The Electrocardiogram And Target Diagram Features Of Idiopathic Ventricular Arrhythmia Originating From The Aortic Root

Objective : To investigate the features of surface and intracardiac electrograms of Premature Ventricular Contractions(PVCs)/Ventricular Tachycardia(VT) originating from the aortic root and right ventricular outflow tract.Methods:A retrospective comparative analysis of ECG characteristic that originated from the aortic root and the right ventricular outflow tract/VT, along with electrophysiology study characteristics and radiofrequency catheter ablation success rate. And the characteristics of the effective ablation target diagram about PVCs were observed.Results:From 11 cases of aortic root PVCs / VT, aged 51.64±8.72 years old, consisted of 7 males and 4 females; and 27 cases of right ventricular outflow tract/VT, aged 54.32±10.24 years old, 17 males and 10 females cases. There were no significant differences of QRS duration found between aortic root and RVOT PVCs / VT(151.7 ± 9.3ms VS 151.2 ± 6.5ms, P = 0.85). In all cases were seen large R wave in the inferior leads(II, III, a VF); As for the precordial leads transition we observed difference in two group, The RVOT group had only 14.81% of precordial leads transitional area ≤lead V3, whereas the aortic root group had up to 81.82%(p < 0.01). Among the patients, 22 cases of right ventricular outflow tract/VT were cured, 7 cases of aortic root origin PVCs / VT were ablated successfully, the success rate was 81.48% and 63.63%, respectively. 29 effective target diagrams and 32 invalid target diagrams were analysed comparatively, in which the earliest local potential QRS were 33.83 ± 8.12 ms, 32.42 ± 7.86 ms in two groups respectively. But the spike potential(SP) and fragmented potential(FP) appeared more frequently in the effective targets. The earliest local potential with SP was considered as the diagnostic parameters of the effective target, then the sensitivity, specificity, as well as positive and negative predictive vanes are 27.59%,100.00%,100.00% and 60.38%,; As for FP, they are 68.96%,68.75%,66.67%, and 70.96%, respectively.Conclusion: The precordial lead migration before the V3 lead can be a notable valid point for identifying the PVCs originating from aortic root with right ventricular outflow tract. The earliest local potential with spike potential or fragmentation potential has better specific ity and positive predictive value that can be used as effective target determination.