Predicting value of coupling interval variability in determining the origin of ventricular premature contractions with V3 transition
- 144 Downloads
We aimed to investigate the predictive value of coupling interval variability (ΔCI) in determining the origin of idiopathic outflow tract ventricular tachycardia (OTVT) with V3 transition.
We reviewed data from 126 patients who underwent catheter ablation of OTVT between 2015 and 2018 at our institution. We identified 32 patients of successful OTVT ablation with a precordial transition at V3 derivation. The ΔCI (maximum − minimum CI) was measured.
CI variability was significantly smaller for right ventricular (RV) OT than left ventricular (LV) OT premature ventricular contractions (PVCs) (p = 0.004). In multivariate analysis, including QRS duration, R-wave duration in lead V1, R-wave amplitude in V1, PVC burden, and ΔCI, ΔCI was the only independent predictor of PVC origin (OR 0.963, 95% CI, 0.939–0.988, p < 0.001). A CI variability ≥ 30 predicted a PVC from LVOT origin with a sensitivity of 83% and specificity of 89%. ΔCI was compared with other previously proposed ECG criteria used to differentiate LVOT from RVOT PVCs. ΔCI exhibited a greater area under the curve (AUC) (0.867) than the other ECG criteria. A ΔCI ≥ 30 ms exhibited a high sensitivity of 89% and a specificity of 83%.
ΔCI is outperformed other ECG criteria to differentiate LVOT from RVOT PVCs, and this parameter may be useful for planning the ablation strategy.
KeywordsPremature ventricular contractions Coupling interval Electrocardiogram V3 transition
Compliance with ethical standards
The study was approved by the Local Ethical Committee.
Conflict of interest
The authors declare that they have no conflict of interest.
- 3.Cheng Z, Cheng K, Deng H, Chen T, Gao P, Zhu K, et al. The R-wave deflection interval in lead V3 combining with R-wave amplitude index in lead V1: a new surface ECG algorithm for distinguishing left from right ventricular outflow tract tachycardia origin in patients with transitional lead at V3. Int J Cardiol. 2013;168(2):1342–8.CrossRefGoogle Scholar
- 4.Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr. 1989;2(5):358–67.CrossRefGoogle Scholar
- 7.de Vries LJ, Martirosyan M, van Domburg RT, Wijchers SA, Géczy T, Szili-Torok T. Coupling interval variability of premature ventricular contractions in patients with different underlying pathology: an insight into the arrhythmia mechanism. J Interv Card Electrophysiol. 2018;51(1):25–33.CrossRefGoogle Scholar
- 8.Bradfield JS, Homsi M, Shivkumar K, Miller JM. Coupling interval variability differentiates ventricular ectopic complexes arising in the aortic sinus of valsalva and great cardiac vein from other sources: mechanistic and arrhythmic risk implications. J Am Coll Cardiol. 2014;63(20):2151–8.CrossRefGoogle Scholar