Session II: Invasive Diagnosis and Treatment-6154-SPECIAL WORKSHOP: 12 Lead ECG for PVC and VT Localization

Video Transcription

Video Summary

In this video, Dr. John Miller discusses the localization of ventricular tachycardia (VT) and premature ventricular contractions (PVCs) using the 12-lead ECG. He explains the importance of knowing the source of ventricular ectopy for pre-procedure planning and for predicting outcomes. Dr. Miller outlines several general principles for localizing the origin of VT and PVCs from the ECG, including analyzing the QRS morphology and frontal plane axis. He also discusses patterns observed in different regions of the heart, such as the ventricular outflow tracts, papillary muscles, and mitral annulus. Dr. Miller highlights the limitations of ECG localization, particularly in the presence of structural heart disease, where scar tissue and changes in conduction pathways can make localization challenging. He also mentions some special cases to consider, such as PVCs originating from the left-right junction and VT from the crux region. Dr. Miller concludes by mentioning some newer criteria and techniques for localization, such as the maximum deflection index and differentiating between fascicular VT and papillary muscle arrhythmias. Dr. Miller then hands over to Dr. Bill Stevenson, who presents several ECGs of ventricular arrhythmias for visual analysis and localization. He explains the QRS morphology, frontal plane axis, and precordial patterns of each arrhythmia to help identify the likely source. Dr. Stevenson emphasizes the importance of accurate ECG localization for successful ablation procedures.

Keywords

ventricular tachycardia

premature ventricular contractions

12-lead ECG

localization

pre-procedure planning

QRS morphology

frontal plane axis

structural heart disease

ablation procedures