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Can the 12‐lead ECG distinguish RVOT from aortic cusp PVCs in pediatric patients?
Author(s) -
Clark Bradley C.,
Ceresnak Scott R.,
Pass Robert H.,
Nappo Lynn,
Sumihara Kohei,
Dubin Anne M.,
Motonaga Kara,
Moak Jeffrey P.
Publication year - 2020
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.13885
Subject(s) - medicine , cardiology , ventricular outflow tract , qrs complex , precordial examination , left bundle branch block , lead (geology) , demographics , electrocardiography , heart failure , geomorphology , geology , demography , sociology
Background The ability to differentiate right ventricular outflow tract (RVOT) from coronary cusp (CC) site of origin (SOO) by 12‐lead ECG in pediatric patients may impact efficacy and procedural time. The objective of this study was to predict RVOT versus CC SOO by ECG in pediatric patients. Methods Pediatric patients (<21 years) without structural heart disease with RVOT or CC premature ventricular contraction (PVC) ablations performed (2014‐2018) were evaluated through multi‐institution retrospective review. Demographics, ECG PVC parameters, ablation site, recurrence, and repeat procedures were collected. Results Thirty‐seven patients were evaluated (mean age 14.6 years, weight 60.6 kg): 11 CC and 26 RVOT PVC SOO. CC PVCs were less likely to exhibit left bundle branch block (64% vs 100%, P = .005), had larger R‐wave amplitude in V1 (0.27 vs 0.11 mV, P = .03), larger R/S ratio in V1 (0.37 vs 0.09, P = .003), and had precordial transition in V3 or earlier (73% vs 15%, P = .002). A composite score was created with the following variables: isodiphasic or positive QRS in V1, R/S ratio in V1 > 0.05, S wave in V1 < 0.9 mV, and precordial transition at or before V3. Composite score ≥ 2 was associated with a CC SOO (OR 42.0, P = .001, and AUC 0.86). Conclusions 12‐lead ECG of PVCs from the CC was associated with larger V1 R‐wave amplitude, larger R/S ratio in V1, and precordial transition at or before V3. A composite score may help predict PVC/VT arising from the CC.