Abstract:Aim To analyze the 12-lead surface ECG of premature ventricular complex (PVC) originating from the summit to identify some ECG characteristics that may accurately determine the ablation target. Methods Between June 2018 and February 2021, a total of 36 patients with PVC arising from the summit underwent percutaneous radiofrequency catheter ablation (RFCA) in the coronary venous circulation or opposite left ventricular endocardial sites. The 12-lead ECG recordings about these patients were analyzed. Results 25 patients successfully ablated from the endocardial approach (endocardial group), 11 patients successfully ablated from the coronary venous circulation (epicardial group). The intrinsicoid deflection (ID) was smaller in the endocardial group than that in the epicardial group, and the difference was statistically significant (P=0.022). The maximum deflection index (MDI) was smaller in the endocardial group than that in the epicardial group, and the difference was statistically significant (P=0.020). The duration of the negative pseudodelta wave was shorter in the endocardial group compared to the epicardial group, the difference was statistically significant (P=0.004). After follow-up 6~36 months, the RFCA success rate was 100% (11/11) in the epicardial group, 1 case in the endocardial group was lost, and the RFCA success rate was 87.5% (21/24) in the remaining 24 patients. Subgroup analysis of the endocardial group showed when the duration of the negative pseudodelta wave ≥25 ms, the RFCA success rate was 62.5% (5/8), and when the duration of the negative pseudodelta wave <25 ms, the RFCA success rate was 100% (16/16). The duration of the negative pseudodelta wave <25 ms had sensitivity and specificity of 94% and 72%, for the identification of successful ablation in the adjacent endocardium. Conclusion The negative pseudodelta wave of PVC originating from the summit <25 ms was closely related to the success rate of RFCA.