Ventricular tachycardias mimicking those arising from the right ventricular outflow tract

Mark E. Krebs, Philip C. Krause, Erica D. Engelstein, Douglas P. Zipes, William M. Miles

Research output: Contribution to journalArticle

56 Citations (Scopus)

Abstract

RVOT VT Mimics. Introduction: Ablation of ventricular tachycardia (VT) arising from the right ventricular outflow tract (RVOT) has proven highly successful, yet VTs with similar ECG features may originate outside the RVOT. Methods and Results: We reviewed the clinical, echocardiographic, and ECG findings of 29 consecutive patients referred for ablation of monomorphic VT having a left bundle branch block pattern in lead V1 and tall monophasic R waves inferiorly. Nineteen patients (group A) had VTs ablated from the RVOT, and 10 patients (group B) had VTs that could not be ablated from the RVOT. The QRS morphology during VT or frequent ventricular premature complexes was the only variable that distinguished the two groups. During the target arrhythmia, ECGs of group B patients displayed earlier precordial transition zones (median V3 vs V5; P < 0.001), more rightward axes (90 ± 4 vs 83 ± 5; P = 0.002), taller R waves inferiorly (aVF: 1.9 ± 1.0 vs 2.4 ± 0.5; P = 0.020) and small R waves in lead V1 (10/10 vs 9/19; P = 0.011). Radiofrequency catheter ablation from the RVOT failed to eliminate VT in any group B patient, but ablation from the left ventricular outflow tract (LVOT) eliminated VT in 2 of 6 patients in whom left ventricular ablation was attempted. Conclusion: The absence of an R wave in lead V1 and a late precordial transition zone suggest an RVOT origin of VT, whereas an early precordial transition zone characterizes VTs that mimic an RVOT origin. The latter VTs occasionally can be ablated from the LVOT. Recognition of these ECG features may help the physician advise patients and direct one's approach to ablation.

Original languageEnglish
Pages (from-to)45-51
Number of pages7
JournalJournal of Cardiovascular Electrophysiology
Volume11
Issue number1
StatePublished - 2000

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Ventricular Tachycardia
Electrocardiography
Ventricular Premature Complexes
Catheter Ablation
Bundle-Branch Block
Cardiac Arrhythmias
Physicians
Lead

Keywords

  • Ablation
  • Electrophysiology
  • Tachyarrhythmias
  • Ventricular

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology

Cite this

Krebs, M. E., Krause, P. C., Engelstein, E. D., Zipes, D. P., & Miles, W. M. (2000). Ventricular tachycardias mimicking those arising from the right ventricular outflow tract. Journal of Cardiovascular Electrophysiology, 11(1), 45-51.

Ventricular tachycardias mimicking those arising from the right ventricular outflow tract. / Krebs, Mark E.; Krause, Philip C.; Engelstein, Erica D.; Zipes, Douglas P.; Miles, William M.

In: Journal of Cardiovascular Electrophysiology, Vol. 11, No. 1, 2000, p. 45-51.

Research output: Contribution to journalArticle

Krebs, ME, Krause, PC, Engelstein, ED, Zipes, DP & Miles, WM 2000, 'Ventricular tachycardias mimicking those arising from the right ventricular outflow tract', Journal of Cardiovascular Electrophysiology, vol. 11, no. 1, pp. 45-51.
Krebs, Mark E. ; Krause, Philip C. ; Engelstein, Erica D. ; Zipes, Douglas P. ; Miles, William M. / Ventricular tachycardias mimicking those arising from the right ventricular outflow tract. In: Journal of Cardiovascular Electrophysiology. 2000 ; Vol. 11, No. 1. pp. 45-51.
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