Can the 12-lead ECG distinguish RVOT from aortic cusp PVCs in pediatric patients?

Bradley C. Clark, Scott R. Ceresnak, Robert H. Pass, Lynn Nappo, Kohei Sumihara, Anne M. Dubin, Kara Motonaga, Jeffrey P. Moak

Research output: Contribution to journalArticlepeer-review


Background: The ability to differentiate right ventricular outflow tract (RVOT) from coronary cusp (CC) site of origin (SOO) by 12-lead ECG in pediatric patients may impact efficacy and procedural time. The objective of this study was to predict RVOT versus CC SOO by ECG in pediatric patients. Methods: Pediatric patients (<21 years) without structural heart disease with RVOT or CC premature ventricular contraction (PVC) ablations performed (2014-2018) were evaluated through multi-institution retrospective review. Demographics, ECG PVC parameters, ablation site, recurrence, and repeat procedures were collected. Results: Thirty-seven patients were evaluated (mean age 14.6 years, weight 60.6 kg): 11 CC and 26 RVOT PVC SOO. CC PVCs were less likely to exhibit left bundle branch block (64% vs 100%, P =.005), had larger R-wave amplitude in V1 (0.27 vs 0.11 mV, P =.03), larger R/S ratio in V1 (0.37 vs 0.09, P =.003), and had precordial transition in V3 or earlier (73% vs 15%, P =.002). A composite score was created with the following variables: isodiphasic or positive QRS in V1, R/S ratio in V1 > 0.05, S wave in V1 < 0.9 mV, and precordial transition at or before V3. Composite score ≥ 2 was associated with a CC SOO (OR 42.0, P =.001, and AUC 0.86). Conclusions: 12-lead ECG of PVCs from the CC was associated with larger V1 R-wave amplitude, larger R/S ratio in V1, and precordial transition at or before V3. A composite score may help predict PVC/VT arising from the CC.

Original languageEnglish (US)
Pages (from-to)308-313
Number of pages6
JournalPACE - Pacing and Clinical Electrophysiology
Issue number3
StatePublished - Mar 1 2020


  • ablation
  • coronary cusp
  • electrocardiogram
  • pediatric
  • premature ventricular contraction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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