Utility of Circadian Variability Patterns in Differentiating Origins of Premature Ventricular Complexes

Figures

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  Figure 1. Circadian variability of PVC burden. Circadian rhythms of PVC burdens (as a percentage) and HR in F-PVC (a), S-PVC (b), and I-PVC (c). HR, heart rate; PVC, premature ventricular complexes.

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  Figure 2. Origin distributions for PVC circadian patterns. Origin distributions for F-PVC (a), S-PVC (b), and I-PVC (c), respectively. ASV, aortic sinus of Valsalva; GCV, great cardiac vein; LAF, left anterior fascicle; LAPM, left anterior papillary muscle; LBB, left bundle branch; LPF, left posterior fascicle; LPPM, left posterior papillary muscle; LV, left ventricle; LVOT, left ventricular outflow tract; PSC, pulmonary sinus cusp; PVC, premature ventricular complexes; RV, right ventricle; RVOT, right ventricular outflow tract.

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  Figure 3. Differences in circadian patterns among PVCs of left fascicular origin. Circadian pattern distributions for PVCs arising from left fascicular systems and left papillary muscles. ∗Indicates p < 0.05. LAF, left anterior fascicle; LAPM, left anterior papillary muscle; LBB, left bundle branch; LPF, left posterior fascicle; LPPM, left posterior papillary muscle.

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  Figure 4. Differences in circadian patterns between ASV and LVOT PVCs. Circadian pattern distributions for ASV and LVOT PVCs. ∗Indicates p < 0.05. ASV, aortic sinus of Valsalva; LVOT, left ventricular outflow tract; PVC, premature ventricular complexes.

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  Figure 5. ROC curve documenting the ability of diurnal/nocturnal PVC burden ratio to differentiate LVOT and ASV origins. ROC curves plotting the true-positive rate (sensitivity) versus false-positive rate (1 − specificity) documenting the ability of diurnal/nocturnal burden ratio to differentiate LVOT and ASV origins in all patients (blue curve, AUC = 0.827) and in patients without PVC recurrence after ablation (red curve, AUC = 0.910). The ROC curve in combination with Youden's index supports a diurnal/nocturnal burden ratio of 0.92 as a cutoff. ASV, aortic sinus of Valsalva; AUC, area under the curve; LVOT, left ventricular outflow tract; PVC, premature ventricular complexes; ROC, receiver-operating characteristic.

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  Figure 6. Scatter plot of the diurnal/nocturnal PVC burden ratio in the prospective cohort consisting of ASV and LVOT PVCs. Using a 0.92 cutoff successfully predicted PVC origin in 16/18 cases in a prospective cohort. ASV, aortic sinus of Valsalva; LVOT, left ventricular outflow tract; PVC, premature ventricular complexes.