The R-S difference index: A new electrocardiographic method for differentiating idiopathic premature ventricular contractions originating from the left and right ventricular outflow tracts presenting a left bundle branch block pattern

• DOI: 10.3389/fphys.2022.1002926
• Publication Date: 2022-09-19T04:25:25Z
• Authors: Lei Zhao; Ruibin Li; Jidong Zhang; Ruiqin Xie; Jingchao Lu; Jinming Liu; Chenglong Miao; Wei Cui
• Keywords: Ventricular outflow tract

Introduction: Differentiating idiopathic premature ventricular contractions (PVCs) originating from the right and left outflow tracts with a bundle branch block (LBBB) morphology is relevant to catheter ablation planning important for lowering risk of complications. This study established novel electrocardiographic (ECG) criterion discriminate PVCs septum tract (s-RVOT) those aortic sinus cusp (LVOT-ASC). Methods: A total 259 patients LBBB pattern who underwent successful were retrospectively included. Among them, originated s-RVOT in 183 LVOT-ASC 76 patients. The surface ECGs beats analyzed using an electronic caliper. R-S difference index precordial leads was calculated as V2R + V3R V4R - V1S. Results: both displayed inferior axis (dominant R waves II, III, aVF). Compared group, R-wave amplitudes on aVF significantly larger group (p < 0.001, p 0.003, respectively). showed smaller V1-V6 = 0.021, respectively) S-wave V1-V3 Lead V3 most common transitional lead groups. Analysis receiver operating characteristic curve that amplitude had largest area under (AUC) 0.856 followed by V4 (0.834) V2 (0.806). AUC 0.867. An greater than 20.9 predicted origin 73.7% sensitivity 86.3% specificity. superior previous criteria differentiating vs. LVOT-ASC. Conclusions: useful new ECG distinguishing LVOT-PVCs RVOT-PVCs morphology.