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Journal of Interventional Cardiac Electrophysiology

Published in:

01-09-2017

Novel electrocardiogram and electrophysiological findings for differentiating idiopathic left posterior papillary muscle and left posterior fascicular ventricular arrhythmias

Authors: Hung-Kai Huang, Fa-Po Chung, Yenn-Jiang Lin, Shih-Lin Chang, Li-Wei Lo, Yu-Feng Hu, Ta-Chuan Tuan, Tze-Fan Chao, Jo-Nan Liao, Chin-Yu Lin, Yao-Ting Chang, Abigail Louise D. Te, Shinya Yamada, Shih-Ann Chen

Published in: Journal of Interventional Cardiac Electrophysiology | Issue 3/2017

Abstract

Purpose

Differentiation between idiopathic left posterior fascicular ventricular arrhythmias (LPF-VAs) and posterior papillary muscle (PPM) VAs is of clinical value. This study aimed to develop an algorithm to distinguish PPM-VAs from LPF-VAs.

Methods

This study enrolled 73 consecutive cases, including 31 with PPM-VAs and 42 with LPF-VAs, undergoing successful ablation by using 3D mapping and intracardiac echography to confirm the origin of the VAs. Electrocardiographic and electrophysiological parameters were compared between two groups.

Results

The 12-lead electrocardiography of the PPM-VAs was characterized by a longer QRS duration than that in LPF-VAs (154.4 ± 14.5 vs. 132.3 ± 13.1 ms, P < 0.001). A QRS duration ≥133 ms was observed in all patients (100%) with PPM-VAs and 13/42 (31.0%) patients with LPF-VAs. The conduction duration from the earliest left ventricular activation site of the VA to the proximal right bundle branch (VA-RBB) was longer in patients with PPM-VAs than LPF-VAs (51.3 ± 12.2 vs. 23.6 ± 7.7 ms, P < 0.001). Based on the ROC analysis, a VA-RBB >36 ms was recognized in 28/31 patients with PPM-VAs (90.3%) and 2/42 with LPF-VAs (4.8%). An algorithm incorporating a QRS duration of ≥133 ms with a conduction duration of a VA-RBB of >36 ms could yield a sensitivity of 90.3% and specificity of 100% for discriminating PPM-VAs from LPF-VAs.

Conclusions

The novel algorithm incorporating a QRS duration of ≥133 ms with a conduction duration of the VA-RBB of >36 ms could be useful in differentiating PPM-VAs from LPF-VAs.

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Title: Novel electrocardiogram and electrophysiological findings for differentiating idiopathic left posterior papillary muscle and left posterior fascicular ventricular arrhythmias
Authors: Hung-Kai Huang
Fa-Po Chung
Yenn-Jiang Lin
Shih-Lin Chang
Li-Wei Lo
Yu-Feng Hu
Ta-Chuan Tuan
Tze-Fan Chao
Jo-Nan Liao
Chin-Yu Lin
Yao-Ting Chang
Abigail Louise D. Te
Shinya Yamada
Shih-Ann Chen
Publication date: 01-09-2017
Publisher: Springer US
Published in: Journal of Interventional Cardiac Electrophysiology / Issue 3/2017
Print ISSN: 1383-875X
Electronic ISSN: 1572-8595
DOI: https://doi.org/10.1007/s10840-017-0265-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Novel electrocardiogram and electrophysiological findings for differentiating idiopathic left posterior papillary muscle and left posterior fascicular ventricular arrhythmias

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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