Localisation of the origin of a ventricular tachycardia

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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.[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.

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
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 | PubMed ID:3349580 | HubMed [Miller]
  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 | PubMed ID:17338765 | HubMed [segal]

All Medline abstracts: PubMed | HubMed