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A hybrid clinical and electrocardiographic score to predict the origin of outflow tract ventricular arrhythmias

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

To predict the outflow tract ventricular arrhythmias (OTVA) site of origin (SOO) before the ablation procedure has important practical implications. The present study sought to prospectively evaluate the accuracy of a clinical and electrocardiographic hybrid algorithm (HA) for the prediction of OTVAs-SOO, and at the same time to develop and to prospectively validate a new score with improved discriminatory capacity.

Methods

In this multicenter study, we prospectively enrolled consecutive patients referred for OTVA ablation (N = 202), and we divided them in a derivation sample and a validation cohort. Surface ECGs during OTVA were analyzed to compare previous published ECG-only criteria and to develop a new score.

Results

In the derivation sample (N = 105), the correct prediction rate of HA and ECG-only criteria ranged from 74 to 89%. R-wave amplitude in V3 was the best ECG parameter for discriminating LVOT origin in V3 precordial transition (V3PT) patients, and was incorporated to the novel weighted hybrid score (WHS). WHS correctly classified 99 (94.2%) patients, presenting 90% sensitivity and 96% specificity (AUC 0.97) in the entire population; WHS mantained a 87% sensitivity and 91% specificity (AUC 0.95) in patients with V3PT subgroup. The high discriminatory capacity was confirmed in the validation sample (N = 97): the WHS exhibited an AUC (0.93), and a WHS ≥ 2 allowed a correct prediction of LVOT origin in 87 (90.0%) cases, yielding a sensitivity of 87% and specificity of 90%; moreover, the V3PT subgroup showed an AUC of 0.92, and a punctuation ≥ 2 predicted an LVOT origin with a sensitivity of 94% and specificity of 78%.

Conclusions

The novel hybrid score has proved to accurately anticipate the OTVA’s origin, even in those with a V3 precordial transition.

Graphical Abstract

A Weighted hybrid score. B Typical examples of the use of the weighted hybrid score. C ROC analysis of WHS and previous ECG criteria for prediction of LVOT origin in the derivation cohort. D ROC analysis of WHS and previous ECG criteria for prediction of LVOT origin in the V3 precordial transition OTVA subgroup

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Data Availability

Data could be available upon request.

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Author information

Author notes

  1. Diego Penela and Giulio Falasconi equally contributed to the article and should be considered as shared first authors

Authors and Affiliations

  1. Heart Institute, Teknon Medical Centre, C/ Vilana, 12; 08022, Barcelona, Spain

    Diego Penela, Giulio Falasconi, Jose Miguel Carreño, David Soto-Iglesias, Julio Martí-Almor, Aldo Bellido, Alfredo Chauca, Claudia Scherer, Daniel Viveros, Jose Alderete, Augusto Ordoñez, Julia Meca-Santamaria, Paula Franco & Antonio Berruezo

  2. University of Barcelona, Campus Clínic, Barcelona, Spain

    Giulio Falasconi, Daniel Viveros & Jose Alderete

  3. Puerta del Mar University Hospital, Cádiz, Spain

    Juan Fernández-Armenta & Etelvino Silva

  4. Virgen del Rocío University Hospital, Sevilla, Spain

    Juan Acosta

  5. Hospital Vall d’Hebron, Barcelona, Spain

    Begoña Benito, Jaume Francisco-Pascual & Nuria Rivas-Gandara

  6. Universitat Autònoma de Barcelona, Barcelona, Spain

    Begoña Benito

  7. IRCCS Multimedica Group, Sesto San Giovanni, Italy

    Carmine De Lucia, Hussam Ali & Riccardo Cappato

  8. Pompeu Fabra University, Barcelona, Spain

    Oscar Cámara

  9. Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital, Sapienza University, Rome, Italy

    Pietro Francia

Authors
  1. Diego Penela
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  2. Giulio Falasconi
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Corresponding author

Correspondence to Antonio Berruezo.

Ethics declarations

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by Ethics Committee of each center.

Conflict of interest

A. Berruezo is stockholder of Galgo Medical. D. Soto-Iglesias is an employee of Biosense Webster. A. Berruezo received speaker fees from Biosense and research grants from Biotronik. P. Francia received speaker fees, research and educational grants from Boston Scientific and Abbott. The other authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

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Key messages

• To anticipate the OTVA’s site of origin has relevant implications for ablation. Several ECG algorithms had been proposed but, until now, baseline clinical information has been disregarded for this purpose. .

• This study supports that patients with LVOT-OTVA have a different clinical profile than those with RVOT-OTVA. The present study translates this different clinical profile into a practical tool for choosing the first chamber to be mapped during catheter ablation procedures.

• A simple-to-use score combining electrocardiographic and clinical information correctly classified 99 (94.2%) patients, presenting 90% sensitivity and 96% specificity (AUC 0.97), maintaining his discriminatory capacity in V3 precordial transition subgroup (AUC 0.95).

• This is the first study that prospectively evaluates the usefulness of a predefined algorithm for identifying the site of origin, and hence for choosing the vascular access, in consecutive patients referred for OTVA ablation.

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Penela, D., Falasconi, G., Carreño, J.M. et al. A hybrid clinical and electrocardiographic score to predict the origin of outflow tract ventricular arrhythmias. J Interv Card Electrophysiol 66, 1877–1888 (2023). https://doi.org/10.1007/s10840-023-01507-x

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  • DOI: https://doi.org/10.1007/s10840-023-01507-x

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