Electrocardiographic Characteristics of Ventricular Arrhythmias Originating from Different Areas Adjacent to the Mitral Annulus.

BACKGROUND

This study aimed to explore the electrocardiographic (ECG) characteristics of ventricular arrhythmias (VAs) arising from epicardial and endocardial areas adjacent to the mitral annulus (MA).

METHODS

This study involved 283 patients with MA-VAs who received radiofrequency catheter ablation at the center. The ECG characteristics of these patients were analyzed retrospectively.

RESULTS

The origin of MA-VAs was judged based on the ECG variables. Among all MA-VAs, intrinsicoid deflection time (IDT) > 77 ms or maximum deflection index (MDI) > 0.505 predicted the VAs arising from the epicardium (sensitivity of 70.20% and 73.51%, specificity of 94.70% and 82.58%, positive predictive value (PPV) of 93.81% and 82.84%, and negative predictive value (NPV) of 73.53% and 73.15%). Among all epicardial MA-VAs, the RV1/RV2 ratio > 0.87 predicted the VAs originating from the epicardial anteroseptal wall adjacent to the MA. It had a sensitivity, specificity, PPV, and NPV of 62.86%, 98.06%, 91.67%, and 88.60%, respectively. Among all endocardial MA-VAs, Q(q)R(r) morphology in lead V1 predicted the VAs arising from the endocardial septal wall adjacent to the MA. It had a sensitivity, specificity, PPV, and NPV of 92.98%, 100%, 100%, and 94.94%, respectively. Among all endocardial septal MA-VAs, a predominant positive wave in lead II and a predominant negative wave in lead III predicted the VAs arising from the endocardial midseptal portion adjacent to the MA. It had a sensitivity, specificity, PPV, and NPV of 86.04%, 100%, 100%, and 70.00%, respectively.

CONCLUSION

the ECG characteristics of VAs from the different sites adjacent to the MA can enable judging the arrhythmia's origin and designing the ablation plan accordingly.