Po-05-156 differentiating right ventricular from left ventricular outflow tract premature ventricular complexes with a novel qs pattern in lead v1.

Many ECG algorithms for localization of premature ventricular complex (PVC) origin are complex requiring the use of multiple features to achieve high sensitivity and specificity. Simpler diagnostic ECG features may be easier to use and more widely adopted. We hypothesized that a single ECG feature of QS pattern in lead V1 will be specific for PVC localization to the right ventricular outflow tract. All patients at St. Vincent Hospital, Indianapolis from January 01, 2018 to December 31, 2019 that underwent a catheter ablation for outflow tract PVCs were retrospectively evaluated. PVC location was confirmed based on the successful ablation site. For the purpose of this study a QS pattern in V1 was defined if there was no initial R wave and no notching on the downstroke of the Q wave. A total of 63 patients underwent ablation of 70 different PVCs. The median age was 55.6 (interquartile range 47.9, 63.5) years old and included 38 (60.3%) females. Of the 70 PVCs, 47 (67.1%) were right ventricular and 23 (32.9%) were left ventricular outflow tract. A QS pattern was present in 23 (32.8%) of PVCs. Of these 23 PVCs with QS pattern, 22 were right ventricular outflow tract and only 1 localized to the left ventricular outflow tract. The QS pattern in lead V1 had a specificity of 95.6% and sensitivity of 46.8% in identifying a right ventricular outflow tract PVC origin. The novel QS pattern in lead V1 is simple to use and has high specificity for localizing PVC origin to the right ventricular outflow tract.