Catheter Ablation -> Ventricular Arrhythmias -> Electrocardiography D-PO06 - Poster Session VI (ID 26) Poster

D-PO06-081 - A “w” Wave In Lead 1 Localizes Premature Ventricular Contractions To The Great Cardiac Vein (ID 654)

 J.K. Gabriels: Nothing relevant to disclose.


Background: Premature ventricular complexes (PVCs) originating from left ventricular summit (LVS) share common ECG features with PVCs from the left coronary cusp and anterior septal right ventricular outflow tract.
Objective: To identify ECG criteria with a high specificity for localizing a PVC to the LVS.
Methods: We reviewed consecutive patients who underwent successful PVC ablations of outflow tract PVCs at two centers between 9/2010 and 6/2018. The 12-lead ECG was reviewed by two independent electrophysiologists, who were blinded to the successful ablation site, in order to predict the origin of the PVC. The distal great cardiac vein (GCV) was used as a surrogate for a LVS origin. ECG characteristics including QRS axis, morphology, amplitude in leads I, V1, II, III, a ratio of the amplitude in lead II/III and previously described criteria including the maximum deflection index and a V2 transition ratio were examined for their diagnostic accuracy in predicting a GCV origin of the PVC.
Results: From 9/2010 to 6/2018, there were 117 successful outflow tract PVC ablations. Of those, 15 had a GCV origin. The highest diagnostic accuracy of a single ECG characteristic for a GCV origin was the presence of a “w” wave in lead 1 with sensitivity and specificity of 73.3% and 72.3% respectively. Multivariate analysis with binary logistic regression showed that the coexistence of a right bundle morphology (RBBB) (OR:17.53, p=0.023), a “w” morphology in lead I (OR:7.98, p=0.037) and a relatively low (< 2.6 mV) R wave amplitude in leads II and III (OR:29.2, p=0.001) had a 100% specificity, but a low sensitivity (50%) for identifying a GCV origin.
Conclusion: The presence of a “w” wave in lead I is the single ECG criteria with highest diagnostic accuracy in predicting a GCV origin of a PVC. In combination with RBBB morphology and low amplitude in inferior leads, a “w” wave in lead I was 100% specific for a GCV origin.