Key result
Sinus of Valsalva and great cardiac vein PVCs show ~3.5-fold greater coupling interval variability vs. RV/LV PVCs.
Why the study?
Premature ventricular contractions (PVCs) usually occur at relatively fixed coupling intervals, but highly variable coupling intervals were observed in PVCs originating from the aortic sinuses of Valsalva (SOV) and great cardiac vein (GCV). Whether coupling interval characteristics could differentiate SOV and GCV PVCs from other ectopic foci required evaluation.
Does coupling interval variability (ΔCI) differentiate premature ventricular contractions arising from the aortic sinuses of Valsalva and great cardiac vein from those arising in the right or left ventricle?
Cohort (n=73)
Yes
Does coupling interval variability (ΔCI) differentiate premature ventricular contractions arising from the aortic sinuses of Valsalva and great cardiac vein from those arising in the right or left ventricle?
Answers are grounded in this paper and cite their sources.
A coupling interval variability (ΔCI) >60 ms on ECG accurately discriminates PVCs originating in the aortic sinuses of Valsalva or great cardiac vein from RV/LV origins prior to ablation and identifies patients who may have a higher risk of cardiac events.
Objectives The objective of this study was to determine whether premature ventricular contractions (PVCs) arising from the aortic sinuses of Valsalva (SOV) and great cardiac vein (GCV) have coupling interval (CI) characteristics that differentiate them from other ectopic foci. Background PVCs occur at relatively fixed CI from the preceding normal QRS complex in most patients. However, we observed patients with PVCs originating in unusual areas (SOV and GCV) in whom the PVC CI was highly variable. We hypothesized that PVCs from these areas occur seemingly randomly because of the lack of electrotonic effects of the surrounding myocardium. Methods Seventy-three consecutive patients referred for PVC ablation were assessed. Twelve consecutive PVC CIs were recorded. The ΔCI (maximum – minimum CI) was measured. Results We studied 73 patients (age 50 ± 16 years, 47% male). The PVC origin was right ventricular (RV) in 29 (40%), left ventricular (LV) in 17 (23%), SOV in 21 (29%), and GCV in 6 (8%). There was a significant difference between the mean ΔCI of RV/LV PVCs compared with SOV/GCV PVCs (33 ± 15 ms vs. 116 ± 52 ms, p < 0.0001). A ΔCI of >60 ms demonstrated a sensitivity of 89%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 94%. Cardiac events were more common in the SOV/GCV group versus the RV/LV group (7 of 27 [26%] vs. 2 of 46 [4%], p < 0.02). Conclusions ΔCI is more pronounced in PVCs originating from the SOV or GCV. A ΔCI of 60 ms helps discriminate the origin of PVCs before diagnostic electrophysiological study and may be associated with increased frequency of cardiac events.
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Bradfield et al. (2014) conducted a cohort in Idiopathic premature ventricular contractions (PVCs) referred for ablation (n=73). PVCs originating from the aortic sinuses of Valsalva (SOV) or great cardiac vein (GCV) vs. PVCs originating from the right ventricle (RV) or left ventricle (LV) was evaluated on Mean coupling interval variability (ΔCI, maximum minus minimum coupling interval over 12 consecutive PVCs) (p=<0.0001). PVCs originating from the aortic sinuses of Valsalva or great cardiac vein had significantly greater mean coupling interval variability (ΔCI) than RV/LV PVCs (116 ± 52 ms vs. 33 ± 15 ms, p < 0.0001).
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