TY - JOUR
T1 - Can the 12-lead ECG distinguish RVOT from aortic cusp PVCs in pediatric patients?
AU - Clark, Bradley C.
AU - Ceresnak, Scott R.
AU - Pass, Robert H.
AU - Nappo, Lynn
AU - Sumihara, Kohei
AU - Dubin, Anne M.
AU - Motonaga, Kara
AU - Moak, Jeffrey P.
PY - 2020/3/1
Y1 - 2020/3/1
N2 - 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.
AB - 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.
KW - ablation
KW - coronary cusp
KW - electrocardiogram
KW - pediatric
KW - premature ventricular contraction
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U2 - 10.1111/pace.13885
DO - 10.1111/pace.13885
M3 - Article
C2 - 32040211
AN - SCOPUS:85081904598
VL - 43
SP - 308
EP - 313
JO - PACE - Pacing and Clinical Electrophysiology
JF - PACE - Pacing and Clinical Electrophysiology
SN - 0147-8389
IS - 3
ER -