Investigation of the Threshold for Discrimination Between Aortic and Pulmonary Valve Positions Using the Potential Peak Value of Premature Ventricular Contractions Originating from the Outflow Tract in the CARTO® System

Abstract

【Purpose】This study aimed to investigate the threshold for discriminating between aortic and pulmonary valve positions in the Voltage Map of the CARTO^® System using the high-value potential waves of Outflow Tract Ventricular Premature Contractions（OTVPC）. 【Method】In cases where coronary or pulmonary artery angiography was conducted, the study utilized the peak values［mV］of OTVPC obtained through conventional catheters in the left ventricular outflow tract（LVOT）and right ventricular outflow tract（RVOT）. Discrimination thresholds were calculated using Receiver Operating Characteristic（ROC）analysis and Diagnostic Performance Plot（DP）. 【Results】For LVOT bipolar potentials（Bi）, the Best cut-off value（BC）was 0.76［mV］, the Area Under the ROC-Curve（AUC）was 0.92. For RVOT Bi, BC was 0.59［mV］, and AUC was 0.95. Based on DP, the discrimination thresholds for LVOT Bi, ensuring 95％ accuracy, were ≤0.48 for the valve-up position and ≥2.56 for the valve-down position. For RVOT Bi, the thresholds were ≤0.4 for valve-up and ≥0.34 for valve-down. 【Conclusion】The discriminative capability between the aortic and pulmonary valve positions using the peak potential values of Outflow Tract Ventricular Premature Contractions（OTVPC）was excellent with bipolar potentials（Bi）. Specific threshold values for each position were identified.