Electrocardiographic morphology of multiple ventricular arrhythmias originating from the right ventricular outflow tract: inverse correlation of the amplitude in the inferior leads and anatomic height of the origin
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It is unclear whether the electrocardiogram amplitude in the inferior leads (Amp-I) can always predict the height of the origin of right ventricular outflow tract arrhythmias (RVOT-VAs). We analyzed patients who received catheter ablation of multiple RVOT-VAs in the same session in our hospital from 2011 to 2016. Two distinguished RVOT-VAs, those with anatomically higher origins (HOs) and lower origins (LOs), were identified and compared to measure the longitudinal distance. Amp-I was uniquely determined for each OTVA as the highest amplitude in leads II, III, and aVF and compared between the HO-VAs and LO-VAs. In total, out of 187 patients who underwent catheter ablation of RVOT-VAs, 9 (4.8%) had multiple right OTVAs successfully treated. Four cases (Group A) had HO-VAs (10.8 ± 5.3 mm from an LO) with a lower Amp-I (1.28 ± 0.46 mV) than the LO-VAs (1.81 ± 0.59 mV), whereas the other 4 patients (Group B) had HO-VAs with a higher Amp-I (1.91 ± 0.23 mV) than the LO-VAs (1.26 ± 0.35 mV). In Group A, all HO-VAs originated from the lateral free wall and had notched R waves in the inferior leads, whereas all LOs with higher Amp-Is were located on the septum. In one patient, the HO and LO were at almost the same height, while a VA from a lateral origin had lower notched R waves in the inferior leads. A divided excitation from high lateral origins may result in not only QRS notching, but also a reduction in the QRS amplitude. In patients harboring multiple RVOT-VAs, VAs arising from the high lateral free wall could have lower Amp-Is than VAs from low septal origins.
KeywordsCatheter ablation Electrocardiogram Ventricular arrhythmia Ventricular premature contraction Ventricular tachycardia
We would like to thank Mr. John Martin for his help in the preparation of the manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
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