Skip to main content
NCBI home page
British Heart Journal logoLink to British Heart Journal
. 1985 Apr;53(4):417–430. doi: 10.1136/hrt.53.4.417

Ventricular arrhythmias. A guide to their localisation.

P M Holt, C Smallpeice, P B Deverall, A K Yates, P V Curry
PMCID: PMC481783  PMID: 3986056

Abstract

An electrocardiographic atlas of ventricular tachycardias was produced by pacing 27 epicardial sections of the heart and the mitral papillary muscles to simulate focal ventricular arrhythmias and simultaneously recording their 12 lead electrocardiographic appearances. One hundred and twenty nine patients undergoing cardiac surgery were studied. In five patients all 27 epicardial sites were paced at operation and in 124 individual sections were paced postoperatively with temporary epicardial wires and the electrocardiograms analysed in terms of frontal and horizontal plan QRS axis, maximum limb lead QRS amplitude, and QRS duration. Each ventricular region paced produced a distinctive 12 lead electrocardiographic pattern. Simulated right ventricular arrhythmias had either inferior frontal plane QRS axes (from the anterobasal region) or superior frontal plane QRS axes (from the apical and posterior right ventricular sections). Horizontal plane QRS axes were directed leftwards, with some posterior shift in the anteroapical regions. Simulated arrhythmias from the base of the left ventricle (anteriorly and laterally) had inferior frontal plane QRS and anterorightward horizontal plane QRS axes. Left ventricular arrhythmias with a superior frontal plane QRS axis were readily distinguished by their horizontal plane QRS axes: posterorightwards from the anterior and anterorightwards from the posterior left ventricular sections. Standard errors of the paced QRS axes for the various epicardial sections paced postoperatively ranged from 3.0 degrees to 6.0 degrees using the frontal plane axis. The electrocardiogram was most accurate in localising ventricular arrhythmias from the anterior left ventricle and least accurate for those arising from the inferior right ventricle. The appearance of the paced electrocardiograms was slightly modified by underlying disease such as myocardial infarction and left ventricular hypertrophy. This atlas may be useful in comparing the localisation of ventricular tachycardia with the site of underlying cardiac disease and may facilitate mapping in patients with refractory ventricular tachycardia requiring ablation (either surgical or by high energy impulses).

Full text

PDF
417

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bodenheimer M. M., Banka V. S., Helfant R. H. Relation between the site of origin of ventricular premature complexes and the presence and severity of coronary artery disease. Am J Cardiol. 1977 Dec;40(6):865–869. doi: 10.1016/0002-9149(77)90036-4. [DOI] [PubMed] [Google Scholar]
  2. Gallagher J. J., Kasell J. H., Cox J. L., Smith W. M., Ideker R. E., Smith W. M. Techniques of intraoperative electrophysiologic mapping. Am J Cardiol. 1982 Jan;49(1):221–240. doi: 10.1016/0002-9149(82)90296-x. [DOI] [PubMed] [Google Scholar]
  3. Hartzler G. O. Electrode catheter ablation of refractory focal ventricular tachycardia. J Am Coll Cardiol. 1983 Dec;2(6):1107–1113. doi: 10.1016/s0735-1097(83)80337-4. [DOI] [PubMed] [Google Scholar]
  4. Horowitz L. N., Spear J. F., Moore E. N. Subendocardial origin of ventricular arrhythmias in 24-hour-old experimental myocardial infarction. Circulation. 1976 Jan;53(1):56–63. doi: 10.1161/01.cir.53.1.56. [DOI] [PubMed] [Google Scholar]
  5. Josephson M. E., Horowitz L. N., Farshidi A., Kastor J. A. Recurrent sustained ventricular tachycardia. 1. Mechanisms. Circulation. 1978 Mar;57(3):431–440. doi: 10.1161/01.cir.57.3.431. [DOI] [PubMed] [Google Scholar]
  6. Josephson M. E., Horowitz L. N., Farshidi A., Spear J. F., Kastor J. A., Moore E. N. Recurrent sustained ventricular tachycardia. 2. Endocardial mapping. Circulation. 1978 Mar;57(3):440–447. doi: 10.1161/01.cir.57.3.440. [DOI] [PubMed] [Google Scholar]
  7. Josephson M. E., Horowitz L. N., Farshidi A., Spielman S. R., Michelson E. L., Greenspan A. M. Recurrent sustained ventricular tachycardia. 4. Pleomorphism. Circulation. 1979 Mar;59(3):459–468. doi: 10.1161/01.cir.59.3.459. [DOI] [PubMed] [Google Scholar]
  8. Josephson M. E., Waxman H. L., Cain M. E., Gardner M. J., Buxton A. E. Ventricular activation during ventricular endocardial pacing. II. Role of pace-mapping to localize origin of ventricular tachycardia. Am J Cardiol. 1982 Jul;50(1):11–22. doi: 10.1016/0002-9149(82)90003-0. [DOI] [PubMed] [Google Scholar]
  9. Kaplinsky E., Ogawa S., Kmetzo J., Dreifus L. S. Origin of so-called right and left ventricular arrhythmias in acute myocardial ischemia. Am J Cardiol. 1978 Nov;42(5):774–780. doi: 10.1016/0002-9149(78)90097-8. [DOI] [PubMed] [Google Scholar]
  10. Kastor J. A., Spear J. F., Moore E. N. Localization of ventricular irritability by epicardial mapping. Origin of digitalis-induced unifocal tachycardia from left ventricular Purkinje tissue. Circulation. 1972 May;45(5):952–964. doi: 10.1161/01.cir.45.5.952. [DOI] [PubMed] [Google Scholar]
  11. Lewis S., Kanakis C., Rosen K. M., Denes P. Significance of site of origin of premature ventricular contractions. Am Heart J. 1979 Feb;97(2):159–164. doi: 10.1016/0002-8703(79)90350-8. [DOI] [PubMed] [Google Scholar]
  12. Mardelli T. J., Morganroth J., Dreifus L. S. Superior QRS axis of ventricular premature complexes: an additional criterion to enhance the sensitivity of exercise stress testing. Am J Cardiol. 1980 Feb;45(2):236–243. doi: 10.1016/0002-9149(80)90641-4. [DOI] [PubMed] [Google Scholar]
  13. Oppenheimer B. S., Stewart H. J. DEPENDENCE OF THE FORM OF THE ELECTRO-CARDIOGRAM UPON THE SITE OF MECHANICAL STIMULATION OF THE HUMAN VENTRICLES. J Clin Invest. 1927 Feb;3(3):593–612. doi: 10.1172/JCI100103. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Puech P., Gallay P., Grolleau R., Koliopoulos N. Traitement par électrofulguration endocavitaire d'une tachycardie ventriculaire récidivante par dysplasie ventriculaire droite. Arch Mal Coeur Vaiss. 1984 Jul;77(7):826–834. [PubMed] [Google Scholar]
  15. Talbot S., Dreifus L. S. Characteristics of ventricular extrasystoles and their prognostic importance: a reappraisal of their method of classification. Chest. 1975 Jun;67(6):665–674. doi: 10.1378/chest.67.6.665. [DOI] [PubMed] [Google Scholar]
  16. Waxman H. L., Josephson M. E. Ventricular activation during ventricular endocardial pacing: I. Electrocardiographic patterns related to the site of pacing. Am J Cardiol. 1982 Jul;50(1):1–10. doi: 10.1016/0002-9149(82)90002-9. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES