{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T15:50:38Z","timestamp":1753890638325,"version":"3.41.2"},"reference-count":13,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,10,10]],"date-time":"2022-10-10T00:00:00Z","timestamp":1665360000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The ventricular premature complexes (PVCs) originating from the superior right ventricular outflow tract (RVOT) have high success rates by catheter ablation. It may not be the same when the origin is in the inferior RVOT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To identify electrocardiographic (ECG) characteristics that predict the site for successful ablation of PVCs originating in the inferior RVOT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Of 309 consecutive patients with symptomatic PVCs despite medical therapy, 124 had PVCs originating from the RVOT, and 107 RVOT cases without structural heart disease and no bundle branch block in sinus rhythm were enrolled in the study. Among them, 74 have a superior RVOT origin, and 33 have an inferior RVOT origin.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The proportion with multiple morphologies of PVC was significantly higher in the inferior RVOT group than in the superior RVOT group (24.24 vs. 6.76%, <jats:italic>P<\/jats:italic> = 0.011). The QRS duration of PVCs with an inferior RVOT origin was more expansive than PVCs with a superior RVOT origin (162.42 \u00b1 19.69 ms vs. 140.90 \u00b1 11.30 ms; <jats:italic>P<\/jats:italic> &amp;lt; 0.001). Furthermore, the QRS wave in V1 in patients in the inferior RVOT group was more likely to have a negative delta wave at the onset of the QRS (27.27 vs. 1.39%, <jats:italic>P<\/jats:italic> &amp;lt; 0.001). We found that the areas under the receiver-operating characteristic curve (AUCs) for PVC diagnosis with an inferior RVOT origin ranged from 0.812 to 0.841 depending on ECG features, with the highest AUC for the QRS duration of PVCs and the amplitude of R waves in lead II. These ECG indices had good predictability for judging the origin of PVCs in the RVOT; the best threshold for the QRS duration of PVCs was 145 ms, and the best thresholds for the amplitude of R waves in leads II, III, and aVF were 1.35, 1.35, and 1.15 mV, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>When evaluating a patient with PVCs, the source is likely to be the inferior RVOT if the ECG presentation conforms to the morphological characteristics of the RVOT, meanwhile, the QRS wave is relatively broad and polymorphic, and the main waves in limb leads (II, III, and aVF) are upward with low amplitude.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2022.950401","type":"journal-article","created":{"date-parts":[[2022,10,10]],"date-time":"2022-10-10T08:07:46Z","timestamp":1665389266000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Electrocardiographic criteria for localization of ventricular premature complexes from the inferior right ventricular outflow tract"],"prefix":"10.3389","volume":"9","author":[{"given":"Kang","family":"Li","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pinchao","family":"Lv","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuchuan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fangfang","family":"Fan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yansheng","family":"Ding","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianping","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jing","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,10,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1161\/CIRCEP.113.000805","article-title":"Radiofrequency ablation versus antiarrhythmic medication for treatment of ventricular premature beats from the right ventricular outflow tract: prospective randomized study","volume":"7","author":"Ling","year":"2014","journal-title":"Circ Arrhythm Electrophysiol."},{"key":"B2","doi-asserted-by":"publisher","first-page":"e2","DOI":"10.1016\/j.hrthm.2019.03.002","article-title":"2019 HRS\/EHRA\/APHRS\/LAHRS expert consensus statement on catheter ablation of ventricular arrhythmias","volume":"17","author":"Cronin","year":"2020","journal-title":"Heart Rhythm"},{"key":"B3","doi-asserted-by":"publisher","first-page":"2633","DOI":"10.1016\/j.jacc.2015.09.094","article-title":"Idiopathic ventricular arrhythmias originating from the pulmonary sinus cusp: prevalence, electrocardiographic\/electrophysiological characteristics, and catheter ablation","volume":"66","author":"Liao","year":"2015","journal-title":"J Am Coll Cardiol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1016\/j.hrthm.2017.08.007","article-title":"Pulmonary sinus cusp mapping and ablation: A new concept and approach for idiopathic right ventricular outflow tract arrhythmias","volume":"15","author":"Zhang","year":"2018","journal-title":"Heart Rhythm."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1101","DOI":"10.1016\/j.hrthm.2013.05.011","article-title":"Reasons for failed ablation for idiopathic right ventricular outflow tract-like ventricular arrhythmias","volume":"10","author":"Yokokawa","year":"2013","journal-title":"Heart Rhythm."},{"key":"B6","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1111\/jce.13359","article-title":"Electrocardiographic features of failed and recurrent right ventricular outflow tract catheter ablation of idiopathic ventricular arrhythmias","volume":"29","author":"Yamada","year":"2018","journal-title":"J Cardiovasc Electrophysiol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"i2","DOI":"10.1136\/hrt.2005.077875","article-title":"Anatomy, echocardiography, and normal right ventricular dimensions","volume":"92","author":"Ho","year":"2006","journal-title":"Heart."},{"key":"B8","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1016\/j.jjcc.2016.06.001","article-title":"Idiopathic ventricular arrhythmias: Relevance to the anatomy, diagnosis, and treatment","volume":"68","author":"Yamada","year":"2016","journal-title":"J Cardiol."},{"key":"B9","doi-asserted-by":"publisher","first-page":"2164","DOI":"10.1016\/j.hrthm.2020.07.006","article-title":"Amplitude of QRS complex within initial 40 ms in V2 (V2 QRSi40): Novel electrocardiographic criterion for predicting accurate localization of outflow tract ventricular arrhythmia origin","volume":"17","author":"Xia","year":"2020","journal-title":"Heart Rhythm."},{"key":"B10","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1016\/j.hrthm.2017.09.008","article-title":"Idiopathic ventricular arrhythmias originating from the right coronary sinus: Prevalence, electrocardiographic and electrophysiological characteristics, and catheter ablation","volume":"15","author":"Wang","year":"2018","journal-title":"Heart Rhythm."},{"key":"B11","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1111\/jce.12551","article-title":"Ventricular tachycardia originating from the septal papillary muscle of the right ventricle: electrocardiographic and electrophysiological characteristics","volume":"26","author":"Santoro","year":"2015","journal-title":"J Cardiovasc Electrophysiol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"2278","DOI":"10.1161\/CIRCULATIONAHA.117.031343","article-title":"Use of intracardiac echocardiography in interventional cardiology: working with the anatomy rather than fighting it","volume":"137","author":"Enriquez","year":"2018","journal-title":"Circulation"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1405","DOI":"10.1016\/j.hrthm.2020.02.037","article-title":"How to use intracardiac echocardiography to guide catheter ablation of outflow tract ventricular arrhythmias","volume":"17","author":"Ehdaie","year":"2020","journal-title":"Heart Rhythm."}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2022.950401\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,10]],"date-time":"2022-10-10T08:07:49Z","timestamp":1665389269000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2022.950401\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,10]]},"references-count":13,"alternative-id":["10.3389\/fcvm.2022.950401"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2022.950401","relation":{},"ISSN":["2297-055X"],"issn-type":[{"type":"electronic","value":"2297-055X"}],"subject":[],"published":{"date-parts":[[2022,10,10]]},"article-number":"950401"}}