A Simplified Two-Stepwise Electrocardiographic Algorithm to Distinguish Left from Right Ventricular Outflow Tract Tachycardia Origin

Cardiology ◽  
2020 ◽  
Vol 145 (11) ◽  
pp. 710-719
Author(s):  
Miao Yu ◽  
Xiaofeng Li ◽  
Hao Zhang ◽  
Yu Xia ◽  
Jun Liu ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Transitional Zone ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Receiver Operating Characteristic Curves ◽  
Ventricular Outflow Tract Tachycardia ◽  
Left Ventricular Outflow ◽  
Sensitivity Specificity

<b><i>Background:</i></b> There are several electrocardiographic algorithms to predict the origin of idiopathic outflow tract ventricular arrhythmias (OT-VAs). This study aimed to develop a more accurate and efficient stepwise electrocardiographic algorithm to discriminate left ventricular outflow tract (LVOT) from right ventricular outflow tract (RVOT) origin. <b><i>Methods and Results:</i></b> We analyzed 12-lead electrocardiographic characteristics of 173 consecutive OT-VAs patients who underwent successful radiofrequency catheter ablation in the RVOT (<i>n</i> = 124) or LVOT (<i>n</i> = 49). Based on the areas under the receiver operating characteristic curves, the combination of transitional zone (TZ) index &#x3c;0 and V2S/V3R index ≤1.5 exhibited 93.5% sensitivity, 85.9% specificity, and 87.3% accuracy. A further analysis was performed in the 71 OT-VAs with a V3-lead precordial transition. The sensitivity, specificity, and accuracy of the integration of V2S/V3R index ≤1.5 and R-wave deflection interval in lead V3 &#x3e;80 ms were 91.7, 83.1, and 85.9%, respectively. In the prospective evaluation, the combination of TZ index and V2S/V3R index could identify the correct origin sites with 91.2% accuracy in the overall analysis, and the integration of V2S/V3R index ≤1.5 and R-wave deflection interval in lead V3 &#x3e;80 ms exhibited 94% accuracy in V3-lead precordial transition. <b><i>Conclusions:</i></b> The combination of TZ index &#x3c;0 and V2S/V3R index ≤1.5 is a simple and efficient stepwise electrocardiographic algorithm for predicting LVOT origin. For the OT-VAs with a V3-lead precordial transition, the integration of V2S/V3R index ≤1.5 and R-wave deflection interval in lead V3 &#x3e;80 ms would be a better choice.

scholarly journals The Clinical Manifestation of Straight Back Syndrome in Echocardiogram Performance

2021 ◽  
Author(s):  
Wanqian Yu ◽  
Hongzhou Zhang ◽  
Pingping Yang ◽  
Lujin Gan ◽  
Chenxi Wang ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Supine Position ◽  
Left Ventricular Outflow Tract ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Standing Position ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Left Ventricular Outflow ◽  
Experimental Group

Abstract Background: There were no studies on the mechanism of clinical manifestations of straight back syndrome. Our aim was to explore the mechanism of clinical symptoms of straight back syndrome.Methods: From February 2018 to February 2021, we included 4 patients (3 males and 1 female) with straight back syndrome as the experimental group, and 4 normal people matched with sex and BMI as the normal control group. Basic information of patients, laboratory examination, echocardiography in supine and standing position, chest film in positive and lateral position, basic information of control group and echocardiography in supine and standing position were collected. The differences of clinical data between the two groups were compared and analyzed. Results: There were significant differences in left ventricular outflow tract diameter, right ventricular outflow tract diameter and right ventricular outflow tract velocity in the experimental group (their P values were 0.035, 0.011 and 0.015, respectively), but there was no significant difference in left ventricular outflow tract velocity in the standing and supine position (P=0.638). The left ventricular outflow tract diameter, the right ventricular outflow tract diameter and the right ventricular outflow tract velocity in the experimental group were significantly different (P<0.05). The internal diameters of left ventricular outflow tract in upright position, supine position, right ventricular outflow tract, supine position, right ventricular outflow tract were20.50±1.91mm, 18.75±0.96mm;10.00±6.68mm, 15.45±6.06mm;124.25±40.29cm/s and 91.00±28.93cm/s, respectively, in standing position, recumbent position, right ventricular outflow tract, right ventricular outflow tract, supine position, right ventricular outflow tract, supine position, supine position. The velocity of left ventricular outflow tract in upright position was 82.50±2.01 cm/s, and that in supine position was 83.25±2.06 cm/s. There was no significant difference in left ventricular outflow tract velocity in standing and supine position, which may be related to the compression of right ventricular outflow tract.Conclusions: In this study, we got the clinical manifestations of direct-back syndrome patients through comparison of straight back syndrome.

Surgical Treatment of a 4-Year-Old Child with Hypertrophic Obstructive Cardiomyopathy: Case Report

2016 ◽  
Vol 19 (1) ◽  
pp. 043
Author(s):  
Jin Chen ◽  
Qingyu Wu ◽  
Zhonghua Xu ◽  
Xiangchen Kong
Keyword(s):  
Surgical Treatment ◽  
Right Ventricular ◽  
Left Ventricular Outflow Tract ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Hypertrophic Obstructive Cardiomyopathy ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Left Ventricular Outflow ◽  
Left And Right

The incidence of pediatric hypertrophic obstructive cardiomyopathy is low. The lesions usually involve the left ventricle or ventricular septum, leading to either left or right ventricular outflow tract stenosis. However, combined left and right ventricular outflow tract stenosis is rare, and the surgical treatment is limited, especially in children. Surgery to release the obstruction was performed successfully in a 4-year-old child with right and left ventricular outflow tract obstruction together with a hypertrophic cardiomyopathy. The result was excellent.

scholarly journals Right ventricular outflow tract tachycardia worsened during pregnancy

2015 ◽  
Vol 20 ◽  
Author(s):  
Yibar Kambiré ◽  
Lassina Konaté ◽  
Georges Rosario Christian ◽  
Elodie Sib ◽  
Myriam Amoussou ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Ventricular Outflow Tract Tachycardia ◽  
Outflow Tract Tachycardia

scholarly journals P180 Pulmonary valve stenosis and pulmonary trunk aneurysm in old female with syncope

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
C Fiore ◽  
A M F Ali ◽  
T Kemaloglu Oz ◽  
G Cagnazzo ◽  
M Melone ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Pulmonary Valve ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Pulmonary Trunk ◽  
Aortic Aneurysms ◽  
Heart Team ◽  
The Right

Abstract A 77-year-old female, known hypertensive and dyslipidemic on treatment presented with three episodes of syncope in the last two months. On examination; there was grade 4/6 harsh systolic murmur on the lateral sternal border. Transthoracic echocardiography was difficult because of mesocardia and abnormal rotation of the heart due to enlarged right sided chambers. There is mild left ventricular hypertrophy with normal ejection fraction, no left sided valvular disease. The right ventricle was hypertrophied and dilated with normal RV function. The pulmonary valve was thickened with significant systolic flow aliasing through the valve with significant regurgitation and huge main pulmonary trunk aneurysm (59 mm at its wideset diameter) (Figure 1). Transthoracic approach did not allow a correct alignment of the Doppler CW and the correct estimate of pulmonary valvulopathy; TEE was performed with a correct visualization of the valve in deep transgastric projection at 90 degrees. The valve was thickened, fibrotic, degenerated with systolic doming of leaflets (Figure 2) and peak systolic gradient ∼ 70 mmHg (Figure 3). 3D reconstruction of the valve showed a tricuspid valve (Figure 4) with a valve area ∼ 0.9 cm2 using planimetry in MPR (Figure 5). CT scan was performed which confirmed the main pulmonary trunk aneurysm ∼ 60 mm (Figure 6). Therefore, in light of the clinical and instrumental picture, the patient was referred to heart team discussion for the plan of surgical intervention. Discussion According to the ESC guidelines for grown up congenital heart disease in 2010, this pulmonary valve should be intervened upon as it is severe symptomatic PS (1), but there are 2 problems with this case; the first is significant associated PR, so no place for balloon dilatation here, the second problem is the pulmonary artery aneurysm (PAA). The dilemma of management of pulmonary PAA is that all the available data are about aortic aneurysms. Indications for intervention for PAA include: Absolute PAA diameter ≥ 5.5 cm, Increase in the diameter of the aneurysm of ≥ 0.5 cm in 6 mo, Compression of adjacent structures, Thrombus formation in the aneurysm sack, Evidence of valvular pathologies or shunt flow Verification of PAH, Signs of rupture or dissection (2). Surgery could include: Aneurysmorrhaphy only decreases the diameter of the vessel (3). Aneurysmectomy and repair or replacement of the right ventricular outflow tract is commonly used technique recently and mostly suits connective tissue disorders (6). Also, Replacement of the PA and the pulmonary trunk with a conduit (Gore-Tex or Dacron tubes, homografts, or xenografts) starting in the right ventricular outflow tract with replacement of the pulmonary valve (4). Conclusion PAA management is currently challenging because there are no clear guidelines on its optimal treatment. The presence of significant pulmonary valve dysfunction could affect the decision making of the associated PAA management. Abstract P180 Figure.

Sign in / Sign up

Export Citation Format

Share Document