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How to identify & treat epicardial origin of RVOT tachycardias

The right ventricle outflow tract (RVOT) is the most common site of origin of idiopathic ventricular arrhythmias. The typical outflow tract arrhythmias pattern on ECG is an inferior axis deviation and left bundle branch block when originated on the RVOT and right bundle branch block morphology when originated on the left ventricular outflow tract (LVOT). There are several ECG tricks for different locations of origin. An increased Maximum Deflection Index (MDI) suggests epicardial origin of arrhythmia. In general the result of ablation is very good, but sometimes there are difficult and unsuccessful procedures. The origin in the aortic cusps and epicardial are the reason for failure in some cases. When they are epicardial, the arrhythmias can be accessed by the venous system or by subxiphoid epicardial mapping.

Credits: Cristiano F Pisani; Sissy Lara; Carina Hardy; Mauricio Scanavacca

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Introduction to AFib
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