Aim

The current study aimed to establish a novel electrocardiographic (ECG) criterion for discrimination of idiopathic premature ventricular contractions (PVCs) originating from posteroseptal right ventricular outflow tract (sRVOT-p) versus right coronary cusp (RCC).

Methods

A total of 76 patients with idiopathic PVCs who underwent mapping and successful ablation were retrospectively included. Among them, 37 patients had PVCs from sRVOT-p origin and 39 patients from RCC origin. The surface ECGs during PVCs were recorded. S-R different index in V1/V3 was calculated with the following formula of 0.134*V3R-0.133*V1S.

Results

ECG characteristics showed wider total QRS duration, smaller R-wave amplitude on lead V2-V5, and larger S-wave amplitude on lead V1-V3 in sRVOT-p origin than RCC origin. Lead V3 was the most common transitional lead in two groups. Receiver operating characteristic (ROC) curve analysis showed that S-wave amplitude on lead V1 exhibited the largest AUC of 0.772, followed by the AUC of R-wave amplitude on lead V3 of 0.771. Subsequently, 0.134*V3R-0.133*V1S index was obtained by multiplication, subtraction, sum, and division of these ECG measurements, which exhibited the largest AUC of 0.808. The optimal cut-off value was −0.26 for differentiating RCC from sRVOT-p origin, with the sensitivity of 78.4% and specificity of 77.8%. Moreover, 0.134*V3R-0.133*V1S index was superior to previous criteria in analysis of PVCs originating from sRVOT-p and RCC.

Conclusions

0.134*V3R-0.133*V1S is a novel ECG criterion to discriminate sRVOT-p from RCC origin in patients with idiopathic PVCs, which may provide guidance for approach of radiofrequency catheter ablation.

中文翻译：

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V1/V3 中的 SR 指数作为一种新的标准来区分起源于后中隔右心室流出道与右冠状动脉尖的特发性室性早搏

目的

目前的研究旨在建立一种新的心电图 (ECG) 标准，用于区分源自后间隔右心室流出道 (sRVOT-p) 与右冠状动脉尖 (RCC) 的特发性室性早搏 (PVC)。

方法

回顾性纳入了 76 例接受标测和成功消融的特发性 PVC 患者。其中，37 名患者的 PVC 来自 sRVOT-p，39 名患者来自 RCC。记录 PVC 期间的表面心电图。V1/V3中的SR不同指标计算公式为0.134*V3R-0.133*V1S。

结果

心电图特征显示 sRVOT-p 起源的总 QRS 持续时间较 RCC 起源更宽，V2-V5 导联 R 波幅度较小，V1-V3 导联 S 波幅度较大。导联 V3 是两组中最常见的过渡导联。接受者操作特征 (ROC) 曲线分析显示，V1 导联 S 波幅度最大 AUC 为 0.772，其次是 V3 导联 R 波幅度 AUC 为 0.771。随后，通过这些心电图测量值的乘法、减法、加法和除法得到0.134*V3R-0.133*V1S指数，其最大AUC为0.808。区分 RCC 与 sRVOT-p 起源的最佳临界值为 -0.26，敏感性为 78.4%，特异性为 77.8%。此外，在分析源自 sRVOT-p 和 RCC 的 PVC 时，0.134*V3R-0.133*V1S 指数优于先前的标准。

结论

0.134*V3R-0.133*V1S 是一种新的心电图标准，用于区分特发性 PVC 患者的 sRVOT-p 与 RCC 起源，可为射频导管消融的方法提供指导。