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 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.
-[[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==
 <biblio>