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

Abstract

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. 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. 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.