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Initial negative concordance on unipolar and bipolar electrograms: a novel parameter for localizing the origin of premature ventricular contractions arising from pulmonary sinus cusps

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Abstract

Background

The features of the unipolar electrogram (UEGM) and bipolar electrogram (BEGM) have been utilized to identify the site of origin of idiopathic premature ventricular contractions (PVCs) arising from pulmonary sinus cusps (PSCs), but for these PVCs, whether a negative concordance in the initial waves of both EGMs recorded above pulmonary valves can be used as a parameter to localize the origin has not been previously studied. We aimed to assess whether an initial negative concordance (INC) between the UEGM and BEGM might determine the origin of PVCs mapped and ablated within PSCs.

Methods

Data were collected from 22 patients undergoing successful radiofrequency catheter ablation for symptomatic idiopathic PVCs within PSCs. The morphological features of both the UEGM and the BEGM recorded at all ablation sites were analyzed.

Results

A total of 109 sites within PSCs were ablated in 22 patients with an age (mean ± SD) of 47.2 ± 17.2 years. Ablation resulted in procedural success in all patients. The INC was observed at 18 of 22 (81.8%) successful ablation sites, contrasted with 3 of 87 (3.4%) unsuccessful sites (P < 0.001). The INC was consistent with the outcomes of conventional mapping parameters and proved to be an additional useful predictor of ablation success, with a sensitivity, specificity, positive predictive value and negative predictive value of 81.8%, 96.6%, 85.7% and 95.5%, respectively.

Conclusions

An INC between the UEGM and the BEGM can predict the origin of PVCs arising from PSCs.

Graphical Abstract

An initial negative concordance between unipolar and bipolar electrograms indicates that the distal electrode of the ablation catheter is at the origin of premature ventricular contractions within pulmonary sinus cusps.

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Data Availability

Data available on request from the authors.

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Authors and Affiliations

  1. Department of Cardiology, The First Affiliated Hospital of Soochow University, No.188 Shizi St, Suzhou, 215006, Jiangsu, China

    Xiaoqing Wang & Jie Hui

  2. Department of Cardiology, The Third Affiliated Hospital of Soochow University, Changzhou, China

    Xiaoqing Wang, Mengfei Wang & Yamin Cheng

Authors
  1. Xiaoqing Wang
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  2. Mengfei Wang
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  3. Yamin Cheng
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  4. Jie Hui
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Contributions

All authors contributed to the study conception and design. Dr. Xiaoqing Wang was responsible for the material preparation, data collection and analysis, and the writing of the article. Dr. Xiaoqing Wang, Dr. Mengfei Wang and Dr. Yamin Cheng performed the electrophysiological procedures. Dr. Jie Hui contributed to the study design and the article reviewing and editing. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jie Hui.

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Ethical approval

The study was approved by the ethics committee of the Third Affiliated Hospital of Soochow University.

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All patients provided written informed consent prior to the procedure.

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The authors declare no competing interests.

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Wang, X., Wang, M., Cheng, Y. et al. Initial negative concordance on unipolar and bipolar electrograms: a novel parameter for localizing the origin of premature ventricular contractions arising from pulmonary sinus cusps. J Interv Card Electrophysiol 66, 1651–1658 (2023). https://doi.org/10.1007/s10840-023-01473-4

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  • DOI: https://doi.org/10.1007/s10840-023-01473-4

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