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CLINICAL RESEARCH: ELECTROPHYSIOLOGICAL DISORDERS

Quantitative comparison of spontaneous and paced 12-lead electrocardiogram during right ventricular outflow tract ventricular tachycardia

^a Division of Cardiology, Department of Internal Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA

Manuscript received October 22, 2002; revised manuscript received January 6, 2003, accepted February 20, 2003.

^* Reprint requests and correspondence: Dr. Edward P. Gerstenfeld, University of Pennsylvania Medical Center, 9 Founders Pavilion, 3400 Spruce Street, Philadelphia, Pennsylvania 19104, USA.
edward.gerstenfeld{at}uphs.upenn.edu

OBJECTIVES: The purpose of this study was to objectively quantify the similarity of 12-lead electrocardiogram (ECG) waveforms using two quantitative metrics, the correlation coefficient (CORR) and the mean absolute deviation (MAD).

BACKGROUND: Comparison of the 12-lead ECG morphology between ventricular tachycardia (VT) and a pace-map is frequently performed; however, there are no objective criteria for quantifying the similarity between two waveform morphologies.

METHODS: During ablation of right ventricular outflow tract (RVOT) VT, 12-lead ECG pace-maps were acquired from three superior septal sites, three superior free wall sites, and before each ablation attempt in 15 patients. The 12-lead ECG waveforms of the clinical tachycardia and pace-maps were compared using both MAD and CORR at each site.

RESULTS: The MAD scores were lower (i.e., more closely matched) for septal compared with free wall sites (15.9 ± 5.3% vs. 25.3 ± 10.2%; p < 0.001). Successful ablation sites had a significantly lower MAD score compared with unsuccessful sites (9.5 ± 2.8% vs. 13.3 ± 5.6%; p = 0.01), whereas there was only a trend toward a higher CORR for successful ablation sites (98.2 ± 1.2% vs. 96 ± 4.7%; p = 0.07). A MAD score 12% was 93% sensitive and 75% specific for identifying a successful ablation site. There was an inverse correlation between MAD score and distance from the site of VT origin (r = 0.63, p < 0.001).

CONCLUSIONS: A MAD score >12% between RVOT VT and a pace-map at any site suggests sufficient dissimilarity to dissuade ablation at that site. The MAD score can be used to standardize 12-lead ECG waveform morphology comparisons among different laboratories, and may be useful for guiding ablation of VT.

Abbreviations and Acronyms   CORR   correlation coefficient   ECG   electrocardiogram   MAD   mean absolute deviation   PVCs   premature ventricular complexes   RF   radiofrequency   RV   right ventricular   RVOT   right ventricular outflow tract   VT   ventricular tachycardia

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