{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T05:28:48Z","timestamp":1788931728110,"version":"build-2803163510"},"reference-count":22,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"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>Accurate localization of premature ventricular contraction (PVC) origin from 12\u2010lead electrocardiography (ECG) is important for procedural planning in catheter ablation. Although convolutional neural network (CNN)\u2010based models have shown promising diagnostic performance, they require task\u2010specific training and remain limited in interpretability. We evaluated whether large language model (LLM)\u2010based ECG image interpretation could perform binary left\u2010versus\u2010right PVC origin localization from 12\u2010lead ECG images while providing a traceable diagnostic process.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We retrospectively studied 157 patients who underwent successful catheter ablation of PVCs or idiopathic ventricular tachycardia. ECG images were classified as RIGHT\u2010origin (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009103) or LEFT\u2010origin (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200954) according to the final successful ablation site. Three approaches were compared: a CNN\u2010based baseline model, an LLM\u2010based one\u2010shot approach, and an LLM\u2010based staged extraction framework with deterministic rule\u2010based integration. Performance was evaluated across five independent seeds using positive predictive value (PPV), negative predictive value (NPV), recall, and PPV\u2009+\u2009NPV.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The CNN\u2010based baseline model achieved a PPV of 0.546\u2009\u00b1\u20090.058 and an NPV of 0.793\u2009\u00b1\u20090.047, with area under the curve values ranging from 0.595 to 0.730. The staged extraction framework generated a continuous rule\u2010based score with discrimination numerically comparable to the CNN\u2010based model (AUC 0.720\u2009\u00b1\u20090.045 vs. 0.712\u2009\u00b1\u20090.054). A stricter threshold, determined from training data, increased PPV at the expense of recall and warrants prospective external validation of this operating point.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>LLM\u2010based staged extraction demonstrated the potential to achieve binary left\u2010versus\u2010right PVC origin localization from 12\u2010lead ECG images while providing a traceable stepwise diagnostic process. The continuous rule\u2010based score showed discrimination numerically comparable to the CNN\u2010based model, and the strict threshold\u2014determined using training data\u2014identified a potential high\u2010PPV operating point that requires prospective external validation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jce.70464","type":"journal-article","created":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T12:51:45Z","timestamp":1785588705000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Large Language Model\u2010Based Localization of Premature Ventricular Contraction Origins: A Retrospective Diagnostic Accuracy Study"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5648-8135","authenticated-orcid":false,"given":"Kazuhisa","family":"Matsumoto","sequence":"first","affiliation":[{"name":"Department of Cardiology Saitama Medical University, International Medical Center Hidaka Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuya","family":"Fujisaki","sequence":"additional","affiliation":[{"name":"Sera, Inc Meguro Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0941-3484","authenticated-orcid":false,"given":"Syunta","family":"Higuchi","sequence":"additional","affiliation":[{"name":"Department of Clinical Engineer Saitama Medical University International Medical Center Hidaka Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0624-9639","authenticated-orcid":false,"given":"Masataka","family":"Narita","sequence":"additional","affiliation":[{"name":"Department of Cardiology Saitama Medical University, International Medical Center Hidaka Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1418-6566","authenticated-orcid":false,"given":"Wataru","family":"Sasaki","sequence":"additional","affiliation":[{"name":"Department of Cardiology Saitama Medical University, International Medical Center Hidaka Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1133-8367","authenticated-orcid":false,"given":"Tsukasa","family":"Naganuma","sequence":"additional","affiliation":[{"name":"Department of Cardiology Saitama Medical University, International Medical Center Hidaka Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naomichi","family":"Tanaka","sequence":"additional","affiliation":[{"name":"Department of Cardiology Saitama Medical University, International Medical Center Hidaka Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3347-6772","authenticated-orcid":false,"given":"Daisuke","family":"Kawano","sequence":"additional","affiliation":[{"name":"Department of Cardiology Saitama Medical University, International Medical Center Hidaka Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kei","family":"Matsumoto","sequence":"additional","affiliation":[{"name":"Department of Cardiology Saitama Medical University, International Medical Center Hidaka Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wataru","family":"Yoshino","sequence":"additional","affiliation":[{"name":"Department of Clinical Engineer Saitama Medical University International Medical Center Hidaka Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9857-9281","authenticated-orcid":false,"given":"Yoshifumi","family":"Ikeda","sequence":"additional","affiliation":[{"name":"Department of Cardiology Saitama Medical University, International Medical Center Hidaka Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9989-8708","authenticated-orcid":false,"given":"Ritsushi","family":"Kato","sequence":"additional","affiliation":[{"name":"Department of Cardiology Saitama Medical University, International Medical Center Hidaka Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1172-2995","authenticated-orcid":false,"given":"Hitoshi","family":"Mori","sequence":"additional","affiliation":[{"name":"Department of Cardiology Saitama Medical University, International Medical Center Hidaka Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,1]]},"reference":[{"issue":"3","key":"e_1_2_14_2_1","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1002\/joa3.12185","article-title":"2019 HRS\/EHRA\/APHRS\/LAHRS Expert Consensus Statement on Catheter Ablation of Ventricular Arrhythmias","volume":"35","author":"Cronin E. M.","year":"2019","journal-title":"Journal of Arrhythmia"},{"issue":"22","key":"e_1_2_14_3_1","doi-asserted-by":"crossref","first-page":"2214","DOI":"10.1016\/j.jacc.2024.03.416","article-title":"Arrhythmia\u2010Induced Cardiomyopathy","volume":"83","author":"Shoureshi P.","year":"2024","journal-title":"Journal of the American College of Cardiology"},{"issue":"3","key":"e_1_2_14_4_1","first-page":"116","article-title":"Multicenter Outcomes for Catheter Ablation of Idiopathic Premature Ventricular Complexes","volume":"1","author":"Latchamsetty R.","year":"2015","journal-title":"JACC: Clinical Electrophysiology"},{"issue":"2","key":"e_1_2_14_5_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2023-081815","article-title":"Outcomes of Single\u2010Procedure Radiofrequency Catheter Ablation for Idiopathic Ventricular Arrhythmias: A Single\u2010Centre Retrospective Cohort Study","volume":"14","author":"Jiang Z.","year":"2024","journal-title":"BMJ Open"},{"issue":"1","key":"e_1_2_14_6_1","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1038\/s41591-018-0268-3","article-title":"Cardiologist\u2010Level Arrhythmia Detection and Classification in Ambulatory Electrocardiograms Using a Deep Neural Network","volume":"25","author":"Hannun A. Y.","year":"2019","journal-title":"Nature Medicine"},{"issue":"1","key":"e_1_2_14_7_1","doi-asserted-by":"crossref","first-page":"1760","DOI":"10.1038\/s41467-020-15432-4","article-title":"Automatic Diagnosis of the 12\u2010lead ECG Using a Deep Neural Network","volume":"11","author":"Ribeiro A. H.","year":"2020","journal-title":"Nature Communications"},{"issue":"7","key":"e_1_2_14_8_1","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1038\/s41569-020-00503-2","article-title":"Artificial Intelligence\u2010Enhanced Electrocardiography in Cardiovascular Disease Management","volume":"18","author":"Siontis K. 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B.Das \u201cCan Large Language Models Challenge CNNs in Medical Image Analysis? \u201d paper presented at 2025 IEEE International Conference on Image Processing (ICIP)2025.","DOI":"10.1109\/ICIP55913.2025.11084721"},{"issue":"1","key":"e_1_2_14_20_1","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1111\/jce.70212","article-title":"Deep Learning\u2010Based Prediction Model for Cardiac Resynchronization Therapy Responders Using Electrocardiogram Data","volume":"37","author":"Mori H.","year":"2026","journal-title":"Journal of Cardiovascular Electrophysiology"},{"key":"e_1_2_14_21_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euae240"},{"issue":"5","key":"e_1_2_14_22_1","doi-asserted-by":"crossref","first-page":"764","DOI":"10.3390\/jpm12050764","article-title":"A High\u2010Precision Deep Learning Algorithm to Localize Idiopathic Ventricular Arrhythmias","volume":"12","author":"Chang T. Y.","year":"2022","journal-title":"Journal of Personalized Medicine"},{"key":"e_1_2_14_23_1","doi-asserted-by":"crossref","DOI":"10.3389\/fcvm.2025.1458289","article-title":"Assessing the Performance of Zero\u2010Shot Visual Question Answering in Multimodal Large Language Models for 12\u2010Lead ECG Image Interpretation","volume":"12","author":"Seki T.","year":"2025","journal-title":"Frontiers in Cardiovascular Medicine"}],"container-title":["Journal of Cardiovascular Electrophysiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jce.70464","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jce.70464","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jce.70464","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T12:51:54Z","timestamp":1785588714000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jce.70464"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,1]]},"references-count":22,"alternative-id":["10.1111\/jce.70464"],"URL":"https:\/\/doi.org\/10.1111\/jce.70464","archive":["Portico"],"relation":{},"ISSN":["1045-3873","1540-8167"],"issn-type":[{"value":"1045-3873","type":"print"},{"value":"1540-8167","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,1]]},"assertion":[{"value":"2026-04-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-21","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-01","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"jce.70464"}}