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Background <p>Accurate identification of the site of origin (SOO) of outflow tract ventricular arrhythmias (OTVAs) is critical for effective ablation planning. Accuracy of the existing algorithms/scores in patients with wide baseline QRS has not been previously described. This study sought to evaluate the performance of available algorithms/scores in predicting the OTVA-SOO in patients with wide baseline QRS due to intraventricular conduction abnormalities or paced rhythm (NCT06602635).</p> Methods <p>Eighty-eight patients with intraventricular conduction disturbances (baseline QRS &gt;110 ms) or a paced rhythm who underwent OTVA ablation in 9 European centers were included. The predictive performance of the existing algorithms/scores was compared using receiver operating characteristic curve analysis, accuracy, sensitivity, and specificity.</p> Results <p>Median baseline QRS duration was 122ms (114–144), sixty-five (73.9%) patients had OTVA originating from left ventricular outflow tract (LVOT) and 23 (26.1%) from right ventricular outflow tract. LVOT-SOO patients were older (69 vs. 56 years, <i>p</i> = 0.01), more frequently hypertensive (55.4% vs. 26.1%, <i>p</i> = 0.03), cardiac implantable electronic device (CIED)-carriers (33.8% vs. 4.3%, <i>p</i> = 0.01), and had lower LV ejection fraction (45% vs. 56%, <i>p</i> = 0.05). LVOT-OTVAs more often showed early R/S precordial transition (63.1% vs. 0.0%, <i>p</i> &lt; 0.001). The Weighted Hybrid Score (WHS), which incorporates clinical and ECG variables, achieved the highest diagnostic performance (AUC 0.971), surpassing ECG-based scores (AUC from 0.919 to 0.510). A WHS ≥ 2 accurately predicted a LVOT-SOO in 80 of 88 cases (accuracy 91.0%), with 92% sensitivity and 91% specificity, outperforming existing scores (accuracy from 59% to 83%).</p> Conclusions <p>In patients with a wide baseline QRS the most frequent OTVA-SOO is the LVOT. The WHS demonstrated accurate prediction of the OTVA-SOO in this specific population, outperforming previously published ECG-based algorithms/scores.</p> Graphical Abstract <p></p>

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Weighted hybrid score predicts outflow tract ventricular arrhythmia origin in patients with intraventricular conduction disorders or paced rhythm: an international multicenter study

  • 期刊论文

  • 发表日期：

    2026年3月21日

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  • Giulio Falasconi,
  • Diego Penela,
  • David Soto-Iglesias,
  • Luigi Pannone,
  • Etelvino Silva,
  • Matteo Parollo,
  • Marco Bergonti,
  • Alberto Preda,
  • Alessandro di Vilio,
  • Kazutaka Nakasone,
  • Stefano Valcher,
  • Alessia Chiara Latini,
  • Pietro Francia,
  • Andrea Saglietto,
  • Federico Landra,
  • Lucio Teresi,
  • Lautaro Sanchez-Mollá,
  • Fabrizio Guarracini,
  • Julio Martí-Almor,
  • Pasquale Vergara,
  • Sebastiano Carli,
  • Dario Turturiello,
  • Massimo Tritto,
  • Giulio Conte,
  • Giulio Zucchelli,
  • Saverio Iacopino,
  • Carlo de Asmundis,
  • Patrizio Mazzone,
  • Juan Fernandez-Armenta,
  • Antonio Berruezo

摘要

Background

Accurate identification of the site of origin (SOO) of outflow tract ventricular arrhythmias (OTVAs) is critical for effective ablation planning. Accuracy of the existing algorithms/scores in patients with wide baseline QRS has not been previously described. This study sought to evaluate the performance of available algorithms/scores in predicting the OTVA-SOO in patients with wide baseline QRS due to intraventricular conduction abnormalities or paced rhythm (NCT06602635).

Methods

Eighty-eight patients with intraventricular conduction disturbances (baseline QRS >110 ms) or a paced rhythm who underwent OTVA ablation in 9 European centers were included. The predictive performance of the existing algorithms/scores was compared using receiver operating characteristic curve analysis, accuracy, sensitivity, and specificity.

Results

Median baseline QRS duration was 122ms (114–144), sixty-five (73.9%) patients had OTVA originating from left ventricular outflow tract (LVOT) and 23 (26.1%) from right ventricular outflow tract. LVOT-SOO patients were older (69 vs. 56 years, p = 0.01), more frequently hypertensive (55.4% vs. 26.1%, p = 0.03), cardiac implantable electronic device (CIED)-carriers (33.8% vs. 4.3%, p = 0.01), and had lower LV ejection fraction (45% vs. 56%, p = 0.05). LVOT-OTVAs more often showed early R/S precordial transition (63.1% vs. 0.0%, p < 0.001). The Weighted Hybrid Score (WHS), which incorporates clinical and ECG variables, achieved the highest diagnostic performance (AUC 0.971), surpassing ECG-based scores (AUC from 0.919 to 0.510). A WHS ≥ 2 accurately predicted a LVOT-SOO in 80 of 88 cases (accuracy 91.0%), with 92% sensitivity and 91% specificity, outperforming existing scores (accuracy from 59% to 83%).

Conclusions

In patients with a wide baseline QRS the most frequent OTVA-SOO is the LVOT. The WHS demonstrated accurate prediction of the OTVA-SOO in this specific population, outperforming previously published ECG-based algorithms/scores.

Graphical Abstract