TY - JOUR
T1 - Validation of an electrocardiographic marker of low voltage areas in the right ventricular outflow tract in patients with idiopathic ventricular arrhythmias
AU - Parreira, Leonor
AU - Marinheiro, Rita
AU - Carmo, Pedro
AU - Chambel, Duarte
AU - Mesquita, Dinis
AU - Amador, Pedro
AU - Marques, Lia
AU - Mancelos, Sofia
AU - Reis, Roberto Palma
AU - Adragao, Pedro
N1 - Funding Information:
This study was in part funded by a grant from the Hospital Luz Lisbon as project NoSA‐APVC (Reference LH.INV.F2019005) under the initiative “Luz Investigação.”
Publisher Copyright:
© 2022 Wiley Periodicals LLC.
PY - 2022/11
Y1 - 2022/11
N2 - Background: Previous studies have reported the presence of subtle abnormalities in the right ventricular outflow tract (RVOT) in patients with apparently normal hearts and ventricular arrhythmias (VAs) from the RVOT, including the presence of low voltage areas (LVAs). This LVAs seem to be associated with the presence of ST-segment elevation in V1 or V2 leads at the level of the 2nd intercostal space (ICS). Objective: Our aim was to validate an electrocardiographic marker of LVAs in the RVOT in patients with idiopathic outflow tract VAs. Methods: A total of 120 patients were studied, 84 patients referred for ablation of idiopathic VAs with an inferior axis by the same operator, and a control group of 36 patients without VAs. Structural heart disease including arrhythmogenic right ventricular cardiomyopathy was ruled out in all patients. An electrocardiogram was performed with V1–V2 at the 2nd ICS, and ST-segment elevation ≥1 mm and T-wave inversion beyond V1 were assessed. Bipolar voltage map of the RVOT was performed in sinus rhythm (0.5–1.5 mV color display). Areas with electrograms <1.5 mV were considered LVAs, and their presence was assessed. We compared three groups, VAs from the RVOT (n = 66), VAs from the LVOT (n = 18) and Control group (n = 36). ST-elevation, T-wave inversion and left versus right side of the VAs were tested as predictors of LVAs, respective odds ratio (ORs) (95% confidence interval [CI]) and p values, were calculated with univariate logist regression. Variables with a p <.005 were included in the multivariate analysis. Results: ST-segment elevation, T-wave inversion and LVAs were present in the RVOT group, LVOT group and Control group as follows: (62%, 17%, and 6%, p <.0001), (33%, 29%, and 0%, p =.001) and (62%, 25%, and 14%, p <.0001). The ST-segment elevation, T-wave inversion and right-sided VAs were all predictors of LVAs, respective unadjusted ORs (95% CI), p values were, 32.31 (11.33–92.13), p <.0001, 4.137 (1.615–10.60), p =.003 and 8.200 (3.309–20.32), p <.0001. After adjustment, the only independent predictor of LVAs was the ST-segment elevation, with an adjusted OR (95% CI) of 20.94 (6.787–64.61), p <.0001. Conclusion: LVAs were frequently present in patients with idiopathic VAs. ST-segment elevation was the only independent predictor of their presence.
AB - Background: Previous studies have reported the presence of subtle abnormalities in the right ventricular outflow tract (RVOT) in patients with apparently normal hearts and ventricular arrhythmias (VAs) from the RVOT, including the presence of low voltage areas (LVAs). This LVAs seem to be associated with the presence of ST-segment elevation in V1 or V2 leads at the level of the 2nd intercostal space (ICS). Objective: Our aim was to validate an electrocardiographic marker of LVAs in the RVOT in patients with idiopathic outflow tract VAs. Methods: A total of 120 patients were studied, 84 patients referred for ablation of idiopathic VAs with an inferior axis by the same operator, and a control group of 36 patients without VAs. Structural heart disease including arrhythmogenic right ventricular cardiomyopathy was ruled out in all patients. An electrocardiogram was performed with V1–V2 at the 2nd ICS, and ST-segment elevation ≥1 mm and T-wave inversion beyond V1 were assessed. Bipolar voltage map of the RVOT was performed in sinus rhythm (0.5–1.5 mV color display). Areas with electrograms <1.5 mV were considered LVAs, and their presence was assessed. We compared three groups, VAs from the RVOT (n = 66), VAs from the LVOT (n = 18) and Control group (n = 36). ST-elevation, T-wave inversion and left versus right side of the VAs were tested as predictors of LVAs, respective odds ratio (ORs) (95% confidence interval [CI]) and p values, were calculated with univariate logist regression. Variables with a p <.005 were included in the multivariate analysis. Results: ST-segment elevation, T-wave inversion and LVAs were present in the RVOT group, LVOT group and Control group as follows: (62%, 17%, and 6%, p <.0001), (33%, 29%, and 0%, p =.001) and (62%, 25%, and 14%, p <.0001). The ST-segment elevation, T-wave inversion and right-sided VAs were all predictors of LVAs, respective unadjusted ORs (95% CI), p values were, 32.31 (11.33–92.13), p <.0001, 4.137 (1.615–10.60), p =.003 and 8.200 (3.309–20.32), p <.0001. After adjustment, the only independent predictor of LVAs was the ST-segment elevation, with an adjusted OR (95% CI) of 20.94 (6.787–64.61), p <.0001. Conclusion: LVAs were frequently present in patients with idiopathic VAs. ST-segment elevation was the only independent predictor of their presence.
KW - catheter ablation
KW - high right precordial leads
KW - idiopathic ventricular arrhythmias
KW - low voltage
KW - right ventricular outflow tract
KW - ST-segment elevation
UR - http://www.scopus.com/inward/record.url?scp=85136507163&partnerID=8YFLogxK
U2 - 10.1111/jce.15654
DO - 10.1111/jce.15654
M3 - Article
C2 - 35971685
AN - SCOPUS:85136507163
SN - 1045-3873
VL - 33
SP - 2322
EP - 2334
JO - Journal of Cardiovascular Electrophysiology
JF - Journal of Cardiovascular Electrophysiology
IS - 11
ER -