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Coupling interval variability differentiates ventricular ectopic complexes arising in the aortic sinus of valsalva

Jason S Bradfield1, Mohamed Homsi2, Kalyanam Shivkumar1

  • 1UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, California.

Journal of the American College of Cardiology
|March 25, 2014
PubMed

Insights

Premature ventricular contractions (PVCs) from the aortic sinuses of Valsalva (SOV) and great cardiac vein (GCV) show greater variability in coupling intervals (ΔCI) compared to other origins. A ΔCI exceeding 60 ms can help identify these specific PVC origins.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Cardiac Arrhythmias

Background:

  • Premature ventricular contractions (PVCs) typically exhibit consistent coupling intervals (CI) from the preceding QRS complex.
  • However, PVCs originating from the aortic sinuses of Valsalva (SOV) and great cardiac vein (GCV) present with highly variable CIs.
  • This variability is hypothesized to result from a lack of electrotonic effects from surrounding myocardium.

Purpose of the Study:

  • To investigate if PVCs from the SOV and GCV possess distinct CI characteristics differentiating them from other ectopic foci.
  • To establish whether the degree of CI variability (ΔCI) can predict the origin of PVCs.

Main Methods:

  • Seventy-three patients undergoing PVC ablation were evaluated.
  • Twelve consecutive PVC coupling intervals were recorded for each patient.
  • The difference between the maximum and minimum CI (ΔCI) was calculated.

Main Results:

  • PVC origins included right ventricle (RV) in 29%, left ventricle (LV) in 23%, SOV in 29%, and GCV in 8%.
  • A significantly greater mean ΔCI was observed in SOV/GCV PVCs (116 ± 52 ms) compared to RV/LV PVCs (33 ± 15 ms) (p < 0.0001).
  • A ΔCI >60 ms demonstrated high diagnostic accuracy (89% sensitivity, 100% specificity) for identifying SOV/GCV origins. Cardiac events were more frequent in the SOV/GCV group.

Conclusions:

  • The ΔCI is significantly more pronounced in PVCs originating from the SOV or GCV.
  • A ΔCI threshold of 60 ms effectively discriminates PVC origin prior to electrophysiological study.
  • Increased ΔCI may correlate with a higher incidence of cardiac events.
Abstract

Keywords:
aortic sinus of Valsalvacoupling intervalgreat cardiac veinpremature ventricular contraction

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