{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T21:15:16Z","timestamp":1783545316593,"version":"3.55.0"},"reference-count":17,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cardiovasc electrophysiol"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Radiofrequency catheter ablation within the aortic cusp can eliminate left ventricular outflow tract (LVOT) ventricular arrhythmias (VAs). However, in a significant proportion of cases, successful ablation requires targeting the aorto\u2010mitral continuity, the endocardium just below the left ventricular summit, and\/or the mitral annulus. This study aimed to identify electrocardiographic (ECG) indices useful for differentiating VAs originating from the aortic cusp from those arising outside the cusp among LVOT\u2010VAs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective study included 159 idiopathic VAs (79 in the derivation cohort and 80 in the validation cohort) successfully ablated from the LVOT. Based on the site of VA origin, VAs were classified into cusp (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009125) and non\u2010cusp (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200934) groups. Detailed PVC morphologies were compared between the two groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In the derivation cohort (mean age 60\u2009\u00b1\u200916 years, 43 men), the ratio of R\u2010wave amplitude in lead V6 to that in lead V4 was significantly higher in the cusp group than in the non\u2010cusp group (0.64 [0.56\u20131.00] vs. 0.32 [0.24\u20130.40],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Receiver operating characteristic curve analysis showed that a V6R\/V4R amplitude index &gt;\u20090.55 predicted cusp\u2010origin VAs with 0.80 sensitivity and 0.88 specificity (area under the curve, 0.865; 95% confidence interval [CI], 0.762\u20130.967). In the validation cohort, the sensitivity and specificity of a V6R\/V4R amplitude index &gt;\u20090.55 for predicting cusp origin were 84% and 82%, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The V6R\/V4R index is a simple and practical ECG criterion for distinguishing VAs originating from the aortic cusp from those arising outside the cusp among LVOT\u2010VAs, with high accuracy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jce.70436","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T20:32:06Z","timestamp":1783542726000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The V6R\/V4R Index: A Novel ECG Parameter for Identifying Idiopathic Ventricular Arrhythmias Originating From the Aortic Cusp"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9630-951X","authenticated-orcid":false,"given":"Yoshihisa","family":"Naruse","sequence":"first","affiliation":[{"name":"Division of Cardiology, Internal Medicine III Hamamatsu University School of Medicine Hamamatsu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9777-4592","authenticated-orcid":false,"given":"Kohki","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0517-0255","authenticated-orcid":false,"given":"Kanae","family":"Hasegawa","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Faculty of Medical Sciences University of Fukui Eiheiji\u2010cho Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshihiko","family":"Tsuji","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Faculty of Medical Sciences University of Fukui Eiheiji\u2010cho Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Machiko","family":"Miyoshi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Faculty of Medical Sciences University of Fukui Eiheiji\u2010cho Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4015-3365","authenticated-orcid":false,"given":"Tatsuhiro","family":"Kataoka","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Faculty of Medical Sciences University of Fukui Eiheiji\u2010cho Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-4155-9868","authenticated-orcid":false,"given":"Hideyuki","family":"Aoki","sequence":"additional","affiliation":[{"name":"Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1089-7951","authenticated-orcid":false,"given":"Yoshinori","family":"Okazaki","sequence":"additional","affiliation":[{"name":"Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7092-0445","authenticated-orcid":false,"given":"Shigeto","family":"Naito","sequence":"additional","affiliation":[{"name":"Division of Cardiology Gunma Prefectural Cardiovascular Center Maebashi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8578-2328","authenticated-orcid":false,"given":"Hiroshi","family":"Tada","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Faculty of Medical Sciences University of Fukui Eiheiji\u2010cho Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"and other members of the V6R\/V4R Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"issue":"4","key":"e_1_2_14_2_1","doi-asserted-by":"crossref","DOI":"10.1002\/joa3.70173","article-title":"The Japanese Catheter Ablation Registry (J\u2010AB): Annual Report in 2023","volume":"41","author":"Kusano K.","year":"2025","journal-title":"Journal of Arrhythmia"},{"issue":"3","key":"e_1_2_14_3_1","doi-asserted-by":"crossref","DOI":"10.1002\/joa3.70033","article-title":"JCS\/JHRS 2024 Guideline Focused Update on Management of Cardiac Arrhythmias","volume":"41","author":"Iwasaki Y. K.","year":"2025","journal-title":"Journal of Arrhythmia"},{"issue":"11","key":"e_1_2_14_4_1","doi-asserted-by":"crossref","first-page":"2603","DOI":"10.1111\/jce.14152","article-title":"Twelve\u2010Lead Electrocardiographic Localization of Idiopathic Premature Ventricular Contraction Origins","volume":"30","author":"Yamada T.","year":"2019","journal-title":"Journal of Cardiovascular Electrophysiology"},{"issue":"12","key":"e_1_2_14_5_1","doi-asserted-by":"crossref","first-page":"1280","DOI":"10.1046\/j.1540-8167.2003.03211.x","article-title":"Development and Validation of an ECG Algorithm for Identifying the Optimal Ablation Site for Idiopathic Ventricular Outflow Tract Tachycardia","volume":"14","author":"Ito S.","year":"2003","journal-title":"Journal of Cardiovascular Electrophysiology"},{"issue":"6","key":"e_1_2_14_6_1","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1016\/j.jacc.2004.12.025","article-title":"Idiopathic Ventricular Arrhythmia Arising From the Mitral Annulus: A Distinct Subgroup of Idiopathic Ventricular Arrhythmias","volume":"45","author":"Tada H.","year":"2005","journal-title":"Journal of the American College of Cardiology"},{"issue":"1","key":"e_1_2_14_7_1","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.hrthm.2014.08.029","article-title":"Idiopathic Ventricular Arrhythmias Originating From the Moderator Band: Electrocardiographic Characteristics and Treatment by Catheter Ablation","volume":"12","author":"Sadek M. 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