Multistep Algorithm to Predict RVOT PVC Site of Origin for Successful Ablation Using Available Criteria: A Two-Center Cross-Validation Study.

IF 1.7 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Pace-Pacing and Clinical Electrophysiology Pub Date : 2025-01-01 Epub Date: 2024-12-10 DOI:10.1111/pace.15118
Muhammad Rafdi Amadis, Li-Wei Lo, Simon Salim, Muhammad Yamin, Yenn-Jiang Lin, Shih-Lin Chang, Yu-Feng Hu, Fa-Po Chung, Rubiana Sukardi, Chin-Yu Lin, Ting-Yung Chang, Ling Kuo, Angga Pramudita, Chih-Min Liu, Shin-Huei Liu, Cheng-I Wu, Yu-Shan Huang, Dinh Son Ngoc Nguyen, Dat Cao Tran, Shih-Ann Chen
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引用次数: 0

Abstract

Background: Predicting premature ventricular contraction (PVC) origin pre-ablation is a fundamental step, as right ventricular outflow tract (RVOT) PVC often leads to higher success rates.

Objective: To compare nine published ECG criteria to differentiate between RVOT and non-RVOT origins of PVCs and develop a stepwise algorithm using those criteria to better determine PVC origin to predict ablation success.

Methods: Two centers were involved in this study, the derivation group and the validation group. The derivation group included 65 patients with PVC left bundle branch block (LBBB) pattern morphology (predominantly negative in lead V1) and inferior axis (predominantly positive in leads II and III), who underwent ablation at Cipto Mangunkusumo Hospital (RSCM) (2017-2022). The validation group included 291 patients who underwent ablation at the Taipei Veteran General Hospital (2020-2023). We calculated and compared six diagnostic accuracy measures from nine previously published ECG morphology criteria to develop an algorithm to enhance the accuracy of predicting RVOT PVC origin for successful ablation.

Results: Our multistep algorithm using Criteria 5, 8, and 1 enhanced diagnostic performance compared to using each criterion alone. The accuracy, sensitivity, and specificity in the derivation group were 86.2%, 93.6%, and 66.7%, respectively; those in the validation group were 85.9%, 90.8%, and 64.7%, respectively. The ROC curve AUCs were 0.802 and 0.775, respectively.

Conclusion: In cases of inferior axis and LBBB pattern PVCs, a multistep algorithm using multiple criteria increases the accuracy of predicting RVOT PVC origin instead of using a single criterion.

使用可用标准预测RVOT PVC起始部位的多步算法:一项双中心交叉验证研究。
背景:预测室性早搏(PVC)起源的预消融是一个基本步骤,因为右心室流出道(RVOT) PVC通常具有较高的成功率。目的:比较已发表的9个心电图标准,以区分心室早搏的RVOT起源和非RVOT起源,并根据这些标准开发一种逐步算法,以更好地确定心室早搏起源,以预测消融成功。方法:本研究分为两个中心,衍生组和验证组。衍生组包括65例在Cipto Mangunkusumo医院(RSCM)接受消融术的PVC左束支阻滞(LBBB)模式形态学(V1导联主要为阴性)和下轴导联主要为阳性(II和III导联主要为阳性)患者(2017-2022)。验证组包括台北退伍军人总医院(2020-2023)行消融术的291例患者。我们计算并比较了先前发表的9个ECG形态学标准中的6个诊断准确性指标,以开发一种算法来提高预测RVOT PVC起源的准确性,以成功消融。结果:与单独使用每个标准相比,我们使用标准5、8和1的多步算法提高了诊断性能。衍生组的准确性、敏感性和特异性分别为86.2%、93.6%和66.7%;验证组分别为85.9%、90.8%和64.7%。ROC曲线auc分别为0.802和0.775。结论:对于下轴型和LBBB型室性早搏,使用多标准的多步算法比使用单一标准预测RVOT室性早搏起源的准确性更高。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Pace-Pacing and Clinical Electrophysiology
Pace-Pacing and Clinical Electrophysiology 医学-工程:生物医学
CiteScore
2.70
自引率
5.60%
发文量
209
审稿时长
2-4 weeks
期刊介绍: Pacing and Clinical Electrophysiology (PACE) is the foremost peer-reviewed journal in the field of pacing and implantable cardioversion defibrillation, publishing over 50% of all English language articles in its field, featuring original, review, and didactic papers, and case reports related to daily practice. Articles also include editorials, book reviews, Musings on humane topics relevant to medical practice, electrophysiology (EP) rounds, device rounds, and information concerning the quality of devices used in the practice of the specialty.
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