The QRS morphology pattern in V5R is a novel and simple parameter for differentiating the origin of idiopathic outflow tract ventricular arrhythmias

Aims There are many reports on the ECG characteristics of idiopathic outflow tract ventricular arrhythmias (OT-VAs) to predict their origin. However, differentiating near regions using 12-lead ECGs is still complicated. The synthesized 18-lead ECG derived from the 12-lead ECG can provide virtual waveforms of the right-sided chest leads (V3R, V4R, and V5R) and back leads (V7, V8, and V9). The aim of this study was to develop a simple and useful parameter for differentiating OT-VA origins using the 18-lead ECG. Methods and results We studied 28 and 73 patients with idiopathic VAs in a pacemapping study and validation cohort, respectively. In the pacemapping study, several sites out of five different sites were paced in each patient: the anterior and posterior right ventricular OT (RVOT-ant and RVOT-post), right and left coronary cusps (RCC and LCC), and junction of both cusps (RLJ). The 18-lead ECGs during pacemapping among the five sites were compared for establishing a simple parameter to predict VA origins. A novel parameter using 18-lead ECGs was tested prospectively in 73 patients. In the pacemapping study, the dominant QRS morphology pattern in the synthesized V5R significantly differed among those sites (RVOT-ant:Rs, RVOT-post:rS, RCC:QS, RLJ:qR, and LCC:R). The patients in the validation cohort were divided into five groups depending on those QRS morphology patterns during VAs in the synthesized V5R. Each V5R QRS morphology pattern could predict a precise origin of the OT-VAs with an overall accuracy of 75%. Conclusion The QRS morphology pattern in V5R was a simple and useful parameter for differentiating detailed OT-VA origins.