Diagnostic performance of electrocardiogram- derived algorithms, differentiating left ventricular from right ventricular outflow tract originating arrhythmias

Idiopathic premature ventricular 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 published to assist preprocedural localization.

We sought to evaluate the diagnostic performance of three commonly implemented algorithms.

This study included 18 patients (47.4% women, mean age 52 ± 22.9 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 and the lead I R wave amplitude (an R wave amplitude ≥ 0.1 mV in lead I predicts 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.

Electroanatomic 3D mapping depicted as site of origin the RVOT in 7 patients (42.9% women, mean age 33.9 ± 21.4 years) and the LVOT in 11 patients (54.5% women, mean age 64.1 ±14.7 years). The V2S/V3R index yielded a sensitivity of 0.86 and a specificity of 0.73. The AUC was 0.94 (Figure 1). As for the transition score index, sensitivity and specificity were 0.83 and 0.63, respectively, with an AUC 0.86. Lead I R wave amplitude demonstarted a sensitivity of 0.57 and a specificity of 0.9, respectively. The AUC was 0.7.

Published diagnostic algorithms can reliably differentiate right ventricular from left ventricular originating outflow tract arrhythmias.

ROC Curve of each algorithm