Success of catheter ablation of idiopathic ventricular extrasystoles and establishment of a new algorithm for the determination of anatomic location of extrasystoles with 12 derivated ecg

Success of Catheter Ablation of Idiopathic Ventricular Extrasystoles and Establishment of a New Algorithm for the Determination of Anatomic Location of Extrasystoles with 12 Derivated ECG Aim: Catheter ablation is frequently used in the treatment of ventricular arrhythmias. It is possible to determine the anatomical origin of VES using various algorithms with 12-lead ECG. These algorithms shorten the duration of the procedure and reduce procedural complications especially in patients undergoing catheter ablation. The aim of this study is to determine the clinical and symptomatic success of patients with VES ablation, to determine the clinical and demographic characteristics that affect this success, and to find a new algorithm if the ECG can be constructed using various parameters. Materials and methos: Forty-four patients with symptomatic idiopathic frequent ventricular extrasystoles (patients with more than 10% of total beat with 24-hour holter ECG) were included in the study. ECG, transthoracic echocardiography and 24-hour holter ECG were performed in each patient before and after one month ablation. Patients were divided into two groups as those with right ventricular ventricular arrhythmia (n = 22) and those with left ventricular arrhythmia (n = 22). Between these two groups; the ratio of the V3 R wave voltage to the V2 S wave voltage and the V3 R wave voltage to the V3 lead maximum deflection index have been examined in order to determine if the inferior leads are notched. Results: In our study, 29.5% of patients with inferior derivations (DII, DIII, aVF) have R wave notches. 38.5% of these patients are from the left ventricle, 61.5% from the right ventricle, with idiopathic ventricular arrhythmia. V3 R-wave voltage> V2 S-wave voltage showed 100% sensitivity and 88% specificity for left ventricular arrhythmia in patients with notch in inferior derivations (Area Uder Curve: 0.88 p = 0.005). In patients with inferior derivation haven't notches, The VES transition zone after V3 predict the origin to be the right ventricle with 85.7% sensitivity and 85.7% specificity in 7 patients (p = 0.028). V3 R wave voltage / V3 maximal deflection index ratio in 24 patients before V3 and at or before V3 ≥3,9% 72 Sensitivity Left ventricular arrhythmia with 100% specificity if rate ≤ 2,1% 86 sensitivity% 76 specificity and right ventricular systolic idiopathic ventricular arrhythmia (Area Under Curve: 0.73 p = 0.037). Conclusion: It is possible to predict ventricular origin caused by ventricular arrhythmia by using a new algorithm developed for inferior derivations with respect to the presence or absence of notch in R wave. The accuracy of the newly developed algorithm should be tested in determining the anatomic location of idiopathic ventricular arrhythmia. Key Words: Algorithm, idiopathic ventricular extrasystoles, notch in inferior leads, V3 R voltage> V2 S voltage, V3 R voltage / V3 maximum deflection index