106 patients (59 males, 56 ± 14 years) who underwent successful PVC ablation were studied. Various ECG patterns and measurements were analyzed to identify the unique features of RCC PVC origins. The R-wave duration index (RWDI) was calculated as a percentage by dividing the QRS complex duration by the longest R-wave duration in lead V1 or V2.
Successful ablation sites were the RCC in 18 patients, the left coronary cusp (LCC) in 20, the RCC/LCC junction (RLJ) in 22, the AIV/GCV in 11 and the right ventricular outflow tract in 35. Forty-seven patients had dominantly positive forces in lead I. Among these 47 patients, 19 were ablated from the RCC (18/18, 100%), eighteen from the RVOT (18/35, 51%), five from the LCC (5/20, 25%), and five from the RLJ (6/22, 27%). The S-wave amplitude in lead aVL was significantly smaller in RCC than LCC or RLJ PVCs (0.1 ± 0.3 mV vs. 1.1 ± 0.5 mV, p < 0.001). The V1–2 RWDI was significantly greater in RCC than RVOT PVCs (51.8 ± 20.5% vs. 30.8 ± 13.9%, p < 0.001). The optimal cut-off values of < 0.95 mV for S-wave (area under the curve, AUC: 0.76, p < 0.01) and > 43.6% for R-wave duration index in V1 or V2 (AUC: 0.83, p < 0.001) were determined by ROC analysis.
The presence of a dominant positive lead I, RWDI > 43.6% and S-wave amplitude in aVL < 0.95 mV predicted RCC PVCs with a sensitivity of 83% and specificity of 94%.