Key result
S-R difference in V1-V2 > 1.625 mV predicted right ventricular outflow tract arrhythmia origin with 95.1% sensitivity, 85.5% specificity, and an AUC of 0.929 (p < .001).
Why the study?
Does the S-R difference in V1-V2 accurately differentiate left from right ventricular outflow tract arrhythmias in patients with symptomatic premature ventricular contractions?
Observational (n=123)
Does the S-R difference in V1-V2 accurately differentiate left from right ventricular outflow tract arrhythmias in patients with symptomatic premature ventricular contractions?
Effect estimate: AUC 0.929
p-value: p=<.001
The S-R difference in V1-V2 is a novel, simple, and highly accurate electrocardiographic criterion for differentiating RVOT from LVOT origins in ventricular arrhythmias.
May aid pre-ablation localization of outflow tract PVCs; hypothesis-generating and requires prospective validation.
AIM: The correct estimation of the VA origin as RVOT or LVOT results in reduced ablation duration reduced radiation exposure and decreased number of vascular access. In our study, we aimed to detect the predictive value of S-R difference in V1-V2 for differentiating the left from right ventricular outflow tract arrhythmias. METHODS: We included 123 patients with symptomatic frequent premature ventricular outflow tract contractions who underwent successful catheter ablation (70 male, 53 female; mean age 46.2 ± 13.9 years, 61 RVOT, 62 LVOT origins). S-R difference in V1-V2 was calculated with this formula on the 12-lead surface ECG: (V1S + V2S) - (V1R + V2R). Conventional ablation was performed in 101 (82.1%) patients, CARTO electroanatomic mapping system was used in 22 (17.9%) patients. RESULTS: V1-2 SRd was found to be significantly lower for LVOT origins than RVOT origins (p < .001). The cutoff value of V1-2 SRd obtained by ROC curve analysis was 1.625 mV for prediction of RVOT origin (sensitivity: 95.1%, specificity: 85.5%, positive predictive value: 86.5%, negative predictive value: 94.5%). The area under the curve (AUC) was 0.929 (p < .001). CONCLUSION: S-R difference in V1-V2 is a novel and simple electrocardiographic criterion for accurately differentiating RVOT from LVOT sites of ventricular arrhythmia origins. The use of this simple ECG measurement could improve the accuracy of OTVA localization, could be beneficial for decreasing ablation duration and radiation exposure. Further studies with larger patient population are needed to verify the results of this study.
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Kaypaklı et al. (2017) conducted an observational in symptomatic frequent premature ventricular outflow tract contractions (n=123). S-R difference in V1-V2 vs. LVOT origin was evaluated on Prediction of RVOT origin (AUC 0.929, p=<.001). S-R difference in V1-V2 > 1.625 mV predicted right ventricular outflow tract arrhythmia origin with 95.1% sensitivity, 85.5% specificity, and an AUC of 0.929 (p < .001).
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