The 12-lead electrocardiograph (ECG) is of critical importance both in the diagnosis
of wide complex tachycardia and in the further classification, characterisation and
management of ventricular arrhythmias. With its diligent application and interpretation,
remarkable precision can be achieved in the localisation of the site of origin of
ventricular arrhythmias and this may have major implications in the care of these
patients. This review discusses the technical, anatomic and mechanistic basis of ECG
interpretation in ventricular arrhythmias.
Keywords
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References
- Ventricular tachycardia as default diagnosis in broad complex tachycardia.Lancet. 1994; 343: 386-388
- Wide complex tachycardia – ventricular tachycardia or not ventricular tachycardia, that remains the question.Arrhythm Electrophysiol Rev. 2013; 2: 23-29
- Wide QRS tachycardia in the conscious adult: ventricular tachycardia is the most frequent cause.JAMA. 1989; 261: 1013-1016
- P-wave morphology in focal atrial tachycardia: development of an algorithm to predict the anatomic site of origin.J Am Coll Cardiol. 2006; 48: 1010-1017
- Ventricular tachycardia: mechanistic insights derived from adenosine.Circ Arrhythm Electrophysiol. 2015; 8: 483-491
- Ventricular arrhythmias in normal hearts.Cardiol Clin. 2008; 26 (vi): 367-380
- Ubiquitous myocardial extensions into the pulmonary artery demonstrated by integrated intracardiac echocardiography and electroanatomic mapping: changing the paradigm of idiopathic right ventricular outflow tract arrhythmias.Circ Arrhythm Electrophysiol. 2014; 7: 691-700
- Anatomical correlates relevant to ablation above the semilunar valves for the cardiac electrophysiologist: a study of 603 hearts.J Interv Card Electrophysiol. 2011; 30: 5-15
- Idiopathic ventricular arrhythmias originating from the pulmonary sinus cusp: prevalence, electrocardiographic/electrophysiological characteristics, and catheter ablation.J Am Coll Cardiol. 2015; 66: 2633-2644
- The V(2) transition ratio: a new electrocardiographic criterion for distinguishing left from right ventricular outflow tract tachycardia origin.J Am Coll Cardiol. 2011; 57: 2255-2262
- Value of a posterior electrocardiographic lead for localization of ventricular outflow tract arrhythmias: the V4/V8 ratio.J Am Coll Cardiol Clin Electrophysiol. 2017; 3: 678-686
- Electrocardiographic patterns of superior right ventricular outflow tract tachycardias: distinguishing septal and free-wall sites of origin.J Cardiovasc Electrophysiol. 2003; 14: 1-7
- Catheter ablation of ventricular arrhythmias originating in the vicinity of the His bundle: significance of mapping the aortic sinus cusp.Heart Rhythm. 2008; 5: 37-42
- Inferior lead discordance in ventricular arrhythmias: a specific marker for certain arrhythmia locations.J Cardiovasc Electrophysiol. 2017; 28: 1179-1186
- Ventricular tachycardias arising from the aortic sinus of valsalva: an under-recognized variant of left outflow tract ventricular tachycardia.J Am Coll Cardiol. 2001; 37: 1408-1414
- Idiopathic ventricular arrhythmias originating from the right coronary sinus: prevalence, electrocardiographic and electrophysiological characteristics, and catheter ablation.Heart Rhythm. 2018; 15: 81-89
- Electrocardiographic and electrophysiologic features of ventricular arrhythmias originating from the right/left coronary cusp commissure.Heart Rhythm. 2010; 7: 312-322
- Identification of distinct electrocardiographic patterns from the basal left ventricle: distinguishing medial and lateral sites of origin in patients with idiopathic ventricular tachycardia.Heart Rhythm. 2005; 2: 485-491
- Idiopathic left ventricular tachycardia originating from the mitral annulus.J Cardiovasc Electrophysiol. 2005; 16: 1029-1036
- Percutaneous epicardial ablation of ventricular arrhythmias arising from the left ventricular summit: outcomes and electrocardiogram correlates of success.Circ Arrhythm Electrophysiol. 2015; 8: 337-343
- Demonstration of diastolic and presystolic Purkinje potentials as critical potentials in a macroreentry circuit of verapamil-sensitive idiopathic left ventricular tachycardia.J Am Coll Cardiol. 2000; 36: 811-823
- Ventricular arrhythmias originating from a papillary muscle in patients without prior infarction: a comparison with fascicular arrhythmias.Heart Rhythm. 2008; 5: 1530-1537
- Idiopathic ventricular arrhythmias originating from the tricuspid annulus: prevalence, electrocardiographic characteristics, and results of radiofrequency catheter ablation.Heart Rhythm. 2007; 4: 7-16
- Ventricular arrhythmias originating from papillary muscles in the right ventricle.Heart Rhythm. 2010; 7: 725-730
- Idiopathic ventricular arrhythmias originating from the moderator band: electrocardiographic characteristics and treatment by catheter ablation.Heart Rhythm. 2015; 12: 67-75
- Idiopathic focal epicardial ventricular tachycardia originating from the crux of the heart.Heart Rhythm. 2009; 6: 44-50
- Idiopathic epicardial left ventricular tachycardia originating remote from the sinus of Valsalva: electrophysiological characteristics, catheter ablation, and identification from the 12-lead electrocardiogram.Circulation. 2006; 113: 1659-1666
- Outcomes of catheter ablation of idiopathic outflow tract ventricular arrhythmias with an R wave pattern break in lead V2: a distinct clinical entity.J Cardiovasc Electrophysiol. 2017; 28: 504-514
- Fundamental differences in electrophysiologic and electroanatomic substrate between ischemic cardiomyopathy patients with and without clinical ventricular tachycardia.J Am Coll Cardiol. 2009; 54: 166-173
- Relationship between the 12-lead electrocardiogram during ventricular tachycardia and endocardial site of origin in patients with coronary artery disease.Circulation. 1988; 77: 759-766
- Electroanatomic substrate and ablation outcome for suspected epicardial ventricular tachycardia in left ventricular nonischemic cardiomyopathy.J Am Coll Cardiol. 2009; 54: 799-808
- Catheter ablation of ventricular arrhythmia in nonischemic cardiomyopathy: anteroseptal versus inferolateral scar sub-types.Circ Arrhythm Electrophysiol. 2014; 7: 414-423
- Sinus rhythm ECG criteria associated with basal-lateral ventricular tachycardia substrate in patients with nonischemic cardiomyopathy.J Cardiovasc Electrophysiol. 2011; 22: 1351-1358
- Isolated septal substrate for ventricular tachycardia in nonischemic dilated cardiomyopathy: incidence, characterization, and implications.Heart Rhythm. 2011; 8: 1169-1176
- Apical ventricular tachycardia morphology in left ventricular nonischemic cardiomyopathy predicts poor transplant-free survival.Heart Rhythm. 2013; 10: 621-626
- Bundle branch reentry ventricular tachycardia: an investigation of the circuit with resetting.J Cardiovasc Electrophysiol. 1996; 7: 1082-1085
- Electrocardiographic recognition of the epicardial origin of ventricular tachycardias.Circulation. 2004; 109: 1842-1847
- Site-specific twelve-lead ECG features to identify an epicardial origin for left ventricular tachycardia in the absence of myocardial infarction.Heart Rhythm. 2007; 4: 1403-1410
- Twelve-lead ECG features to identify ventricular tachycardia arising from the epicardial right ventricle.Heart Rhythm. 2006; 3: 1132-1139
- ECG criteria to identify epicardial ventricular tachycardia in nonischemic cardiomyopathy.Circ Arrhythm Electrophysiol. 2010; 3: 63-71
Article info
Publication history
Published online: September 19, 2018
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© 2018 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.