title: Spot diagnosis of inferior axis and concordant R-pattern predicts left ventricular inflow tract tachycardia: Ablation from the great cardiac vein of an underdiagnosed entity.
abstract: BACKGROUND
  The present literature holds an enormous variation concerning origin and ablation site of idiopathic ventricular arrhythmias (VA), ranging from 2.5 to 15% for the origin within the coronary venous system (CVS). The aim of the study was to detect positive predictive ECG morphology patterns to discriminate VA stemming from the CVS.
  
  
  METHODS
  110 consecutive patients (P) with 111 premature ventricular capture beat (PVC) morphologies undergoing successful ablation for VA were retrospectively analyzed concerning their ECG patterns.
  
  
  RESULTS
  20/110 P (18%) displayed their VA origin in the CVS with anterior/anterolateral left ventricular inflow tract (LVIT) (epicardial/GCV) in 16 P (14%), anterior/anterolateral LVIT (endo- and epicardial/GCV) in 3 P (3%), and anterior interventricular vein (AIV) 1 P (<1%). ECG morphology of all GCV cases demonstrated an inferior axis and concordant R-pattern in all precordial leads resulting in 100% sensitivity. One VA demonstrating this pattern was ablated outside at the LVOT resulting in 95% specificity for origin in the anterior/anterolateral LVIT. 3/20 P that were ablated in the CVS required additional endocardial ablation from the anterior/anterolateral LVIT resulting in 80% specificity for sole successful ablation in the CVS.
  
  
  CONCLUSIONS
  An inferior axis and concordant R-pattern in all precordial leads serve as diagnostic markers for an LVIT origin in the surface ECG and suggest a high primary ablation success via the GCV.
authors.affiliation: Märkische Kliniken GmbH, Department of Cardiology and Angiology, Klinikum Lüdenscheid, Lüdenscheid, Germany; Department of Cardiology, University Witten/Herdecke, Witten, Germany. Electronic address: Harilaos.bogossian@klinikum-luedenscheid.de.
authors.forename: Harilaos
authors.initials: H
authors.lastname: Bogossian
authors.affiliation: Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Münster, Germany.
authors.forename: Gerrit
authors.initials: G
authors.lastname: Frommeyer
authors.affiliation: Märkische Kliniken GmbH, Department of Cardiology and Angiology, Klinikum Lüdenscheid, Lüdenscheid, Germany.
authors.forename: Ilias
authors.initials: I
authors.lastname: Ninios
authors.affiliation: Märkische Kliniken GmbH, Department of Cardiology and Angiology, Klinikum Lüdenscheid, Lüdenscheid, Germany.
authors.forename: Fuad
authors.initials: F
authors.lastname: Hasan
authors.affiliation: Märkische Kliniken GmbH, Department of Cardiology and Angiology, Klinikum Lüdenscheid, Lüdenscheid, Germany.
authors.forename: Quy Suu
authors.initials: QS
authors.lastname: Nguyen
authors.affiliation: Märkische Kliniken GmbH, Department of Cardiology and Angiology, Klinikum Lüdenscheid, Lüdenscheid, Germany.
authors.forename: Zana
authors.initials: Z
authors.lastname: Karosiene
authors.affiliation: Märkische Kliniken GmbH, Department of Cardiology and Angiology, Klinikum Lüdenscheid, Lüdenscheid, Germany.
authors.forename: Dejan
authors.initials: D
authors.lastname: Mijic
authors.affiliation: Märkische Kliniken GmbH, Department of Cardiology and Angiology, Klinikum Lüdenscheid, Lüdenscheid, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Bandorski
authors.affiliation: Department of Cardiology, Helios Klinikum Wuppertal, Wuppertal, Germany; Department of Cardiology, University Witten/Herdecke, Witten, Germany.
authors.forename: Melchior
authors.initials: M
authors.lastname: Seyfarth
authors.affiliation: Märkische Kliniken GmbH, Institute of Pathology, Klinikum Lüdenscheid, Lüdenscheid, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Friemann
authors.affiliation: Märkische Kliniken GmbH, Department of Cardiology and Angiology, Klinikum Lüdenscheid, Lüdenscheid, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Lemke
authors.affiliation: Division of Electrophysiology, Department of Cardiovascular Medicine, University of Münster, Münster, Germany.
authors.forename: Lars
authors.initials: L
authors.lastname: Eckardt
authors.affiliation: Märkische Kliniken GmbH, Department of Cardiology and Angiology, Klinikum Lüdenscheid, Lüdenscheid, Germany; Department of Cardiology, University Witten/Herdecke, Witten, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Zarse
mesh_terms: D017115:Catheter Ablation / Q000379:methods*; D015331:Cohort Studies; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000601:surgery*; D004562:Electrocardiography / Q000379:methods; D006801:Humans; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D017180:Tachycardia, Ventricular / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D018879:Ventricular Premature Complexes / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery
keywords: Concordant R pattern; Great cardiac vein; Idiopathic VT; LV inflow tract; Spot diagnosis