Key result
A multistep algorithm using ECG Criteria 5, 8, and 1 predicted RVOT PVC origin with 85.9% accuracy and an AUC of 0.775 in the validation cohort.
Why the study?
Predicting PVC origin pre-ablation is fundamental because RVOT PVC often leads to higher success rates, prompting the need to compare published ECG criteria and develop an algorithm to better determine PVC origin to predict ablation success.
Does a multistep ECG algorithm improve diagnostic accuracy for predicting RVOT PVC origin compared to single criteria in patients with LBBB pattern and inferior axis PVCs?
Observational
Yes
Does a multistep ECG algorithm improve diagnostic accuracy for predicting RVOT PVC origin compared to single criteria in patients with LBBB pattern and inferior axis PVCs?
Effect estimate: AUC 0.775
A multistep ECG algorithm combining multiple criteria improves the prediction of right ventricular outflow tract (RVOT) origin for premature ventricular contractions compared to single criteria.
May aid RVOT PVC localization; hypothesis-generating and requires prospective validation before practice change.
BACKGROUND: Predicting premature ventricular contraction (PVC) origin pre-ablation is a fundamental step, as right ventricular outflow tract (RVOT) PVC often leads to higher success rates. OBJECTIVE: To compare nine published ECG criteria to differentiate between RVOT and non-RVOT origins of PVCs and develop a stepwise algorithm using those criteria to better determine PVC origin to predict ablation success. METHODS: ) and inferior axis (predominantly positive in leads II and III), who underwent ablation at Cipto Mangunkusumo Hospital (RSCM) (2017-2022). The validation group included 291 patients who underwent ablation at the Taipei Veteran General Hospital (2020-2023). We calculated and compared six diagnostic accuracy measures from nine previously published ECG morphology criteria to develop an algorithm to enhance the accuracy of predicting RVOT PVC origin for successful ablation. RESULTS: Our multistep algorithm using Criteria 5, 8, and 1 enhanced diagnostic performance compared to using each criterion alone. The accuracy, sensitivity, and specificity in the derivation group were 86.2%, 93.6%, and 66.7%, respectively; those in the validation group were 85.9%, 90.8%, and 64.7%, respectively. The ROC curve AUCs were 0.802 and 0.775, respectively. CONCLUSION: In cases of inferior axis and LBBB pattern PVCs, a multistep algorithm using multiple criteria increases the accuracy of predicting RVOT PVC origin instead of using a single criterion.
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Amadis et al. (2024) conducted an observational in Premature ventricular contraction (PVC). Multistep algorithm using ECG Criteria 5, 8, and 1 vs. Single ECG criterion was evaluated on Accuracy of predicting RVOT PVC origin (AUC 0.775). A multistep algorithm using ECG Criteria 5, 8, and 1 predicted RVOT PVC origin with 85.9% accuracy and an AUC of 0.775 in the validation cohort.
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