Electrocardiographic predictors of long-term outcomes after radiofrequency ablation in patients with right-ventricular outflow tract tachycardia.

AIMS The objectives of this study were to identify electrocardiographic (ECG) predictors of long-term outcomes after radiofrequency (RF) ablation in patients with right-ventricular outflow tract (RVOT) tachycardia. METHODS AND RESULTS We correlated ECG characteristics with RF ablation outcomes in 144 patients with RVOT tachycardia who underwent RF ablation for >1 year. Unfavourable RF ablation outcomes were predefined as unsuccessful RF ablation or recurrence of tachycardia requiring repeated ablation. RF ablation was not successful in 11 (7.6%) patients and 16 (12%) patients had arrhythmia recurrence requiring repeated ablation. Average follow-up time was 72.2+/-28.4 months. Selected parameters from univariate analysis included number of RF applications, pacemapping, application of bonus burn, procedure time, monophasic R-wave in lead I, QS pattern in leads I and aVL, QRS duration in leads II and V(2), and right axis deviation, in ventricular tachycardia. From logistic regression analysis, only monophasic R-wave in lead I remained in the final equation (P=0.004, odds ratio 12.9). CONCLUSION Monophasic R-wave in lead I during RVOT tachycardia is associated with unfavourable outcomes after RF ablation. This finding may help clinicians in the selection of patients for RF ablation and for the prediction of RF ablation outcome.

[1]  R. Passman,et al.  New Simplified Technique for 3D Mapping and Ablation of Right Ventricular Outflow Tract Tachycardia , 2005, Pacing and clinical electrophysiology : PACE.

[2]  L. Gepstein,et al.  Usefulness of electroanatomical mapping to differentiate between right ventricular outflow tract tachycardia and arrhythmogenic right ventricular dysplasia. , 2005, The American journal of cardiology.

[3]  H. Hachiya,et al.  Electrocardiographic and electrophysiologic characteristics of ventricular tachycardia originating within the pulmonary artery. , 2005, Journal of the American College of Cardiology.

[4]  G. Hindricks,et al.  Outflow tract tachycardia with R/S transition in lead V3: six different anatomic approaches for successful ablation. , 2005, Journal of the American College of Cardiology.

[5]  Hugh Calkins,et al.  Noninvasive detection of myocardial fibrosis in arrhythmogenic right ventricular cardiomyopathy using delayed-enhancement magnetic resonance imaging. , 2005, Journal of the American College of Cardiology.

[6]  H. Tanner,et al.  Electrocardiographic Pattern as a Guide for Management and Radiofrequency Ablation of Idiopathic Ventricular Tachycardia , 2004, Cardiology.

[7]  H. Calkins,et al.  Magnetic resonance and computed tomography imaging of arrhythmogenic right ventricular dysplasia , 2004, Journal of magnetic resonance imaging : JMRI.

[8]  Delon Wu,et al.  Electrocardiographic predictors of failure and recurrence in patients with idiopathic right ventricular outflow tract tachycardia and ectopy who underwent radiofrequency catheter ablation. , 2003, Journal of electrocardiology.

[9]  F. Marchlinski,et al.  Electrocardiographic Patterns of Superior Right Ventricular Outflow Tract Tachycardias: Distinguishing Septal and Free‐Wall Sites of Origin , 2003, Journal of cardiovascular electrophysiology.

[10]  C. Tai,et al.  Determinants of Successful Ablation of Idiopathic Ventricular Tachycardias with Left Bundle Branch Block Morphology from the Right Ventricular Outflow Tract , 2002, Pacing and clinical electrophysiology : PACE.

[11]  F. Gaita,et al.  Adipose replacement and wall motion abnormalities in right ventricle arrhythmias: evaluation by MR imaging. Retrospective evaluation on 124 patients , 2000, The International Journal of Cardiac Imaging.

[12]  D. Zipes,et al.  Ventricular Tachycardias Mimicking Those Arising from the Right Ventricular Outflow Tract , 2000, Journal of cardiovascular electrophysiology.

[13]  F. Morady,et al.  Electrocardiographic predictors of successful ablation of tachycardia or bigeminy arising in the right ventricular outflow tract. , 1999, The American journal of cardiology.

[14]  W. Shimizu,et al.  Localization of optimal ablation site of idiopathic ventricular tachycardia from right and left ventricular outflow tract by body surface ECG. , 1998, Circulation.

[15]  S. Yeh,et al.  Determinants of tachycardia recurrences after radiofrequency ablation of idiopathic ventricular tachycardia. , 1998, The American journal of cardiology.

[16]  S. Globits,et al.  Significance of morphological abnormalities detected by MRI in patients undergoing successful ablation of right ventricular outflow tract tachycardia. , 1997, Circulation.

[17]  H. Wellens,et al.  Predictors for successful ablation of right- and left-sided idiopathic ventricular tachycardia. , 1997, The American journal of cardiology.

[18]  F. Marchlinski,et al.  Idiopathic right ventricular outflow tract tachycardia: narrowing the anatomic location for successful ablation. , 1996, American heart journal.

[19]  F. Marchlinski,et al.  Utility of the 12-lead electrocardiogram in localizing the origin of right ventricular outflow tract tachycardia. , 1995, American heart journal.

[20]  P. Brugada,et al.  Nonischemic ventricular tachycardia. Clinical course and long-term follow-up in patients without clinically overt heart disease. , 1989, Circulation.

[21]  C. Sticherling,et al.  Arrhythmogenic right ventricular dysplasia presenting as right ventricular outflow tract tachycardia. , 2005, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[22]  P. Brugada,et al.  Nonischemic ventricular tachycardia , 2000 .