Key result
Second intercostal space V1-V2 leads accurately identify LVOT PVC origin with ~94% specificity.
Why the study?
To evaluate the value of QRS onset of outflow tract PVC in V1 and V2 leads recorded across the fourth, third, and second intercostal spaces to differentiate RVOT versus LVOT origins.
Does comparing QRS onset timing from V1 and V2 leads in the second, third, and fourth intercostal spaces accurately differentiate RVOT from LVOT origin in patients with outflow tract premature ventricular contractions?
Cohort (n=58)
No
Does comparing QRS onset timing from V1 and V2 leads in the second, third, and fourth intercostal spaces accurately differentiate RVOT from LVOT origin in patients with outflow tract premature ventricular contractions?
Effect estimate: AUC 0.880, Sensitivity 81.82%, Specificity 94.12%
p-value: p=<0.001
Evaluating QRS onset timing of PVCs in V1 and V2 leads from higher intercostal spaces provides a highly specific, non-invasive method for differentiating LVOT from RVOT origins prior to ablation.
Background: Electrocardiography (ECG) is now proposed as a simple and cost-effective tool to determine the location of arrhythmias before ablation. We aimed to examine the value of the QRS onset of outflow tract PVC in V1 and V2 leads recorded in fourth, third, and second intercostal spaces to differentiate two main origins for premature ventricular contraction (PVC) including right ventricular outflow tract (RVOT) and left ventricular outflow tract (LVOT). Methods: In this prospective cohort study, a total of 58 patients were studied, from whom a surface ECG was obtained using V1 and V2 leads in the fourth, third, and second intercostal spaces. ECG and Electrophysiology studie (EPS) data were then recorded and compared to determine the sensitivity and specificity of QRS onset in locating arrhythmias. The reciever operating characterictic (ROC) curve analysis was applied to test diagnostic performance. Results: Based on the time of PVC initiation in each of the V1 and V2 leads in the fourth intercostal space, if PVC is recorded earlier in the V1 lead, its source in 95.8% of the patients is RVOT and if PVC preceded the V2 lead, 70.59% of the patients had PVC from LVOT. Comparing of QRS onset in V1 and V2 leadsrecorded from third% and and second intercostal spaces had considerable sensitivity and specificity to determine the origin of the outflow tract PVC (81.82 and 94.12%, respectively). Conclusion: Simultaneous recording of outflow tract PVCs from second third and fourth intercostal spaces and comparing their onset can determine the left and right outflow tract PVCs with high sensitivity and specificity.
No takes yet. Share an insight, caveat, or question.
Jorat et al. (2022) conducted a cohort in Premature ventricular contraction (PVC) (n=58). Surface ECG recording in second, third, and fourth intercostal spaces vs. Intracardiac mapping and pacing during electrophysiology study (EPS) was evaluated on Accuracy of QRS onset in V1 and V2 leads in the second intercostal space to determine the left ventricular outflow tract (LVOT) origin of PVC (AUC 0.880, Sensitivity 81.82%, Specificity 94.12%, p=<0.001). Comparing QRS onset in V1 and V2 leads recorded from the second intercostal space accurately predicted left ventricular outflow tract (LVOT) PVC origin with 81.82% sensitivity and 94.12% specificity.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: