MCL1 and MCL6 compared to V1 and V6 in distinguishing aberrant supraventricular from ventricular ectopic beats

Use of V1 and V6 has been suggested for distinguishing aberrant supraventricular from ventricular ectopy. For two decades, "modified" leads MCL1 and MCL6 have been widely used as V1 and V6 substitutes for bedside monitoring, but their use has never been validated. To determine the value of MCL1 and MCL6, 81 morphologically distinct wide QRS ectopic beats were recorded from 46 patients during cardiac electrophysiological study. As determined by the His-bundle electrogram, 31 of the ectopics were aberrant supraventricular, 50 were ventricular. A new criterion, measurement of QRS onset to the predominant peak or nadir of the complex, was valuable in diagnosing wide complexes in MCL6 and V6. An interval of 50 msec or less predicted aberrant supraventricular ectopy; an interval of 70 msec or more predicted ventricular ectopy. There was agreement between the modified and conventional precordial leads regarding which QRS patterns were useful in distinguishing aberrant supraventricular from ventricular ectopy. A greater proportion of wide complexes in MCL1 and V1 exhibited patterns useful in making the diagnosis compared to MCL6 and V6. Using well-established criteria, the proportion of correct diagnoses that was made from individual leads was: MCL1 = 86%, V1 = 85%, MCL6 = 72%, V6 = 67%. The bedside leads (MCL1 and MCL6) were not statistically different in diagnostic accuracy from their conventional lead counterparts (V1 and V6); however, MCL1 and V1 were superior to MCL6 and V6. When the new criterion was added to make the diagnosis from MCL6 and V6, no difference in diagnostic accuracy was present between the four leads.