Electrocardiographic features of epicardial ventricular tachycardia
ZHANG Hai-Tao, ZHANG Shu-Long
(1. Cardiovascular Examination Department, 2. Department of Cardiology, the First Affiliated Hospital of Dalian Medical University, Dalian Liaoning 116011, China)
Abstract：Epicardial ventricular tachycardial(VT) demonstrates common electrocardiographic features: QRS duration ≥200 ms, however, it ≤120 ms partly; There is false Δ wave ≥34 ms at the beginning; Left axis deviation is in majority; Precordial leads migrate after V2 lead; The time to reach the peak for R wave is prolonged by over 85 ms in V2 lead; The shortest RS duartion ≥121 ms. The following features help to identify epicardial VT originating from left ventricle: VT originating from the base and apex of heart with Q waves inⅠlead; Basal VT without Q waves in Ⅱ, Ⅲ, and aVF leads; VT originating from the upper base and apex of heart with Q waves in Ⅱ, Ⅲ, and aVF leads. Maximum deviation index(MDI) can be used in identifying epicardial VT originating from left ventricular outflow tract. When MDI ≥0.55, epicardial VT originating far from aortae sious can be identified. The following features help to identify epicardial VT originating from right ventricle: it implies big chance of epicardial VT when there is Q wave in Ⅰlead and QS in right ventricular anterior wall lead; Epicardial VT originating from right ventricle can be observed during synchronous electrophysiological mapping when there are initating Q waves in Ⅱ, Ⅲ, and aVF leads. However, VT with different originating locations and different causes possess its unique electrocardiographic features. Before VT ablation, accurate location by surface ECG proves to be instructive.
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2015, Vol. 24 
