The RV1-V3 transition ratio: A novel electrocardiographic criterion for the differentiation of right versus left outflow tract premature ventricular complexes
Michael Efremidis, Konstantinos Vlachos, Maria Kyriakopoulou, Panagiotis Mililis, Claire Martin, George Bazoukis, Stylianos Dragasis, Athanasia Megarisiotou, Philippe Unger, Antonio Frontera, Giuseppe Mascia, Athanasios Saplaouras, Sotirios Xydonas, Kosmas Valkanas, Frédéric Sacher, Pierre Jaı̈s, Κonstantinos P. Letsas
Abstract
BackgroundSeveral electrocardiographic (ECG) indices have been proposed to predict the origin of premature ventricular complexes (PVCs) with precordial transition in lead V3. However, the accuracy of these algorithms is limited.ObjectivesWe sought to evaluate a new ECG criterion differentiating the origin of outflow tract with precordial transition in lead V3.MethodsWe included in our study patients exhibiting outflow tract PVCs with precordial transition in lead V3 referred for ablation. We analyzed a novel new ECG criterion, RV1-V3 transition ratio, for distinguishing right from left idiopathic outflow tract PVCs with precordial transition in lead V3. The RV1-V3 transition ratio was defined as (RV1+RV2+RV3) PVC / (RV1+RV2+RV3) SR (sinus rhythm).ResultsWe included 58 patients in our study. The ratio was lower for right ventricular outflow tract origins than left ventricular outflow tract (LVOT) origins (median [interquartile range], 0.6953 [0.4818–1.0724] vs 1.5219 [1.1582–2.4313], P < .001). Receiver operating characteristic analysis revealed an area under the curve of 0.856 for the ratio, and a cut-off value of ≥0.9 predicting LVOT origin with 94% sensitivity and 73% specificity. This ratio was superior to any previously proposed ECG criterion for differentiating right from left outflow tract PVCs.ConclusionThe RV1-V3 transition ratio is a simple and accurate novel ECG criterion for distinguishing right from left idiopathic outflow tract PVCs with precordial transition in lead V3. Several electrocardiographic (ECG) indices have been proposed to predict the origin of premature ventricular complexes (PVCs) with precordial transition in lead V3. However, the accuracy of these algorithms is limited. We sought to evaluate a new ECG criterion differentiating the origin of outflow tract with precordial transition in lead V3. We included in our study patients exhibiting outflow tract PVCs with precordial transition in lead V3 referred for ablation. We analyzed a novel new ECG criterion, RV1-V3 transition ratio, for distinguishing right from left idiopathic outflow tract PVCs with precordial transition in lead V3. The RV1-V3 transition ratio was defined as (RV1+RV2+RV3) PVC / (RV1+RV2+RV3) SR (sinus rhythm). We included 58 patients in our study. The ratio was lower for right ventricular outflow tract origins than left ventricular outflow tract (LVOT) origins (median [interquartile range], 0.6953 [0.4818–1.0724] vs 1.5219 [1.1582–2.4313], P < .001). Receiver operating characteristic analysis revealed an area under the curve of 0.856 for the ratio, and a cut-off value of ≥0.9 predicting LVOT origin with 94% sensitivity and 73% specificity. This ratio was superior to any previously proposed ECG criterion for differentiating right from left outflow tract PVCs. The RV1-V3 transition ratio is a simple and accurate novel ECG criterion for distinguishing right from left idiopathic outflow tract PVCs with precordial transition in lead V3.