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Our objective is to evaluate the accuracy of three algorithms in differentiating the origins of outflow tract ventricular arrhythmias (OTVAs). This study involved 110 consecutive patients with OTVAs for whom a standard 12-lead surface electrocardiogram (ECG) showed typical left bundle branch block morphology with an inferior axis. All the ECG tracings were retrospectively analyzed using the following three recently published ECG algorithms:  1 ) the transitional zone (TZ) index,  2 ) the V 2  transition ratio, and  3 ) V 2  R wave duration and R/S wave amplitude indices. Considering all patients, the V 2  transition ratio had the highest sensitivity (92.3%), while the R wave duration and R/S wave amplitude indices in V 2  had the highest specificity (93.9%). The latter finding had a maximal area under the ROC curve of 0.925. In patients with left ventricular (LV) rotation, the V 2  transition ratio had the highest sensitivity (94.1%), while the R wave duration and R/S wave amplitude indices in V 2  had the highest specificity (87.5%). The former finding had a maximal area under the ROC curve of 0.892. All three published ECG algorithms are effective in differentiating the origin of OTVAs, while the V 2  transition ratio, and the V 2  R wave duration and R/S wave amplitude indices are the most sensitive and specific algorithms, respectively. Amongst all of the patients, the V 2  R wave duration and R/S wave amplitude algorithm had the maximal area under the ROC curve, but in patients with LV rotation the V 2  transition ratio algorithm had the maximum area under the ROC curve.

Differentiating origins of outflow tract ventricular arrhythmias: a comparison of three different electrocardiographic algorithms