Compression of the Right Ventricular Outflow Tract due to ...
董建增 首都医科大学北京安贞医院 ECG Outflow Tract VT. 内容 Ventricular outflow...
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Transcript of 董建增 首都医科大学北京安贞医院 ECG Outflow Tract VT. 内容 Ventricular outflow...
董建增首都医科大学北京安贞医院
ECG Outflow Tract VT
内容Ventricular outflow tract VT
right ventricular outflow tract
septal ( anterior , mid , posterial ) free wall
left ventricular outflow tract
supra valvular (above aortic valve) left cusp , right cusp , non-coronary
infra valvular (below aortic valve)
others
para-His , epicardially….
LV
LVRV
心室流出道有关解剖
Suleiman M, Heart Rhythm 2008;5:1485
VT from Septal RVOT
I: ± , R/S transition late
I
II
III
R
L
F
V1
V2
V3
V4
V5
V6 ②① ③ ④
Electrocardiogram Characteristics of VT from RVOT
*ILs I R/L V1 R/S s /V5-6
① R ± =1 QS >V3 no
② R ± =1 QS >V3 no
③ R ± =1 rS >V3 no
④ R + =1 QS >V2 no*ILs = inferior leads
Septal Wall: ① ②③Free Wall : ④
J Cardiovasc Electrophysiol 2003; 14: 1-7
Electrocardiographic Patterns of Superior RVOTs: Distinguishing Septal and Free-Wall Sites of Origin
J Cardiovasc Electrophysiol 2003; 14: 1-7
Electrocardiographic Patterns of Superior RVOTs: Distinguishing Septal and Free-Wall Sites of Origin
Septal free wall
J Cardiovasc Electrophysiol 2003; 14: 1-7
Electrocardiographic Patterns of Superior RVOTs: Distinguishing Septal and Free-Wall Sites of Origin
J Cardiovasc Electrophysiol 2003; 14: 1-7
Electrocardiographic Patterns of Superior RVOTs: Distinguishing Septal and Free-Wall Sites of Origin
VT from Supravalvular LVOT
30ms↗ aVR<aVL ↗ rS/ S too shallow ↗rS/ r too big ↗ V5 terminated by tiny s
VT from Supravalvular LVOT
IIIIIIRLF V1V2V3V4V5V6Abl
pace map activation map
40ms
VT from infravalvular LVOT
I: more negative , R/S transition V1
I
II
III
R
L
F
V1
V2
V3
V4
V5
V6 ⑥⑤ ⑦ ⑧
Electrocardiogram Characteristics of VT from LVOT
*ILs I R/L V1 R/S s /V4-6
⑤ R - - <1 R <V1 yes
⑥ R - <1 Rs <V3 yes
⑦ R - <1 rS >V3 no
⑧ R - <1 rS <V3 yes*ILs = inferior leads
Infra-valvular: ⑤ Supra-valvular: ⑥⑦⑧
J Cardiovasc Electrophysiol 2002; 13: 1050-1053
Left Ventricular Outflow Tract Tachycardia Originating from the Right Coronary Cusp
J Cardiovasc Electrophysiol 2002; 13: 1050-1053
Left Ventricular Outflow Tract Tachycardia Originating from the Right Coronary Cusp
Left Ventricular Outflow Tract Tachycardia Originating from the Right Coronary Cusp
Left Ventricular Outflow Tract Tachycardia Originating from the Right Coronary Cusp
Left Ventricular Outflow Tract Tachycardia Originating from the Right Coronary Cusp
Left Ventricular Outflow Tract Tachycardia Originating from the Right Coronary Cusp
Noncoronary aortic cusp
J Cardiovasc Electrophysiol, 2012; 23, 98-101
Epicardial Radiofrequency Ablation of an Unusual and Unexpected Ventricular Tachycardia
J Cardiovasc Electrophysiol 2009; 20: 813-817
Ablation of Left Ventricular Epicardial OutflowTract Tachycardia From the Distal Great Cardiac Vein
J Am Coll Cardiol 2006; 48: 1813–17
J Am Coll Cardiol 2005;45:418 –23
Outflow Tract Tachycardia With R/S Transition in Lead V3
J Cardiovasc Electrophysiol 2011; 22: 878-885
Ventricular Arrhythmias Arising from theRight Ventricular Septum Close to the His Bundle
LSVLeft sinus VlsalvaLV endLV endocardiumLV epiLV epicardiumNear Hisnear His bundleRVright ventricle
J Cardiovasc Electrophysiology 2003; 14: 1280-86
ECG Algorityhm for Identifying the Optimal Ablation Site for Idiopathic Outflow Tract VT
脑子中装 3 份体表心电图
典型右室流出道间隔部
典型左室流出道左冠瓣上
典型左室流出道主动脉瓣下
胸导联位置位置关系Holter 的差异左中右 上下前后
J Cardiovasc Electrophysiol 2008: 19: 495-501
Variants of Idiopathic Left Ventricular Outflow Tract Ventricular Tachyarrhythmias
J Cardiovasc Electrophysiol 2008: 19: 495-501
Variants of Idiopathic Left Ventricular Outflow Tract Ventricular Tachyarrhythmias
J Cardiovasc Electrophysiol 2008: 19: 495-501
ECG Variants of Idiopathic Left Ventricular Outflow Tract Ventricular Tachyarrhythmias
ASC-VTs MA AMC
J Cardiovasc Electrophysiol 2005; 1378-1380
Epicardial Left Ventricular Outflow Tract Tachycardia from the Anterior Interventricular Coronary Vein
J Cardiovasc Electrophysiol 2005; 1378-1380
Epicardial Left Ventricular Outflow Tract Tachycardia from the Anterior Interventricular Coronary Vein
J Am Coll Cardiol 2005;45:418 –23
Outflow Tract Tachycardia With R/S Transition in Lead V3
J Cardiovasc Electrophysiol 2011; 22:886-891
Effect of Limb Lead Electrodes Location on ECG andLocalization of Idiopathic Outflow Tract Tachycardia
ECG: ARVC vs. RVOT
J Am Coll Cardiol 2011;58:831–8Examples of Measurements Examples of Notching
ECG: ARVC vs. RVOT
J Am Coll Cardiol 2011;58:831–8
Characteristic Features
ARVCDuration of QRS in lead I of 120 ms
Notching on QRS complex
Notching on upstroke of QRS
Multiple notching of the QRS across several leads
Earliest onset of QRS on lead V1
Transition at V5 or later†
The V2 Transition Ratio
The V2 transition ratio is a novel electrocardiographic measure that reliably distinguishes LVOT from RVOT origin in patients with lead V3 precordial transition
J Am Coll Cardiol 2011;57:2255–62Electrocardiographic Measurements
B/(B+C)VT ÷ E/(E+F)SRLVOT PVCs vs. RVOT PVCs 1.27 0.60 vs. 0.23 0.16; p 0.001
V2 transition ratio 0.60 predicted an LVOT origin with 91% accuracy
A PVC precordial transition occurring later than the sinus rhythm transition excluded an LVOT origin with 100% accuracy
Am J Cardiol 2010; 105: 1821–1824
Precordial TWI to Distinguish Arrhythmogenic Right Ventricular Cardiomyopathy from Idiopathic Ventricular Tachycardia Arising from the Right Ventricular Outflow Tract
During sinus rhythm, 37 patients (47%) withARVC and 5 patients (4%) with RVOT tachycardia had TWI in leads V1 to V3.
For the diagnosis of ARVC, TWI in leads V1 to V3 had sensitivity of 47% and specificity of 96%.
In conclusion, in patients with VT of right ventricular origin, the presence of TWI in electrocardiographic leads V1 to V3 supports the diagnosis of ARVC
ARVOT septalBRVOT free wallC near His bundleDLV endocardiumELeft sinus VlsalvaFLV epicardium
J Cardiovasc Electrophysiology 2003; 14: 1280-86
ECG Algorityhm for Identifying the Optimal Ablation Site for Idiopathic Outflow Tract VT