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: 37 patients were evaluated (mean age 14.6 years, weight 60.6kg): 11 CC and 26 RVOT PVC SOO. CC PVCs were less likely to exhibit left bundle branch block (64vs. 100%, p=0.005), had larger R-wave amplitude in V1 (0.27vs. 0.11mV, p=0.03), larger R/S ratio in V1 (0.37vs. 0.09, p=0.003), and had precordial transition in V3 or earlier (73vs. 15%, p=0.002). 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<0.9mV and precordial transition at or before V3. Composite score = 2 was associated with a CC SOO (OR 42.0, p=0.001, 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. This article is protected by copyright. All rights reserved.

View details for DOI 10.1111/pace.13885

View details for PubMedID 32040211