Validation of a clinical model for predicting left versus right ventricular outflow tract origin of idiopathic

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Luc Bourquin1, Thomas Küffer2, Babken Asatryan2

  • 1Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.

Pacing and Clinical Electrophysiology : PACE
|August 24, 2023
PubMed

Insights

Predicting the origin of outflow tract ventricular arrhythmias (OTVA) is difficult. A clinical score combining age, sex, and hypertension showed moderate accuracy, but improved significantly when paired with an ECG algorithm for specific cases.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Diagnostics

Background:

  • Outflow tract ventricular arrhythmias (OTVA) present a diagnostic challenge.
  • Identifying the chamber of origin is crucial for effective treatment.
  • A prior clinical risk score (age, sex, hypertension) suggested LVOT origin.

Purpose of the Study:

  • To validate a clinical risk score for predicting left ventricular outflow tract (LVOT) origin in OTVA patients.
  • To assess the score's performance in a new cohort.
  • To explore combined diagnostic approaches.

Main Methods:

  • Two-center observational cohort study of 187 patients undergoing catheter ablation for idiopathic OTVA.
  • Utilized an electroanatomical mapping system.
  • Defined successful ablation by ≥80% PVC burden reduction at 3 months.

Main Results:

  • A clinical score (age, sex, hypertension) showed 73% sensitivity and 67% specificity for LVOT origin.
  • The score's performance was lower than initially reported.
  • Combining the clinical score with an ECG algorithm (V2 S/V3 R-index) improved prediction to 81% sensitivity and 70% specificity for PVCs with R/S transition at V3.

Conclusions:

  • The validated clinical score demonstrated moderate predictive value for LVOT origin in OTVA.
  • The combination of the clinical score and a specific ECG algorithm significantly enhances predictability for certain arrhythmia types.
  • Further refinement of diagnostic tools for OTVA is warranted.
Abstract

Keywords:
ablationoutflow tract tachycardiapremature ventricular complexventricular tachycardia

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