Localisation of the origin of a ventricular tachycardia: Difference between revisions

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[[File:VT_origins.svg|thumb|Areas of the left ventricle where VT's can originate from: The left ventricle is depicted as having been opened. Regionsare as follows: '''AA''' = antero-apical; '''AB''' = antero-basal; '''AM''' = mid-anterior; '''SA''' = apical septum; '''SB''' = basal-septum; '''SM''' = mid-septum; '''PA''' = posterior apex; '''PB''' = postero-basal; '''PM''' = mid-posterior.. Adapted from Miller et al.<cite>Miller</cite>]]
[[File:VT_origins.svg|thumb|Areas of the left ventricle where VT's can originate from: The left ventricle is depicted as having been opened. Regions are defined as: '''AA''' = antero-apical; '''AB''' = antero-basal; '''AM''' = mid-anterior; '''SA''' = apical septum; '''SB''' = basal-septum; '''SM''' = mid-septum; '''IA''' = inferior apex; '''IB''' = inferior-basal; '''IM''' = mid-inferior. '''Posterior / lateral''' is located on the part between anterior and inferior. Adapted from Miller et al.<cite>Miller</cite>]]
 
 
The localisation of the origin (or exit site) of a ventricular tachycardia can be helpful in understanding the cause of the VT and is very helpful when planning an ablation procedure to treat a ventricular tachycardia.
The localisation of the origin (or exit site) of a ventricular tachycardia can be helpful in understanding the cause of the VT and is very helpful when planning an ablation procedure to treat a ventricular tachycardia.
The steps to finding the exit site are:
# What is the bundle branch block (BBB) configuration?
# What is the inferior lead QRS complex polarity?
# What is the lead I QRS complex polarity?
# What is the lead aVL QRS complex polarity?
# What is the lead aVR QRS complex polarity?
# Where is the R-wave transition point?


Using this approach and the algorithms below <cite>segal</cite>  the exit site can be estimated with reasonable accuracy (PPV around 70%). In these algorhythms, bundle branch block was defined as “left” or “right” based on QRS morphology in lead V1; right bundle branch block (RBBB) pattern was defined by a mono-, bi-, or triphasic R wave or qR in V1; LBBB pattern was defined by a QS, rS, or qrS in V1.
Using this approach and the algorithms below <cite>segal</cite>  the exit site can be estimated with reasonable accuracy (PPV around 70%). In these algorhythms, bundle branch block was defined as “left” or “right” based on QRS morphology in lead V1; right bundle branch block (RBBB) pattern was defined by a mono-, bi-, or triphasic R wave or qR in V1; LBBB pattern was defined by a QS, rS, or qrS in V1.


[[File:LBBB_VT_i.svg|thumb|left|300px|Localising the VT exit in LBBB VT with negative QRS complexes inferior]]
[[File:LBBB_VT_i.svg|thumb|left|300px|Localising the VT exit in LBBB VT with negative QRS complexes inferior. Adapted from Segal et al.<cite>segal</cite>]]
[[File:LBBB_VT_p.svg|thumb|none|300px|Localising the VT exit in LBBB VT with positive QRS complexes inferior]]
[[File:LBBB_VT_p.svg|thumb|none|300px|Localising the VT exit in LBBB VT with positive QRS complexes inferior. Adapted from Segal et al.<cite>segal</cite>]]
[[File:RBBB_VT.svg|thumb|300px|left|Localising the VT exit in RBBB VT with positive QRS complexes inferior]]
[[File:RBBB_VT.svg|thumb|300px|left|Localising the VT exit in RBBB VT with negative QRS complexes inferior. Adapted from Segal et al.<cite>segal</cite>]]
[[File:RBBB_VT2.svg|thumb|300px|none|Localising the VT exit in RBBB VT with negative QRS complexes inferior]]
[[File:RBBB_VT2.svg|thumb|300px|none|Localising the VT exit in RBBB VT with positive QRS complexes inferior. Adapted from Segal et al.<cite>segal</cite>]]
==References==
==References==
<biblio>
<biblio>

Latest revision as of 15:44, 8 March 2023

Areas of the left ventricle where VT's can originate from: The left ventricle is depicted as having been opened. Regions are defined as: AA = antero-apical; AB = antero-basal; AM = mid-anterior; SA = apical septum; SB = basal-septum; SM = mid-septum; IA = inferior apex; IB = inferior-basal; IM = mid-inferior. Posterior / lateral is located on the part between anterior and inferior. Adapted from Miller et al.[1]

The localisation of the origin (or exit site) of a ventricular tachycardia can be helpful in understanding the cause of the VT and is very helpful when planning an ablation procedure to treat a ventricular tachycardia.

The steps to finding the exit site are:

  1. What is the bundle branch block (BBB) configuration?
  2. What is the inferior lead QRS complex polarity?
  3. What is the lead I QRS complex polarity?
  4. What is the lead aVL QRS complex polarity?
  5. What is the lead aVR QRS complex polarity?
  6. Where is the R-wave transition point?

Using this approach and the algorithms below [2] the exit site can be estimated with reasonable accuracy (PPV around 70%). In these algorhythms, bundle branch block was defined as “left” or “right” based on QRS morphology in lead V1; right bundle branch block (RBBB) pattern was defined by a mono-, bi-, or triphasic R wave or qR in V1; LBBB pattern was defined by a QS, rS, or qrS in V1.

Localising the VT exit in LBBB VT with negative QRS complexes inferior. Adapted from Segal et al.[2]
Localising the VT exit in LBBB VT with positive QRS complexes inferior. Adapted from Segal et al.[2]
Localising the VT exit in RBBB VT with negative QRS complexes inferior. Adapted from Segal et al.[2]
Localising the VT exit in RBBB VT with positive QRS complexes inferior. Adapted from Segal et al.[2]

References

Error fetching PMID 17338765:
Error fetching PMID 3349580:
  1. Error fetching PMID 3349580: [Miller]
  2. Error fetching PMID 17338765: [segal]

All Medline abstracts: PubMed | HubMed

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