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Electrocardiographic characteristics in the patients with a persistent left superior vena cava

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Abstract

A persistent left superior vena cava (PLSVC) is a congenital venous abnormality and is usually asymptomatic and does not cause hemodynamic disturbances. Therefore, it is difficult to identify it by routine examinations in clinical practice. This study aimed to elucidate the electrocardiographic characteristics for the prediction of a PLSVC. Twelve patients (9 males, 56.2 ± 18.3 years) who were diagnosed with a PLSVC were enrolled. The electrocardiographic parameters, including the P-wave duration, axis, and morphology of the P waves, were automatically measured and compared to 150 controls (77 males, 57.3 ± 14.6 years). There were no significant differences in the P-wave duration. Negative or positive/negative P waves in lead III predicted a PLSVC with a sensitivity of 100% and specificity of 81%. The P-wave axis in PLSVC exhibited a significant leftward deviation as compared to the controls (14.8 ± 21.1 vs. 54.0 ± 17.4°, p < 0.001). A receiver operating characteristic curve analysis of the P-wave axis for predicting a PLSVC exhibited an area under curve of 0.93 [CI 95% (0.87–0.98), p < 0.001), and identified a P-wave axis of less than 37.5° to have a 92% sensitivity and 83% specificity in predicting a PLSVC. A negative or positive/negative P-wave morphology in lead III was a useful finding for suggesting the presence of a PLSVC.

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Abbreviations

AF:

Atrial fibrillation

CT:

Computed tomography

CS:

Coronary sinus

ECG:

Electrocardiogram

SVC:

Superior vena cava

TEE:

Transesophageal echocardiography

TTE:

Transthoracic echocardiography

PLSVC:

Persistent left superior vena cava

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Acknowledgements

We thank Mr. John Martin for his linguistic assistance.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan

    Kanako Ito-Hagiwara, Yu-ki Iwasaki, Meiso Hayashi, Yujin Maru, Yuhi Fujimoto, Eiichiro Oka, Kenta Takahashi, Hiroshi Hayashi, Teppei Yamamoto, Kenji Yodogawa & Wataru Shimizu

  2. Department of Cardiovascular Medicine, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan

    Yasushi Miyauchi

Authors
  1. Kanako Ito-Hagiwara
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  2. Yu-ki Iwasaki
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Corresponding author

Correspondence to Yu-ki Iwasaki.

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Electronic supplementary material

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380_2018_1278_MOESM1_ESM.wmv

Supplementary material 1 Angiography of the PLSVC in case 11. The contraction of the PLSVC indicates the presence of atrial working muscle within the PLSVC. PLSVC indicates persistent left superior vena cava (WMV 1122 kb)

380_2018_1278_MOESM2_ESM.mp4

Supplementary material 2 Propagation map movie of the activation pattern of the enlarged CS and PLSVC in case 12. CS indicates coronary sinus; PLSVC, persistent left superior vena cava (MP4 3949 kb)

380_2018_1278_MOESM3_ESM.mp4

Supplementary material 3 Propagation map movie of the activation pattern of the enlarged CS and PLSVC in case 11. CS indicates coronary sinus; PLSVC, persistent left superior vena cava (MP4 5427 kb)

Supplementary material 4 (DOCX 13 kb)

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Ito-Hagiwara, K., Iwasaki, Yk., Hayashi, M. et al. Electrocardiographic characteristics in the patients with a persistent left superior vena cava. Heart Vessels 34, 650–657 (2019). https://doi.org/10.1007/s00380-018-1278-2

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  • DOI: https://doi.org/10.1007/s00380-018-1278-2

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