Comparative analysis of electrocardiographic imaging and ECG in predicting the origin of outflow tract ventricular arrhythmias

Objectives The aim of this study was to investigate the accuracy of electrocardiographic imaging (ECGI) in localizing the origin of outflow tract ventricular arrhythmias (OTVAs) and compare its performance with that of seven published 12-lead electrocardiography (ECG) algorithms. Methods Patients with OTVAs who were undergoing catheter ablation were prospectively investigated. The OVTA origins were localized using both ECGI and seven 12-lead ECG algorithms, with the successful ablation site set as the gold standard. The performance of the ECGI and 12-lead ECG algorithms were compared. Results Twenty-seven patients were enrolled into the study. The ECGI system correctly identified the chamber of OTVA origin in 27/27 (100%) patients and the sublocalization within the right ventricular outflow tract (RVOT) in 21/22 (95.5%) patients. However, the ECG algorithms correctly diagnosed the chamber and sublocalization in only 21/27 (77.8%) patients and 13/22 (59.1%) patients, respectively, which was significantly lower compared with the ECGI system. Conclusions Non-invasive ECGI can accurately predict the origin of OTVAs in a manner that is superior to that of conventional 12-lead ECGs in differentiating the RVOT from the left ventricular outflow tract (LVOT) and septum from free wall in the RVOT. This provides a useful tool to guide catheter ablation. This trial has been registered in the Chinese Clinical Trial Registry (Registration number: ChiCTR1900025527).