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董建增 首都医科大学北京安贞医院

ECG Outflow Tract VT. 董建增 首都医科大学北京安贞医院. 内容. Ventricular outflow tract VT right ventricular outflow tract septal （ anterior ， mid ， posterial ） free wall left ventricular outflow tract supra valvular (above aortic valve)

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董建增 首都医科大学北京安贞医院

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  1. ECG Outflow Tract VT 董建增 首都医科大学北京安贞医院

  2. 内容 • Ventricular outflow tract VT • right ventricular outflow tract septal （anterior，mid，posterial） free wall • left ventricular outflow tract • supra valvular (above aortic valve) • left cusp，right cusp，non-coronary • infra valvular (below aortic valve) • others • para-His，epicardially…. RV LV LV

  3. 心室流出道有关解剖 Suleiman M, Heart Rhythm 2008;5:1485

  4. VT from Septal RVOT I: ± , R/S transition late

  5. I II III R L F V1 V2 V3 V4 V5 V6 Electrocardiogram Characteristics of VT from RVOT *ILs I R/L V1 R/Ss /V5-6 ① R ± =1 QS >V3 no ② R ± =1 QS >V3 no ③ R ± =1 rS >V3 no ④ R ＋=1 QS >V2 no *ILs = inferior leads Septal Wall: ①②③ Free Wall : ④ ① ② ③ ④

  6. Electrocardiographic Patterns of Superior RVOTs: Distinguishing Septal and Free-Wall Sites of Origin J Cardiovasc Electrophysiol 2003; 14: 1-7

  7. Electrocardiographic Patterns of Superior RVOTs: Distinguishing Septal and Free-Wall Sites of Origin Septal free wall J Cardiovasc Electrophysiol 2003; 14: 1-7

  8. Electrocardiographic Patterns of Superior RVOTs: Distinguishing Septal and Free-Wall Sites of Origin J Cardiovasc Electrophysiol 2003; 14: 1-7

  9. Electrocardiographic Patterns of Superior RVOTs: Distinguishing Septal and Free-Wall Sites of Origin J Cardiovasc Electrophysiol 2003; 14: 1-7

  10. VT from Supravalvular LVOT 30ms ↗aVR<aVL ↗ rS/ S too shallow ↗rS/ r too big ↗ V5 terminated by tiny s

  11. 40ms VT from Supravalvular LVOT I II III R L F V1 V2 V3 V4 V5 V6 Abl pace map activation map

  12. VT from infravalvular LVOT I: more negative , R/S transition V1

  13. I II III R L F V1 V2 V3 V4 V5 V6 Electrocardiogram Characteristics of VT from LVOT *ILs I R/L V1 R/Ss /V4-6 ⑤R - - <1 R <V1 yes ⑥ R - <1 Rs <V3 yes ⑦ R - <1 rS >V3 no ⑧ R - <1 rS <V3 yes *ILs = inferior leads Infra-valvular: ⑤ Supra-valvular: ⑥⑦⑧ ⑤ ⑥ ⑦ ⑧

  14. Left Ventricular Outflow Tract Tachycardia Originating from the Right Coronary Cusp J Cardiovasc Electrophysiol 2002; 13: 1050-1053

  15. Left Ventricular Outflow Tract Tachycardia Originating from the Right Coronary Cusp J Cardiovasc Electrophysiol 2002; 13: 1050-1053

  16. Left Ventricular Outflow Tract Tachycardia Originating from the Right Coronary Cusp

  17. Left Ventricular Outflow Tract Tachycardia Originating from the Right Coronary Cusp

  18. Left Ventricular Outflow Tract Tachycardia Originating from the Right Coronary Cusp

  19. Left Ventricular Outflow Tract Tachycardia Originating from the Right Coronary Cusp

  20. Noncoronary aortic cusp J Cardiovasc Electrophysiol, 2012; 23, 98-101

  21. Epicardial Radiofrequency Ablation of an Unusual and Unexpected Ventricular Tachycardia J Cardiovasc Electrophysiol 2009; 20: 813-817

  22. Ablation of Left Ventricular Epicardial Outflow Tract Tachycardia From the Distal Great Cardiac Vein J Am Coll Cardiol 2006; 48: 1813–17

  23. Outflow Tract Tachycardia With R/S Transition in Lead V3 J Am Coll Cardiol 2005;45:418 –23

  24. Ventricular Arrhythmias Arising from the Right Ventricular Septum Close to the His Bundle J Cardiovasc Electrophysiol 2011; 22: 878-885

  25. ECG Algorityhm for Identifying the Optimal Ablation Site for Idiopathic Outflow Tract VT LSV Left sinus Vlsalva LV end LV endocardium LV epi LV epicardium Near His near His bundle RV right ventricle J Cardiovasc Electrophysiology 2003; 14: 1280-86

  26. 脑子中装3份体表心电图 典型右室流出道间隔部 典型左室流出道左冠瓣上 典型左室流出道主动脉瓣下

  27. 胸导联位置位置关系 Holter的差异 左中右 上下前后

  28. Variants of Idiopathic Left Ventricular Outflow Tract Ventricular Tachyarrhythmias J Cardiovasc Electrophysiol 2008: 19: 495-501

  29. Variants of Idiopathic Left Ventricular Outflow Tract Ventricular Tachyarrhythmias J Cardiovasc Electrophysiol 2008: 19: 495-501

  30. ECG Variants of Idiopathic Left Ventricular Outflow Tract Ventricular Tachyarrhythmias ASC-VTs MA AMC J Cardiovasc Electrophysiol 2008: 19: 495-501

  31. Epicardial Left Ventricular Outflow Tract Tachycardia from the Anterior Interventricular Coronary Vein J Cardiovasc Electrophysiol 2005; 1378-1380

  32. Epicardial Left Ventricular Outflow Tract Tachycardia from the Anterior Interventricular Coronary Vein J Cardiovasc Electrophysiol 2005; 1378-1380

  33. Outflow Tract Tachycardia With R/S Transition in Lead V3 J Am Coll Cardiol 2005;45:418 –23

  34. Effect of Limb Lead Electrodes Location on ECG and Localization of Idiopathic Outflow Tract Tachycardia J Cardiovasc Electrophysiol 2011; 22:886-891

  35. ECG: ARVC vs.RVOT Examples of Measurements Examples of Notching J Am Coll Cardiol 2011;58:831–8

  36. ECG: ARVC vs.RVOT Characteristic Features J Am Coll Cardiol 2011;58:831–8

  37. The V2 Transition Ratio The V2 transition ratio is a novel electrocardiographic measure that reliably distinguishes LVOT from RVOT origin in patients with lead V3 precordial transition B/(B+C)VT ÷ E/(E+F)SR LVOT PVCs vs. RVOT PVCs 1.27 0.60 vs. 0.23 0.16; p 0.001 V2 transition ratio 0.60 predicted an LVOT origin with 91% accuracy A PVC precordial transition occurring later than the sinus rhythm transition excluded an LVOT origin with 100% accuracy Electrocardiographic Measurements J Am Coll Cardiol 2011;57:2255–62

  38. Precordial TWI to Distinguish Arrhythmogenic Right Ventricular Cardiomyopathy from Idiopathic Ventricular Tachycardia Arising from the Right Ventricular Outflow Tract During sinus rhythm, 37 patients (47%) with ARVC and 5 patients (4%) with RVOT tachycardia had TWI in leads V1 to V3. For the diagnosis of ARVC, TWI in leads V1 to V3 had sensitivity of 47% and specificity of 96%. In conclusion, in patients with VT of right ventricular origin, the presence of TWI in electrocardiographic leads V1 to V3 supports the diagnosis of ARVC Am J Cardiol 2010; 105: 1821–1824

  39. ECG Algorityhm for Identifying the Optimal Ablation Site for Idiopathic Outflow Tract VT A RVOT septal B RVOT free wall C near His bundle D LV endocardium E Left sinus Vlsalva F LV epicardium J Cardiovasc Electrophysiology 2003; 14: 1280-86

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