Electrocardiographic characteristics differentiating epicardial outflow tract-ventricular arrhythmias originating from the anterior interventricular vein and distal great cardiac vein.
BACKGROUND
The aim of this study was to identify the ECG features that might differentiate between anterior interventricular vein (AIV) and distal great cardiac vein (d-GCV) outflow tract-ventricular arrhythmias (OT-VAs).


RESULTS
Radiofrequency catheter ablation was performed in 13 of 375 patients (3.5%) for AIV or d-GCV OT-VAs. We grouped the 13 patients by the origin, d-GCV (n=9) or AIV (n=4), and compared their ECGs and electrophysiological data. The OT-VA ECGs had S waves in lead I in all 13 patients. The voltage in the inferior lead III and peak deflection index showed no significant between-group differences (2.3±0.7 vs. 2.5±0.3 mV and 0.65±0.04 vs. 0.68±0.04 mV, respectively) for the d-GCV and AIV groups. There were also no significant between-group differences in the QaVL/QaVR, where Q denotes the amplitude of the Q wave in the suffix lead. However, the R/S ratio in V1 (1.7±1.0 [n=5] vs. 0.2±0.05, P=0.04), and QRS duration (149±16.6 vs. 123±3.8 ms, P=0.012) were greater in the d-GCG group than in the AIV group. There were no significant between-group differences in the activation time or pace mapping score at the optimal ablation sites.


CONCLUSIONS
A low R/S ratio in V1 and shorter QRS duration may help identify AIV sites of epicardial OT-VA origin.
Department of Cardiology, Cardiovascular Center, Tsuchiura Kyodo Hospital.
Hitoshi
H
Hachiya
Kenzo
K
Hirao
Hiroaki
H
Nakamura
Hiroshi
H
Taniguchi
Shinsuke
S
Miyazaki
Yuki
Y
Komatsu
Shigeki
S
Kusa
Takamitsu
T
Takagi
Jin
J
Iwasawa
Noboru
N
Ichihara
Akio
A
Kuroi
Tatsuya
T
Hayashi
Yasuaki
Y
Tanaka
Yoshito
Y
Iesaka
D000200:Action Potentials; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D017115:Catheter Ablation; D003331:Coronary Vessels / Q000503:physiopathology* / Q000601:surgery; D003937:Diagnosis, Differential; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate; D006801:Humans; D007564:Japan; D007700:Kinetics; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016896:Treatment Outcome; D055815:Young Adult