Can the 12‐lead ECG distinguish RVOT from aortic cusp PVCs in pediatric patients?. Issue 3 (16th March 2020)

• Record Type: Journal Article
• Authors: Clark, Bradley C.; Ceresnak, Scott R.; Pass, Robert H.; Nappo, Lynn; Sumihara, Kohei; Dubin, Anne M.; Motonaga, Kara; Moak, Jeffrey P.
• Is Part Of: Pacing and clinical electrophysiology. Volume 43:Issue 3(2020)
• Page Start: 308
• Page End: 313
• Publication Date: 2020-03-16
• Subjects: ablation -- coronary cusp -- electrocardiogram -- pediatric -- premature ventricular contraction; Cardiac pacing -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1111/pace.13885
• Languages: English
• ISSNs: 0147-8389

Abstract

Abstract: 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.