Novel electrocardiogram and electrophysiological findings for differentiating idiopathic left posterior papillary muscle and left posterior fascicular ventricular arrhythmias

作者：Huang Hung Kai; Chung Fa Po; Lin Yenn Jiang^*; Chang Shih Lin; Lo Li Wei; Hu Yu Feng; Tuan Ta Chuan; Chao Tze Fan; Liao Jo Nan; Lin Chin Yu; Chang Yao Ting; Te Abigail Louise D; Yamada Shinya; Chen Shih Ann

来源：Journal of Interventional Cardiac Electrophysiology, 2017, 49(3): 291-297.

DOI：10.1007/s10840-017-0265-3

• Left posterior fascicular
• Posterior papillary muscle
• Right bundle branch
• Ventricular arrhythmia

Purpose Differentiation between idiopathic left posterior fascicular ventricular arrhythmias (LPF-VAs) and posterior papillary muscle (PPM) VAs is of clinical value. This study aimed to develop an algorithm to distinguish PPM-VAs from LPF-VAs.
Methods This study enrolled 73 consecutive cases, including 31 with PPM-VAs and 42 with LPF-VAs, undergoing successful ablation by using 3D mapping and intracardiac echography to confirm the origin of the VAs. Electrocardiographic and electrophysiological parameters were compared between two groups.
Results The 12-lead electrocardiography of the PPM-VAs was characterized by a longer QRS duration than that in LPF-VAs (154.4 +/- 14.5 vs. 132.3 +/- 13.1 ms, P < 0.001). A QRS duration >= 133 ms was observed in all patients (100%) with PPM-VAs and 13/42 (31.0%) patients with LPF-VAs. The conduction duration from the earliest left ventricular activation site of the VA to the proximal right bundle branch (VA-RBB) was longer in patients with PPM-VAs than LPF-VAs (51.3 +/- 12.2 vs. 23.6 +/- 7.7 ms, P < 0.001). Based on the ROC analysis, a VA-RBB > 36 ms was recognized in 28/31 patients with PPM-VAs (90.3%) and 2/42 with LPF-VAs (4.8%). An algorithm incorporating a QRS duration of >= 133 ms with a conduction duration of a VA-RBB of > 36 ms could yield a sensitivity of 90.3% and specificity of 100% for discriminating PPM-VAs from LPF-VAs.
Conclusions The novel algorithm incorporating a QRS duration of >= 133 ms with a conduction duration of the VA-RBB of > 36 ms could be useful in differentiating PPM-VAs from LPF-VAs.

• 出版日期2017-9