Lead aVL in combination with lead V1:A new method for identifying premature ventricular contractions originating from aortic sinus cusp / 中国介入心脏病学杂志

ABSTRACT

Objective To explore the validity of lead aVL in combination with lead V1 for identifying idiopathic outflow tract premature ventricular contractions(PVCs)originating from aortic sinus cusp(ASC).Methods This study consecutively enrolled 102 idiopathic outflow tract PVCs patients who underwent radiofrequency catheter ablation at the Second Xiangya Hospital,Central South University between January 2015 and August 2017.We compared the QRS wave amplitudes in the surface twelve leads electrocardiography between PVCs originating from ASC and right ventricular outflow tract(RVOT).Results(1)The origin sites of PVCs were ASC(n=28,27.5％)and RVOT(n=74,72.5％).The lead V1R/S wave amplitude ratio and lead aVL S wave amplitude were significantly higher in the ASC group than in the RVOT group[(1.14±1.32)vs.(0.16±0.18),P＜0.001;(0.99±0.36)mV vs.(0.56±0.26)mV,P＜0.001].The areas under the receiver operating characteristic curve(AUCs)and 95％confidence intervals of V1R/S wave amplitude ratio and aVL S wave amplitude had relatively larger AUCs which were 0.894(0.824-0.964)and 0.831(0.749-0.912),with the cut-offs of 0.25 and 0.80 respectively.(2)The sensitivity,specificity and accuracy of the lead V1R/S wave amplitude ratio＞0.25 to identify ASC originating PVCs were 78.9％,83.7％and 82.4％,respectively.The sensitivity,specificity and accuracy of the lead aVL S wave amplitude＞0.80 mV were 78.6％,85.1％and 83.3％,respectively.The lead aVL S wave amplitude＞0.80 mV in combination with the lead V1R/S wave amplitude ratio＞0.25 was applied to developed a new diagnostic approach and the sensitivity,specificity and accuracy were 60.7％,93.2％and 84.3％,respectively.Conclusions Lead aVL in combination with lead V1 could be applied to develop a more accurate method for identifying ASC originating PVCs.