Comparative diagnostic performance of electrocardiographic- derived algorithms in identifying the site of origin of idiopathic outflow tract originating ventricular premature complexes
M Botis, D Tsiachris, L I Bartsioka, I Doundoulakis, C K Antoniou, A Kordalis, N Stratopoulos, P Xydis, N Argyriou, A E Karanikola, K TsioufisAbstract
Introduction
Idiopathic ventricular premature complexes (PVCs) commonly originate from the right and left ventricular outflow tracts (RVOT and LVOT, respectively). The surface 12-lead ECG is commonly used to differentiate the anatomic site of origin, prior to catheter ablation. Multiple ECG algorithms have been evaluated to assist preprocedural localization.
Purpose
To evaluate the diagnostic performance of four commonly implemented algorithms.
Methods
This study included 47 patients (29.8% women, mean age 54.1 ± 19.4 years), who underwent successful catheter ablation of outflow tract- originating idiopathic PVCs. The diagnostic algorithms evaluated were the V2S/V3R index, the transition zone index, the lead I R wave amplitude (an R wave amplitude ≥ 0.1 mV in lead I predicts LVOT origin) and the combined transition zone and V2S/3R Index (defined by the formula Y = −1.15 × (Transition Zone Index) − 0.494 × (V2S/V3R), with Y values exceeding 0.76 indicating an LVOT origin). The diagnostic accuracy of the algorithms was assessed by the area under the receiver- operating characteristics curve (AUC). Specificity and sensitivity of each algorithm were measured.
Results
Electroanatomic 3D mapping depicted as site of origin the RVOT in 18 patients (33.3% women, mean age 45.4 ± 14.1 years) and the LVOT in 29 patients (27.6% women, mean age 59.5 ± 20.4 years). The V2S/V3R index yielded a sensitivity of 0.77 and a specificity of 0.79. The AUC was 0.86 (Figure 1). As for the transition score index, sensitivity and specificity were 0.76 and 0.62, respectively, with an AUC 0.76. Lead I R wave amplitude demonstarted a sensitivity of 0.1 and a specificity of 0.79, respectively. The AUC was 0.7. The combined transition zone and V2S/3R Index derived sensitivity 0.88, specificity 0.44 and AUC 0.82.
Conclusions
Published diagnostic algorithms can reliably differentiate right ventricular from left ventricular originating outflow tract arrhythmias. Notably, in our dataset, lead I R wave amplitude did not distinguish LVOT fr0m RVOT originating PVCs.ROC Curves