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Abstract Objective To explore the electrocardiographic (ECG) characteristics of idiopathic premature ventricular complexes (PVC) and ventricular tachycardia (VT) from different origins and put forward a strategy to identify its origins. Methods The effective target site or the earliest ventricular activation site on roentgenogram during radiofrequency ablation was identified as the origin of PVC/VT and the QRS waves of PVC/VT on a 12- lead ECG were analyzed. Results 828 patients underwent ablation for PVC/VT. Of them, 580 cases had PVC/VT originated from right ventricle and 248 from left ventricle. Precordial transition index <0 was seen in 97.58% cases with left ventricular origin and 7.24% cases with right ventricular origin. R wave in inferior leads was the most common pattern for PVC / VT from both right (RVOT) and left ventricular outflow tract. In lead V1, most PVC/VT from RVOT showed rS, PVC/VT from right septum showed QS and those from above aortic valve showed rS or RS. In inferior leads, PVC/VT from left anterior fascicular often manifested as qR, those from left posterior fascicular often manifested as rS. Conclusion Combining precordial transition index with QRS patterns in inferior leads and lead V1 on surface ECG may preliminary determine the origins of idiopathic PVCs/VT.
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