Time to first nadir of the QRS complex in aVR/time to first nadir of the QRS complex in aVL: A novel method for distinguishing left from right outflow tract premature ventricular complexes (PVCs) with precordial transition in V3

IF 1.3 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of electrocardiology Pub Date : 2024-11-21 DOI:10.1016/j.jelectrocard.2024.153831

Alper Kepez , Cagan Yildirim MD , Kamil Gulsen , Kartal Emre Aslanger , Abdulkadir Uslu , Ayhan Kup , Mehmet Celik , Serdar Demir , Ayhan Kol MD , Batur Gonenc Kanar , Kursat Tigen

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Abstract

Background

The aim of the present study was to investigate the value of ‘time to first nadir of the QRS complex in aVR/time to first nadir of the QRS complex in aVL’ for distinguishing left vs. right outflow tract premature ventricular complexes (PVCs) with precordial transition in lead V3.

Methods

Data from 88 eligible consecutive patients (39 males; 48.3 ± 13.4 years of age) who had undergone ablation due to outflow tract PVCs that had transition in V3 were retrospectively evaluated and used in the analysis.

Results

Fifty-one patients (57.9 %) had PVCs with a left ventricular outflow tract (LVOT) origin, and 37 (42.1 %) patients had PVCs with a right ventricular outflow tract (RVOT) origin. There were significant differences between the LVOT and RVOT PVC groups in terms of the V2S/V3R index (0.97 ± 0.70 vs. 1.96 ± 0.80, p < 0.001), V1–V3 transition index (−2.6 ± 4.4 vs. -0.4 ± 4.6, p = 0.026), and ‘aVR/aVL time to first nadir of the QRS complex’ (0.94 ± 0.15 vs. 1.1 ± 0.2, p = 0.001). ROC curve analysis revealed that a ‘aVR/aVL time to first nadir of the QRS complex ratio’ greater than 0.98 predicted the RVOT origin, with 67.6 % sensitivity and 62.7 % specificity. A V1-V3 transition index > − 1.21 predicted an RVOT origin with 75.7 % sensitivity and 72.5 % specificity. A V₂S/V₃R index <1.4 predicted the origin of the LVOT, with a sensitivity of 78.4 % and a specificity of 80.4 %.

Conclusion

Although less precise than other established ECG criteria, the novel parameter ‘time to first nadir of the QRS complex in aVR/aVL’ was able to aid in the differentiation of LVOT vs. RVOT PVCs with V3 precordial transition in our study. Based on this finding, it may be suggested that if an OT PVC has an earlier negative QRS peak on aVL compared with aVR, the probability of it being the RVOT origin is high. This simple observation might aid the preprocedural planning of OT PVC ablation in clinical practice.

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aVR 中 QRS 波群第一基点的时间/aVL 中 QRS 波群第一基点的时间：用于区分左、右流出道室早复合体（PVC）和 V3 心前区转换的新方法

背景本研究旨在探讨 "aVR 中 QRS 复极第一个基点的时间/aVL 中 QRS 复极第一个基点的时间 "对于区分 V3 导联心前区过渡的左侧和右侧流出道室早复极（PVC）的价值。结果51例患者（57.9%）的PVC起源于左室流出道（LVOT），37例患者（42.1%）的PVC起源于右室流出道（RVOT）。LVOT 和 RVOT PVC 组在 V2S/V3R 指数（0.97 ± 0.70 vs. 1.96 ± 0.80，p < 0.001）、V1-V3 过渡指数（-2.6 ± 4.4 vs. -0.4 ± 4.6，p = 0.026）和 "aVR/aVL 到 QRS 复极第一低点的时间"（0.94 ± 0.15 vs. 1.1 ± 0.2，p = 0.001）方面存在明显差异。ROC 曲线分析显示，"aVR/aVL 到 QRS 波群第一个低点的时间比值 "大于 0.98 可预测 RVOT 起源，灵敏度为 67.6%，特异度为 62.7%。V1-V3 过渡指数> - 1.21 预测 RVOT 起源，灵敏度为 75.7%，特异度为 72.5%。结论在我们的研究中，"aVR/aVL 中 QRS 波群第一个低点的时间 "这一新颖参数虽然不如其他已确立的心电图标准精确，但却能帮助区分 LVOT 和 RVOT PVCs 与 V3 心前区转换。基于这一发现，我们可以认为，如果 OT PVC 在 aVL 上的负 QRS 峰早于 aVR，则其来源于 RVOT 的可能性很高。这一简单的观察结果可能有助于在临床实践中制定 OT PVC 消融术前计划。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of electrocardiology 医学-心血管系统

CiteScore

2.70

自引率

7.70%

发文量

152

审稿时长

38 days

期刊介绍： The Journal of Electrocardiology is devoted exclusively to clinical and experimental studies of the electrical activities of the heart. It seeks to contribute significantly to the accuracy of diagnosis and prognosis and the effective treatment, prevention, or delay of heart disease. Editorial contents include electrocardiography, vectorcardiography, arrhythmias, membrane action potential, cardiac pacing, monitoring defibrillation, instrumentation, drug effects, and computer applications.