Analysis Of Electrocardiogram And Radiofrequency Ablation Of The Premature Ventricular Complexes Originating From Left Ventricular Outflow Tract

Objectives：This study analyzed the electrocardiogram(ECG) and radiofrequency ablation ofpremature ventricular complexes(PVC) originating from left ventricular outflowtract(LVOT) to find out the differences between left sinus side and right sinus side,within aortic valve and below aortic valve, guiding its radiofrequency.Methods：We analyzed31PVC cases ablation success in LVOT retrospectively. Accordingto the ECG of the PVC, measuring its QRS wave duration, R wave amplitude of Ⅱ,Ⅲ,aVF leads, QS wave amplitude of aVL,aVR leads,Ⅰlead’s R or QS waveamplitude and record its precordial R/S transition lead, s wave in leads V5V6andmeasuring method of the ablation process, to analyse the PVC ECG characteristics ofdifferent part of LVOT.Results：A total of31case PVC were diagnosed as originating from LVOT by RFoperation. Grouping these cases by within aortic valve of below it, to compare thedifferences of indexes above. The R wave amplitudes ofⅡ,Ⅲ,aVF leads, R waveamplitude ratio of leadⅢ/Ⅱ, QS wave amplitudes in leads aVL and aVR, and leadⅠhave no significance. Grouping these PVCs by left sinus side and right side,comparing the indexes differences between two groups, calculating and drawing itspredictor, sensitivity and specificity. Through the analysis we find out that about theleft side sinus PVC diagnose, the cut-off value are: R wave of amplitude of lead Ⅲ ≥1.85mV, QS wave amplitude of lead aVL≥0.85mV, QS wave amplitude of leadⅠ≥0.25mV. In leadⅠ,the main wave is upright of R wave suggests right sinus sidePVC,while downward of S wave suggest left side.In the precordial R/S transition,theleft sinus side PVC always transform at lead V1,while right sinus side at V2or V3. Theindexes above are statistically significant(P<0.05),the area under the ROC curve isgreater than0.750.In this study, the RF operation is based on activation mapping,supplemented by pacing mapping.20cases got ECG similar to the PVC ECG whilepacing at the ablation successful targets.Conclusions：1.For the PVC originating from LVOT,the precordial leads transition at V1andV2,V3have significance of distinguish.2.For the ECG amplitude of PVC originating from LVOT, ⅠQS≥0.25mV, aVLQS≥0.85mV, Ⅲ R≥1.85mV is helpful to diagnose the PVC from left sinus side withfavorable sensibility and specificity. And lead Ⅰ major in R wave tend to beoriginating from the right sinus side.3.The R wave amplitude of Ⅱ,Ⅲ,aVF leads, R wave ratio of lead Ⅲ/Ⅱ,Qwave amplitude of aVL,aVR leads, Q wave ratio of lead aVL/aVR have nosignificance of the PVC from within aortic valve and below it.4. The main measuring method in aorta is activation mapping, supplemented bypacing mapping.