Twelve-Lead ECG of Ventricular Tachycardia in Structural Heart Disease

Abstract

Several algorithms for identifying the VT origin based on the analysis of the 12-lead VT ECG have been suggested. These algorithms have applied different definitions for VT SoO that include not only VT exit sites but also re-entry circuit exit sites and isthmus sites. In addition, they have been validated by different mapping techniques encompassing not only activation and entrainment mapping but also pacemapping. None of the algorithms integrated information on the scar extension and distribution, which may increase the accuracy of the ECG to precisely predict the VT origin. A systematic re-evaluation of the value of the 12-lead ECG for VT ablation in the context of 3D electroanatomical mapping, scar imaging, and changing ablation strategies with a shift from targeting clinical and induced VTs to substrate ablation approaches is needed.