, Barcelona, Catalonia, Spain.
authors: Roger
authors: R
authors: Borras
authors: Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut D'Investigació Agustí Pi i Sunyer), C/ Villarroel 170 08036, Barcelona, Catalonia, Spain.
authors: Jose
authors: J
authors: Rios
authors: Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut D'Investigació Agustí Pi i Sunyer), C/ Villarroel 170 08036, Barcelona, Catalonia, Spain.
authors: Lluis
authors: L
authors: Mont
authors: Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut D'Investigació Agustí Pi i Sunyer), C/ Villarroel 170 08036, Barcelona, Catalonia, Spain.
authors: Josep
authors: J
authors: Brugada
authors: Centro Cardiologico Monzino, Milan, Italy.
authors: Corrado
authors: C
authors: Carbucicchio
authors: Leiden University Medical Center, Leiden, The Netherlands.
authors: Katja
authors: K
authors: Zeppenfeld
authors: Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic and IDIBAPS (Institut D'Investigació Agustí Pi i Sunyer), C/ Villarroel 170 08036, Barcelona, Catalonia, Spain berruezo@clinic.ub.es.
authors: Antonio
authors: A
authors: Berruezo
mesh_terms: D018780:Body Surface Potential Mapping / Q000379:methods*; D003198:Computer Simulation; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D003937:Diagnosis, Differential; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D017180:Tachycardia, Ventricular / Q000175:diagnosis* / Q000503:physiopathology*; D014584:User-Computer Interface
keywords: Cardiovascular risk factors; Outflow tract; Radiofrequency ablation; Site of origin; Ventricular arrhythmias