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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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, <em>p</em> < 0.001), V1–V3 transition index (−2.6 ± 4.4 vs. -0.4 ± 4.6, <em>p</em> = 0.026), and ‘aVR/aVL time to first nadir of the QRS complex’ (0.94 ± 0.15 vs. 1.1 ± 0.2, <em>p</em> = 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 V<sub>2</sub>S/V<sub>3</sub>R index <1.4 predicted the origin of the LVOT, with a sensitivity of 78.4 % and a specificity of 80.4 %.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":15606,"journal":{"name":"Journal of electrocardiology","volume":"88 ","pages":"Article 153831"},"PeriodicalIF":1.3000,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"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\",\"authors\":\"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\",\"doi\":\"10.1016/j.jelectrocard.2024.153831\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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, <em>p</em> < 0.001), V1–V3 transition index (−2.6 ± 4.4 vs. -0.4 ± 4.6, <em>p</em> = 0.026), and ‘aVR/aVL time to first nadir of the QRS complex’ (0.94 ± 0.15 vs. 1.1 ± 0.2, <em>p</em> = 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 V<sub>2</sub>S/V<sub>3</sub>R index <1.4 predicted the origin of the LVOT, with a sensitivity of 78.4 % and a specificity of 80.4 %.</div></div><div><h3>Conclusion</h3><div>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.</div></div>\",\"PeriodicalId\":15606,\"journal\":{\"name\":\"Journal of electrocardiology\",\"volume\":\"88 \",\"pages\":\"Article 153831\"},\"PeriodicalIF\":1.3000,\"publicationDate\":\"2024-11-21\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of electrocardiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0022073624003017\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of electrocardiology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0022073624003017","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
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
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.
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.
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