Electrocardiographic algorithm to identify the optimal target ablation site for idiopathic right ventricular outflow tract ventricular premature contraction

Europace. 2009 Sep;11(9):1214-20. doi: 10.1093/europace/eup231.


Aims: Several electrocardiographic (ECG) algorithms have been developed to identify the site of origin of ventricular premature contractions (VPCs) from right ventricular outflow tract (RVOT) based on pacemapping; however, their accuracy remains unclear.

Methods and results: We evaluated the accuracy of these algorithms in 52 consecutive patients (31 female, mean age 42.6+/-14.6 years) with successful radiofrequency ablation of RVOT-VPC as guided by 3D electroanatomical non-contact mapping (Ensite, St Jude Medical, USA) and compared with a newly proposed ECG algorithm. As guided by 3D electroanatomical mapping, the successful ablation sites of RVOT-VPC were RVOT septum (n=31), RVOT free wall (n=19), and His region (n=2). Retrospective evaluation in the initial 39 patients shows that the overall positive prediction value to identify a successful ablation site of this newly proposed ECG algorithm is 77.3% and is higher than the 73.3% by Ito et al., 73.3% by Joshi et al., and 53.8% by Dixit et al. (P>0.05). Prospective evaluation in the subsequent 13 patients also demonstrate similar high overall sensitivity (79.0%), specificity (92.7%), and positive prediction value (88.2%) to identify a successful ablation site with this newly proposed ECG algorithm.

Conclusion: On the basis of detail 3D electroanatomical mapping of successful ablation sites, a newly proposed ECG algorithm was developed to improve the sensitivity, specificity, and positive prediction value in identification of targeted ablation sites for RVOT-VPC.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Algorithms*
  • Body Surface Potential Mapping / methods*
  • Catheter Ablation / methods*
  • Electrocardiography / methods
  • Heart Conduction System / surgery
  • Humans
  • Middle Aged
  • Reproducibility of Results
  • Retrospective Studies
  • Sensitivity and Specificity
  • Surgery, Computer-Assisted / methods*
  • Treatment Outcome
  • Ventricular Outflow Obstruction / complications
  • Ventricular Outflow Obstruction / diagnosis*
  • Ventricular Outflow Obstruction / surgery*
  • Ventricular Premature Complexes / diagnosis*
  • Ventricular Premature Complexes / etiology
  • Ventricular Premature Complexes / surgery*
  • Young Adult