Coupling interval variability differentiates ventricular ectopic complexes arising in the aortic sinus of valsalva and great cardiac vein from other sources: mechanistic and arrhythmic risk implications
Jason S Bradfield, Mohamed Homsi, Kalyanam Shivkumar, John M Miller, Jason S Bradfield, Mohamed Homsi, Kalyanam Shivkumar, John M Miller
Abstract
Objectives: The objective of this study was to determine whether premature ventricular contractions (PVCs) arising from the aortic sinuses of Valsalva (SOV) and great cardiac vein (GCV) have coupling interval (CI) characteristics that differentiate them from other ectopic foci.
Background: PVCs occur at relatively fixed CI from the preceding normal QRS complex in most patients. However, we observed patients with PVCs originating in unusual areas (SOV and GCV) in whom the PVC CI was highly variable. We hypothesized that PVCs from these areas occur seemingly randomly because of the lack of electrotonic effects of the surrounding myocardium.
Methods: Seventy-three consecutive patients referred for PVC ablation were assessed. Twelve consecutive PVC CIs were recorded. The ΔCI (maximum - minimum CI) was measured.
Results: We studied 73 patients (age 50 ± 16 years, 47% male). The PVC origin was right ventricular (RV) in 29 (40%), left ventricular (LV) in 17 (23%), SOV in 21 (29%), and GCV in 6 (8%). There was a significant difference between the mean ΔCI of RV/LV PVCs compared with SOV/GCV PVCs (33 ± 15 ms vs. 116 ± 52 ms, p < 0.0001). A ΔCI of >60 ms demonstrated a sensitivity of 89%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 94%. Cardiac events were more common in the SOV/GCV group versus the RV/LV group (7 of 27 [26%] vs. 2 of 46 [4%], p < 0.02).
Conclusions: ΔCI is more pronounced in PVCs originating from the SOV or GCV. A ΔCI of 60 ms helps discriminate the origin of PVCs before diagnostic electrophysiological study and may be associated with increased frequency of cardiac events.
Keywords: aortic sinus of Valsalva; coupling interval; great cardiac vein; premature ventricular contraction.
Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Figures
![Figure 1. Scatter Plot of ΔCI Demonstrating…](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4282189/bin/nihms645252f1.jpg)
Figure 2. ROC Curve
ROC curve plotting…
Figure 2. ROC Curve
ROC curve plotting the true positive rate (sensitivity) versus false positive…
Figure 3. 12-Lead ECGs Demonstrating Examples of…
Figure 3. 12-Lead ECGs Demonstrating Examples of PVCs With Variable and Fixed Coupling
An example…
Figure 4. 12-Lead ECGs Demonstrating Examples of…
Figure 4. 12-Lead ECGs Demonstrating Examples of PVCs With Variable and Fixed Coupling Related to…
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- Research Support, N.I.H., Extramural
- Research Support, Non-U.S. Gov't
- Catheter Ablation / methods*
- Coronary Vessels / physiopathology*
- Electrocardiography*
- Female
- Follow-Up Studies
- Heart Conduction System / physiopathology*
- Heart Conduction System / surgery
- Humans
- Male
- Middle Aged
- Sinus of Valsalva / physiopathology*
- Stroke Volume / physiology*
- Treatment Outcome
- Ventricular Premature Complexes / diagnosis*
- Ventricular Premature Complexes / physiopathology
- Ventricular Premature Complexes / surgery
- Full Text Sources
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- Medical
![Figure 2. ROC Curve](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4282189/bin/nihms645252f2.jpg)
Figure 3. 12-Lead ECGs Demonstrating Examples of…
Figure 3. 12-Lead ECGs Demonstrating Examples of PVCs With Variable and Fixed Coupling
An example…
Figure 4. 12-Lead ECGs Demonstrating Examples of…
Figure 4. 12-Lead ECGs Demonstrating Examples of PVCs With Variable and Fixed Coupling Related to…
![Figure 3. 12-Lead ECGs Demonstrating Examples of…](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4282189/bin/nihms645252f3.jpg)
![Figure 4. 12-Lead ECGs Demonstrating Examples of…](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4282189/bin/nihms645252f4.jpg)
Source: PubMed