Localisation of the origin of 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.

Areas of the left ventricle where VT's can originate from: The left ventricle is depicted as having been opened. Regionsare as follows: AB: anterobasal; AM: mid anterior; AA anterior apex; SB: basal septum; SM, midseptum; SA, apical septum; PB: basal posterior; PM: mid posterior; PA: posterior apex. Adapted from Miller et al.[1]

Using this approach and the algorithm on the right [2] the exit site can be estimated with reasonable accuracy (PPV around 70%).

Localising the VT exit in LBBB VT with negative QRS complexes inferior

Localising the VT exit in LBBB VT with positive QRS complexes inferior

Localising the VT exit in RBBB VT with positive QRS complexes inferior

Localising the VT exit in RBBB VT with negative QRS complexes inferior

References

1. Miller JM, Marchlinski FE, Buxton AE, and Josephson ME. Relationship between the 12-lead electrocardiogram during ventricular tachycardia and endocardial site of origin in patients with coronary artery disease. Circulation. 1988 Apr;77(4):759-66. DOI:10.1161/01.cir.77.4.759 |
2. Segal OR, Chow AW, Wong T, Trevisi N, Lowe MD, Davies DW, Della Bella P, Packer DL, and Peters NS. A novel algorithm for determining endocardial VT exit site from 12-lead surface ECG characteristics in human, infarct-related ventricular tachycardia. J Cardiovasc Electrophysiol. 2007 Feb;18(2):161-8. DOI:10.1111/j.1540-8167.2007.00721.x |