Iranian Heart Journal

Iranian Heart Journal

Electrocardiographic and Demographic Manifestations of Premature Ventricular Complexes From the Left Ventricular Outflow Tract

Document Type : Original Article

Authors
Samira Esfandiari Mehni 1
Mohammad Javad Aminizadeh 1
Ali Daryanavard 1
Roya Rezai 1
Hooman Bakhshandeh 2
Shabnam Madadi 3
1 Rajaie Cardiovascular Medical and Research Center, School of Medicine, Iran University of Medical Sciences, Tehran, IR Iran.
2 Cardiovascular Epidemiology Research Center, Rajaie Cardiovascular Medical and Research Institute, Tehran, IR Iran.
3 Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Institute, Iran University of Medical Sciences, Tehran, IR Iran.
Abstract
Background: This study aimed to compare the prevalence, age, sex, left ventricular ejection fraction, underlying conditions, and smoking status among patients with various types of premature ventricular contractions (PVCs) originating from the left ventricle with an inferior axis. The PVC patterns were investigated using ECG.
 
Methods: Patients who underwent successful catheter ablation for PVCs originating from the left ventricle with an inferior axis between 2017 and 2022 at the Rajaie Cardiovascular Medical and Research Institute were included in this study. Patient data, including ECG records, were collected by reviewing archived patient files.
 
Results: A total of 377 patients aged 15 to 81 years were included in the study, with 56.8% being male. The most common PVC ablation site was the left coronary cusp (39.3%), followed by the right coronary cusp-left coronary cusp commissure (26%). Most of the patients (99.5%) experienced clinical symptoms, and the mean ejection fraction was 44/60%. Nearly 38.19% of the patients had a normal ejection fraction, while 31.56% had a mildly reduced ejection fraction.
 
Conclusions: The study revealed that left-sided PVCs were more prevalent in men and exhibited an increasing trend with age. Among the risk factors, hypertension showed a direct and superior association. The most common PVC pattern observed on ECG was characterized by a monophasic R wave, QS complexes in leads AVL and AVR, and an R/S ratio of less than 1 in lead I and leads V1–V2. The majority of patients with left-sided PVCs exhibited a transition in lead V3, often referred to as the “gray zone.” Additionally, a breakthrough transition pattern was predominantly noted in patients with the most common type of PVCs ablated from the summit, aortomitral continuity, and subvalvular regions. (Iranian Heart Journal 2024; 25(4): 59-72)
Keywords
Left ventricular
Ventricular premature complexes
Catheter ablation
Electrocardiography
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Iranian Heart Journal
Volume 25, Issue 4
Autumn 2024
Pages 59-72