Sinus Rhythm ECG Criteria Associated with Basal-Lateral Ventricular Tachycardia Substrate in Patients with Nonischemic Cardiomyopathy

Authors

  • WENDY S. TZOU M.D.,

    1. Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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  • ERICA S. ZADO P.A.-C.,

    1. Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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  • DAVID LIN M.D.,

    1. Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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  • DAVID J. CALLANS M.D.,

    1. Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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  • SANJAY DIXIT M.D.,

    1. Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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  • JOSHUA M. COOPER M.D.,

    1. Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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  • RUPA BALA M.D.,

    1. Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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  • FERMIN GARCIA M.D.,

    1. Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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  • MATHEW D. HUTCHINSON M.D.,

    1. Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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  • MICHAEL P. RILEY M.D., Ph.D,

    1. Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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  • RAJAT DEO M.D.,

    1. Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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  • EDWARD P. GERSTENFELD M.D.,

    1. Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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  • FRANCIS E. MARCHLINSKI M.D.

    1. Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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  • No disclosures.

Francis E. Marchlinski, M.D., 9 Founders Pavilion, 3400 Spruce Street, Philadelphia, PA 19104, USA. Fax: 215-662-2879; E-mail: francis.marchlinski@uphs.upenn.edu

Abstract

ECG Criteria Associated with NICM VT. Introduction: Patients with nonischemic cardiomyopathy (NICM) and ventricular tachycardia (VT) usually have basal-lateral scar in the left ventricle (LV). We sought to determine electrocardiogram (ECG) characteristics that may help identify NICM patients with basal-lateral scar and VT.

Methods and Results: Phase I, study patients (n = 25) had NICM, VT, and endocardial/epicardial basal-lateral LV low voltage consistent with scar on detailed mapping. ECGs were compared to controls (n = 18) with NICM, and comparable age and gender without VT/known scar. All patients had either sinus or paced atrial rhythm ECGs without bundle-branch block or ventricular pacing. In phase II, criteria were evaluated prospectively, blinded to clinical data, using ECGs from 15 NICM patients, of which 7 patients had VT and endocardial/epicardial basal-lateral LV scar on detailed mapping. Of ECG characteristics studied, V1 R and R:S ratio, and V6 S and S:R ratio were univariately associated with basal-lateral-scar associated VT. Controlling for LVEF and multicollinearity in multivariate analyses, V1 R ≥ 0.15 mV (P = 0.001) and V6 S ≥ 0.15 mV (P < 0.001), or V6 S:R ≥ 0.2 mV (P < 0.001), best predicted presence of basal-lateral scar. In Phase II, the former criteria best identified those with NICM and VT because of basal-lateral scar, with sensitivity and specificity 0.86 and 0.88, respectively. 

Conclusions: Among patients with NICM, VT, and normal QRS duration, V1 R ≥ 0.15 mV and V6 S ≥ 0.15 mV predicted presence of basal-lateral LV areas of bipolar low voltage. This ECG information may have important value in defining presence of LV scar and possible risk for VT in NICM patients.(J Cardiovasc Electrophysiol, Vol. 22, pp. 1351-1358, December 2011)

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