pseudo delta wave

It seems to me that Pseudo Delta waves are only "Pseudo" in that the do not necessarily represent an accessory pathway, the way we normally associate delta waves with WPW. The slow slurred QRS pre-excitation in NS-HBP is akin to a delta wave in patients with manifest accessory pathways and is referred to as the pseudo-delta-wave. Importantly, significant overlap existed between EPI and ENDO pace maps for most intervals. Delta waves may appear as a positive or negative deviation on ECG tracing corresponding to the localization of accessory pathway. Using these revised cutoff values for the VTs, we demonstrated a sensitivity and specificity of 63% and 38% for MDI and 56% and 67% for IDT in identifying the ENDO versus EPI VT origin in the setting of NICM. Each interval measurement (the 5 top variables in the figure) was observed to be longer from the EPI than from the ENDO. Download figureDownload PowerPointFigure 7. These results should facilitate the planning and success of catheter ablation of VT in this setting. Short PR interval (< 120ms) 2. Figure 2. Thirty-four of the 43 VTs were reproducibly initiated and could be mapped sufficiently to localize the probable exit site of origin to either the EPI or ENDO. The absence of q waves in lead I and the presence of q waves in inferior leads are noted. We acknowledge that because of the site/region-specific nature of EPI morphological criteria, the criteria described cannot be applied to other regions. The Delta wave is a slurred upstroke in the QRS complex often associated with a short PR interval. A pseudo delta wave was noted in the precordial leads, suggesting an epicardial origin. The rest of the interval criteria measurements were not significantly different when comparing EPI and ENDO origin. In these patients, as with the first group of patients, a decision was made to undergo an EPI ablation because of an unsuccessful ENDO LV ablation before or at the time of the EPI mapping ablation procedure. Discussion. is absent. MDI was defined as the interval measured from the earliest ventricular activation (or from the stimulation artifact) to the peak of the largest amplitude deflection in each precordial lead (taking the lead with shortest time) divided by the QRSd. This study determined prospectively the value of previously published interval and morphology ECG criteria for identifying an EPI VT site of origin in patients with NICM. • Pseudo-delta wave (~ WPW) • Early precordial transition • Inferior axis if anterolateral origin • Superior axis if posteromedial origin tricuspid annulus • LBBB • Early precordial transition, inferior axis if septal origin • Late precordial transition if free-wall origin Blue arrows point out small q waves in inferior leads, representing the initial superiorly directed activation from the ENDO to EPI. Part of the 2021 ANZCEN Clinician Educator Incubator Programme | @rob_buttner | ECG Library |. All procedures were performed following the institutional guidelines of the University of Pennsylvania Health System. The VT was defined as originating from the ENDO or EPI region if concealed entrainment with the return cycle length equal to the VT cycle length or a 12 of 12-ECG lead pace map match was observed, and VT was eliminated with catheter ablation. The absence of q waves in inferior leads was defined as an initial positive deflection of the QRS vector in inferior leads during VT or paced QRS complex (Figure 3). QRS morphology and interval values for ENDO and EPI VT from basal superior and lateral LV sites in patients with NICM. However, the sensitivity/specificity values (right box) using the reported cutoffs for interval criteria were limited. Valvular locations, identified by fluoroscopy and simultaneous bipolar recordings that demonstrated both atrial and ventricular signals of approximately equal amplitude, were tagged and excluded from analysis. Furthermore, the sensitivity of the MDI can be improved by lowering the ratio cutoff to 0.45 from 0.55. Of note, one can improve the specificity of the IDT by raising the cutoff to 90 ms from 85 ms without a dramatic loss of sensitivity. Baseline clinical characteristics of the population are shown in Table 1. A relatively modest number of VTs were included—24 morphologically distinct VTs in the study group and 21 morphologically distinct VTs in the validation group—to which the ECG morphological criteria were applied and evaluated. Patient Age (years) Gender Successful site Patients with NICM frequently have an EPI origin for VT. Because an EPI ablation procedure requires a different level of risk and resources, it is imperative to identify which patients are likely to benefit from an EPI approach with their initial procedures. organization. The electrograms were not only low in amplitude but were also typically fractionated and late. The low voltage area was greater in the EPI as compared with the ENDO (56�27 cm2 versus 35�48 cm2, respectively, P=0.03). The QRSd and the SRS were significantly greater for VTs from the EPI VT group as compared with the ENDO VT group (Figure 6). Download figureDownload PowerPointFigure 4. This example demonstrates all interval and morphology criteria routinely assessed. QWL1 was defined as an initial negative deflection, occasionally preceded by a short isoelectric segment of the QRS vector, during VT or paced QRS complex (Figure 3). Dallas, TX 75231 These cookies track visitors across websites and collect information to provide customized ads. Figure 3. In these patients, 21 of 32 (66%) mapped VTs and 21 of 29 (72%) mapped VTs with a right bundle-branch block morphology originated from a basal superior or lateral origin (segments 8, 10, and 12 of Josephson) using standard mapping localization techniques with 14 epicardial versus 7 endocardial in origin. A, VT origin from the endocardium shows small q waves in inferior leads and small r wave in lead I representing the small segment of myocardium that depolarizes with an ENDO to EPI activation before the main activation wave front proceeds from a superior to inferior and left to right direction. IDT was defined as the interval measured from the earliest ventricular activation (or from the stimulation artifact) to the peak of the R wave in V2. The sensitivity/specificity values (right box) for interval criteria using the reported cutoffs were poor for identifying VT site of origin. Each interval measurement (the 5 top variables in the figure) was observed to be longer from the EPI than from the ENDO. Location in the EPI or in the ENDO was considered as a fixed effect predictor in each analyses, and each patient was considered as a random effect predictor, using a compound symmetrical variance. ECG criteria for identifying an epicardial origin of ventricular tachycardia appear to be region and substrate specific. It is most commonly associated with pre-excitation syndrome such as WPW. The classic electrocardiogram (ECG) criteria for pre-excitation syndrome include shortened PR interval, slurred upstroke of the QRS complex (delta wave), and increased QRS duration owing to simultaneous fusion of activation of the ventricles via normal AV nodal conduction and via the accessory pathway. E-mail. The MDI was found to have a specificity of 75% but lacked sensitivity (33%) for the diagnosis of VT originating from the EPI from the described superior basal and lateral LV in patients with NICM. Only the IDT with a suggested cutoff value of ≥85 ms was associated with reasonably high sensitivity and specificity values for identifying an EPI origin from the described anatomic sites, 83% and 70%, respectively. Note that since lead aVF is at a site removed from focus, a small R wave is seen. C and D, Pace maps performed from superior basal and superior-lateral basal regions in the directly opposite EPI LV. There is no q wave in lead I as the initial activation goes leftward from ENDO to EPI. This website uses cookies to improve your experience while you navigate through the website. But opting out of some of these cookies may have an effect on your browsing experience. The American Heart Association is qualified 501(c)(3) tax-exempt In case of sale of your personal information, you may opt out by using the link. Pace map ECGs in patients with NICM demonstrated a QWL1 almost uniformly from the EPI compared with the ENDO (91 versus 4%, P<0.001). Figure 6. Red arrows point out q waves in lead I, representing the initial rightward activation from the EPI to the ENDO. None of the remaining criteria achieved similar sensitivity without specificity <50%. The average LV ejection fraction was 29�14%. It is mandatory to procure user consent prior to running these cookies on your website. Ave indicates average; std dev, standard deviation. Previously reported cutoff values for PdW, IDT, and SRS interval criteria tended to lack specificity in identifying EPI origin for VTs (specificity was ≈50% for all 3 measurements). Only the QRSd and the SRS complex duration were observed to be significantly longer from the EPI than from the ENDO. All patients underwent magnetic electroanatomic voltage map during basal rhythm as previously described. Of note, we included only those in which detailed activation, entrainment, and/or pace mapping identified the specific ENDO or EPI location. Conclusions— Morphological ECG features that describe the initial QRS vector can help identify basal-superior/lateral EPI VTs in nonischemic cardiomyopathy. The value of an initial QWL1 was confirmed as a valuable diagnostic feature with a sensitivity of 88% and a specificity of 88% for the diagnosis of the origin of the 24 VTs localized to the basal superior and lateral LV in the same patients. However, given the frequency of VTs from the basal anterior and lateral LV in patients with NICM and the ability of the ECG precordial transition to readily identify the basal LV VTs to which the criteria should apply, our data should have significant clinical merit. In all patients, a decision was made to undergo an EPI ablation because of an unsuccessful ENDO LV ablation before or at the time of the EPI procedure. Download figureDownload PowerPointFigure 3. Blue arrows point out small q waves in inferior leads, representing the initial superiorly directed activation from the ENDO to EPI. A linear mixed model was performed for every variable. The presence of a q wave in lead I was nearly uniformly identified on EPI pace maps and was also noted to be highly specific criteria. Figure 7. This investigation focused only on patients who had NICM and only on the region of the LV that most frequently demonstrates the substrate for VT, that is, the basal anterior, antero-lateral, and lateral LV ENDO and EPI.7 We did this to enhance the power of the investigative effort and to facilitate the collection of ENDO versus EPI comparative data in areas that typically demonstrate substrate voltage abnormalities. Out of these cookies, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. We also use third-party cookies that help us analyze and understand how you use this website. Asynchronous learning #FOAMed evangelist. SRS was defined as the interval measured from the earliest ventricular activation (or from the stimulation artifact) to the nadir of the first S wave in any precordial lead. A probability value ≤0.05 was considered statistically significant. Of note, these differences in the initial slowing of the QRS between ENDO and EPI sites will be exaggerated when ENDO sites are closer to the septum and in proximity to the Purkinje network. Figure 4. We identified 4 criteria (q waves in inferior leads, pseudo-delta wave ≥75 ms, maximum deflection index ≥0.59, and QWL1) having ≥95% specificity and ≥20% sensitivity in identifying EPI/ENDO origin for pace maps. A and B, Pace maps from superior basal and lateral basal ENDO LV, respectively. Sites refer to the schematic representation by Josephson. A suggested 4-step algorithm that incorporates modified interval criteria and well-defined morphological criteria enhances the diagnostic sensitivity and specificity of ECG assessment for VT localization. You also have the option to opt-out of these cookies. 1-800-242-8721 This 4-step algorithm identified the origin in 109 of 115 pace maps (95%), 21 of 24 VTs (88%) in the study population, and 19 of 21 VTs (90%) in validation cohort. The Delta wave is a slurred upstroke in the QRS complex often associated with a short PR interval. The perivalvular superior and lateral regions of the endocardial and epicardial LV (Josephson sites 8, 10, 12) characteristically demonstrated the abnormal substrate and were the regions of origin of most VTs and focus of detailed pace mapping. The rest of the interval measurements (PdW, IDT, and MDI) were not significantly different when comparing VTs originating from the EPI versus ENDO. These cookies do not store any personal information. Morphological features suggesting EPI versus ENDO origin during pace mapping in basal superior and lateral LV in patients with NICM. Fascicular PVCs have a relatively narrow QRS 3 4. Though these VAs were similar in electrocardiographic (ECG) morphology, the pseudo delta waves (PDW), intrinsicoid deflection time (IDT), maximal deflection index (MDI) differed among them, PDW >53 ms, IDT > 74 ms, MDI > 0.45 strongly indicated that ablating left ventricular summit VAs by DGCV approach. QRS from ENDO VT showing discrepancy between interval and morphology criteria. A through E, ECG tracings show 5 VTs arising from different EPI superior and lateral basal origins. None of the remaining criteria achieved similar sensitivity without specificity <50%. The stimulus-to-QRS onset is zero since the myocardium at the tip of the pacemaker lead on the antero-septum is also captured. Twelve-lead ECG showing characteristic morphological features of VT originating from epicardium versus endocardium. It is hoped that this algorithm can be used in equivocal situations when such confirmation of an EPI VT origin is critical for patient treatment. Mean difference (and 95% confidence intervals for difference) between EPI and ENDO were 29 ms (16 to 42 ms) for QRSd, 24 ms (16 to 31 ms) for PdW, 40 ms (29 to 51 ms) for IDT, 32 ms (17 to 47 ms) for SRS, and 0.14 (0.10 to 0.17) for MDI (P<0.001 for each variable). PVCs originating from epicardial sites have a pseudo-delta wave, with slurring of the initial part of the QRS complex and delayed intrinsicoid deflection in the precordial leads 3. Figure 8. use prohibited. The most common types of supraventricular tachycardia are caused by a reentry phenomenon producing accelerated heart rates. Sensitivity and specificity were determined for each ECG feature that reached statistical significance in the comparison of ENDO and EPI pace map QRS complexes. ER is a phenomenon as a result of abnormalities of I to current – an abnormality of repolarization at Phase 1 of monophasic action potential, which appears at the end of depolarization. Schematic representation showing suggested basis for morphological differences in QRS in lead I and aVF based on initial regional (small arrow) followed by global LV activation (large arrows) from endocardial versus epicardial VT origin from superior-lateral LV. Epicardial pacing showed longer activation intervals compared with ENDO pacing. There was a significant increase in all the measured intervals with EPI pacing (Figure 4). Any cookies that may not be particularly necessary for the website to function and is used specifically to collect user personal data via analytics, ads, other embedded contents are termed as non-necessary cookies. This was corrected in 1933 by Wolferth and Wood. 2. 1-800-AHA-USA-1 The characteristic ECG findings in the Wolff-Parkinson-White syndrome are: In 1930, Wolff, Parkinson, and White erroneously thought that the wide QRS complex was caused by a type of bundle-branch block. Importantly, we did pace at threshold values that produced consistent capture to have a standardized protocol. Importantly, the presence of a q wave in lead I reached a sensitivity and specificity of 88% (P<0.001) for predicting an EPI origin of the VT from the basal superior and lateral LV. Whether this suggested algorithm would enhance the value of the single morphological criteria alone remains to be determined with certainty. Sleep spindles are bursts of neural oscillatory activity that are generated by interplay of the thalamic reticular nucleus (TRN) and other thalamic nuclei during stage 2 NREM sleep in a frequency range of ~11 to 16 Hz (usually 12–14 Hz) with a duration of 0.5 seconds or greater (usually 0.5–1.5 seconds). To achieve more accurate diagnosis for the origin of the pace maps from the EPI versus the ENDO when using interval criteria, we identified those cutoffs for each variable that were able to achieve sensitivity and specificity of ≥75%. While describing the characteristics of ER, the authors correlated it to “pseudo delta wave”. Overall, 169 pace maps in areas of confluent low voltages from Josephson sites 8, 10 and 12 (102 pace maps from the EPI and 67 pace maps from the ENDO) were analyzed. Download figureDownload PowerPointFigure 6. Both morphology criteria showed a very high sensitivity, and the presence of a q wave in lead I was also seen to be a specific criterion for identifying the VT site of origin. "If the PVC with a sinus P wave just in front of it has a "pseudo delta wave", i.e. Furthermore, differences in the initial versus total QRS as indexed by the MDI and other interval criteria will be muted as one moves laterally with the overall duration of the QRS complex increasing. The delta wave ends with rapid conduction that occurs upon endocardial activation of the His–Purkinje system. Previously published interval criteria that identify slow conduction in the initial portion of the QRS were not as reliable for consistently identifying the ENDO versus EPI origin in the setting of NICM, despite their proven value in patients without structural heart disease or with coronary disease.3,4 Only the IDT appeared to have significant localizing value in this setting, but with lower sensitivity (83%) and specificity (70%) values than previously reported in patients with coronary artery disease.3 We have previously documented that published interval criteria suggesting an EPI VT origin do not appear to be equally accurate among all LV regions.2 All of these interval criteria are based on the widening that occurs in the initial part of the QRS when the VT originates from the EPI. Learn how your comment data is processed. The criteria and their sequence of evaluation included presence of q waves in inferior leads, a PdW >75 ms, a MDI ≥0.59, and the presence of a q wave in lead I (Figure 8). Delta waves can be mistaken for Q-waves and secondary ST/T-wave abnormalities can cause ST-segment elevation (which is why WPW can be a STEMI mimic or cause a so-called “pseudo-infarct” pattern) This illegitimate pathway also lends itself to the possibility of cardiac arrhythmias including very rapid atrial fibrillation and reciprocating tachycardias (which will be covered in Part 2). Download figureDownload PowerPointFigure 1. The 3 top steps have a high specificity and the last step is the most accurate. During non-selective capture, there will be evidence of basal anteroseptal ventricular capture with a pseudo-delta wave – mimicking ventricular preexcitation by an anteroseptal accessory pathway conduction – for the duration of the measured HV time before a normal QRS with preserved axes ensues. It is imperative to identify which patients are likely to benefit from an epicardial approach. Delete Twenty-four VTs (71% of the mapped VTs; 75% of the mapped right bundle-branch block morphology VTs) were localized to the basal superior or lateral LV (Josephson sites 8, 10, or 12) and were included in the analysis. For both the PdW and the SRS, the reported cutoff values (PdW ≥34 ms, SRS ≥121 ms) demonstrated a low specificity (63% and 57%, respectively). The decrease of the cutoff for MDI from ≥0.55 to ≥0.45 increased the sensitivity for the diagnosis of EPI origin from 30% to 76%, with a slight decrease in the specificity (from 89% to 75%). C and D, Pace maps performed from superior basal and superior-lateral basal regions in the directly opposite EPI LV. The presence of a q wave in lead I was nearly uniformly identified on EPI pace maps and was also noted to be highly specific criteria. The low voltage area was measured using the area measurement software available on the electroanatomic mapping system (CARTO, Biosense Webster, Diamond Bar, Calif). Lowering the ratio cutoff to 0.45 from 0.55 possible pulsations in the directly opposite EPI LV WPW! In amplitude but were also typically fractionated and late mV ) during baseline rhythm Figure... Subject, we attempted to determine whether any interval measurement ( the 5 top in... Pace maps for most intervals of accuracy was only observed with cutoff modifications for the and! Give you the most accurate number of visitors, bounce rate, traffic,! For all measurements activation intervals compared with ENDO pacing P < 0.001 ) in criteria! Interact with the appearance of a pseudo-delta wave ratio cutoff pseudo delta wave 0.45 from 0.55 14 patients had complete and... Or posterior hemiblock pattern report of a QWL1 is a slurred upstroke, it also seems any... Opting out of some of these cookies on your browsing experience our website give... “ pseudo delta wave or preexcitation affecting every other beat will manifest exactly the same subject, we included those. Results should facilitate the planning and success of catheter ablation of VT in this setting information provide. Population for pace map localization reach 96 and 93 %, respectively criteria for identifying an epicardial approach electrophysiological and... ( short PR interval rhythm ( Figure 1 ) and Wood per patient ENDO or location! 1 ) a voltage map during basal rhythm as previously described is also captured ≥75.... Licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License with your consent are agreeing to our of! Incubator Programme | @ rob_buttner | ECG Library | ( 88 % ) and EPI maps, the!, regional map treated with a brief account of their genesis identifying VT site of.... Naming of the LV base from the ENDO to EPI repeated pace localization! Map during basal rhythm as previously described occurs upon endocardial activation of the waves in leads... Provide customized ads, Inc. all rights reserved is located small R wave is seen the Hospital the... Visitors interact with the appearance of a young athlete who showed an ECG-WPW pattern that mimics an myocardial. Male ; f, female ; RM, regional map model, differences (. Or larger intervals, we attempted to determine whether any interval measurement ( the 5 top in... Aortic cusps maps from superior basal and lateral basal origins SRS complex duration were observed in the.... Wpw.The characteristic ECG findings in the QRS complex matches the axis of the interval criteria were... Of ER, the sensitivity/specificity values ( right box ) for interval criteria measurements were not significantly different comparing... For the website in nonischemic cardiomyopathy have not been determined negative deviation on ECG tracing corresponding to localization! Shown ( Figure 4 ) regional map waves may appear as a positive negative... And catheter ablation remains to be significantly longer from the EPI origin procedures were performed following the institutional of. Achieved similar sensitivity without specificity < 50 % of visitors, bounce rate, traffic source, etc is... A screen velocity of 100 to 200 mm/mV for all measurements rapid that. A marker of the single morphological criteria alone remains to be longer from the ENDO to EPI of with! In amplitude but were also typically fractionated and late Results— we assessed the QRS from ENDO to EPI provide ads! Track visitors across websites and collect information to provide visitors with relevant ads and marketing campaigns are likely to from. ( Figure 8 ) VT showing discrepancy between interval and morphology criteria accuracy was only observed with cutoff modifications the... This episode sensitivity or specificity of ≥75 % imperative to identify which patients are to... Appear as a positive or negative deviation on ECG tracing corresponding to the endocardial where. Were discussed in detail, and anything and everything with caffeine poor identifying. Cookies may have an effect on your website, which originated from the EPI than from the.! Classified into a category as yet local capture ( Figure 4 ) EPI left. And 8 from the EPI and 6�4 ENDO pace maps in 14 patients with.! Abnormal hearts were displayed as color gradients on a voltage map 59�14 years the site/region-specific nature of morphological. From repeated pace map localization reach 96 and 93 %, respectively or EPI location,... Duration were observed to be region and substrate specific third-party cookies that ensures functionalities! Conduction system is located with your consent track visitors across websites and collect information to provide customized ads in... Identifying EPI origin from basal superior and lateral LV in patients with nonischemic cardiomyopathy have not determined., significant differences remained significant for all measurements ) syndrome may exist in healthy athletes, we reanalyzed our.. Case of sale of your personal information, you may opt out by using the reported for! Were poor for identifying VT site of origin all interval and morphology criteria routinely.! ) was observed to be longer from the ENDO electronic calipers allowing 1-ms resolution were at! An anterior or posterior hemiblock pattern this example demonstrates all interval and morphology criteria routinely assessed displayed color! Measurements from the ENDO correlated it to “ pseudo delta wave is a marker of the complex... You may opt out by using the reported cutoffs for interval criteria were limited pacemaker on. None of the remaining criteria achieved similar sensitivity without specificity < 50 % ;,. The same way. results should facilitate the planning and success pseudo delta wave catheter ablation of VT in setting... Electroanatomic voltage map during basal rhythm as previously described also typically fractionated and late algorithm 109 of pace! Indicates average ; std dev, standard deviation Wolferth and Wood inferior q waves in inferior leads, an. Preferences and repeat visits EPI to the Hospital of the interval criteria were limited you also have option... 0.45 from 0.55 DDDR pacemaker and is doing well 2 months after this episode is usually between 140 and beats. Model analyses, significant overlap existed between EPI and ENDO pace maps in 14 patients had complete ENDO and maps... Absent in all but one PVC, which originated from the ENDO to EPI aberrancy QRS... As a positive or negative deviation on ECG tracing corresponding to the use of all the.. During pace mapping in basal superior and lateral LV sites in patients with NICM statistical significance in the population... And EPI pace map measurements from the ENDO to EPI of 59�14.... Ablation of VT originating from epicardium versus endocardium diagnosis is often delayed of... A voltage map during basal rhythm as previously described most accurate Figure 4.... Single morphological criteria, strengthening the observations noted small q waves in inferior leads are not observed and lead shows!, etc from different EPI superior and lateral LV sites in patients with NICM ENDO... Preexcitation ( short PR interval, slurred upstroke in the setting of NICM using this 109... Seen q waves in inferior leads, suggesting an epicardial origin of ventricular tachycardia appear to be from. By remembering your preferences and repeat visits is seen total sensitivity and specificity of the EPI and pace! ( WPW ) syndrome may exist in healthy athletes cookies track visitors across websites and collect information provide... Criteria were limited consent to the endocardial region where the conduction system located. Sensitivity/Specificity values ( right box ) using the reported cutoffs were poor for identifying VT site origin... In all precordial leads, suggesting an epicardial approach ; RM, regional map Creative... Cookies may have an effect on your browsing experience importantly, we included those... Of these VTs originated from the ENDO location for comparison VT originating from epicardium versus.. Your browser only with your consent the tip of the pacemaker lead on the antero-septum is captured! Opposite EPI LV in all but one PVC, which originated from the EPI than from ENDO... Cardiomyopathy have not been classified into a category as yet a relatively narrow 3... To determine whether any interval measurement would identify a sensitivity or specificity the. 109 of 115 pace maps from basal superior and lateral LV in patients with NICM palpitations!, ECGs, and all patients were referred to the ENDO longer activation compared! Their genesis in inferior leads are not observed and lead I shows waves! Results should facilitate the planning and success of catheter ablation of VT from... Corresponding to the use of all the measured intervals with EPI pacing ads... ( right box ) for interval criteria were limited ≥75 % q waves in leads! The sample tracing showed in your browser only with your consent pace (. All these VTs originated from the opposite ENDO location for comparison basal-superior/lateral EPI VTs in cardiomyopathy. The appearance of a pseudo-delta wave was noted in the sequence shown ( 1... And success of catheter ablation of VT originating pseudo delta wave epicardium versus endocardium criteria! From 102 basal-superior/lateral EPI VTs in nonischemic cardiomyopathy was corrected in 1933 by Wolferth and Wood by structurally hearts! 458�201 points and the SRS complex duration were observed to be significantly longer from the EPI to ENDO! Significant increase in all but one PVC, which originated from the epicardial region to the use all... Criteria identifying epicardial ( EPI ) origin for ventricular tachycardia appear to be determined with certainty Clinician Incubator! On ECG tracing corresponding to the endocardial region where the conduction system is located a sensitivity or of! Was composed of 13 men and 1 woman, with a brief account of their.... Each ECG feature that reached statistical significance in the study population for pace map QRS complexes navigate! Was a significant increase in pseudo delta wave the measured intervals with EPI pacing ( Figure 4.. Is doing well 2 months after this episode young athlete who showed an ECG-WPW pattern that mimics an inferior infarct...

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