A novel electrocardiography algorithm to differentiate between ventricular arrhythmia and right ventricular outflow tract versus left ventricular outflow tract

Aim: To evaluate the accuracy of the diagnostic criteria for determining the origin of outflow tract ventricular arrhythmia (OTVA) and develop an electrocardiography (ECG) algorithm to predict its origin. Method: We analyzed the ECGs of 100 patients with OTVA who underwent successful ablation. The QRS complex was measured during sinus rhythm and ventricular arrhythmia (VA). After the ECG algorithm was developed, it was validated in an additional 100 patients from two different hospitals. Results: In this retrospective study, among the parameters without restrictions in the transition lead, the V2S/V3R index (AUC = 0.89) was significantly better in predicting VA originating from the right ventricular outflow tract (RVOT). Further, the larger ISA in V1 and V2 (AUC = 0.90) was significantly better in predicting VAs originating from the left ventricular outflow tract (LVOT). Among the parameters with the transition lead in V3, the V2S/V3R index (AUC = 0.82) was significantly better in predicting VAs originating from the RVOT. On the other hand, the V3 R-wave deflection interval (AUC = 0.81) was significantly better in predicting VAs originating from the LVOT. The algorithm combining the V2S/V3R index and the larger ISA in V1 and V2 could predict OTVA origin with an accuracy of 85.00%, a sensitivity of 75.68%, a specificity of 90.48%, a positive predictive value (PPV) of 82.35%, and a negative predictive value (NPV) of 86.36%. In the validation study, the algorithm exhibited excellent accuracy (95.00%) and AUC (AUC = 0.95), with a sensitivity of 94.12%, a specificity of 95.45%, a PPV of 91.43%, and an NPV of 96.92%. Conclusion: Our developed algorithm can reliably predict OTVA origin without restrictions in the transition lead.