aceLarge Language Model-Based Localization of Premature Ventricular Contraction Origins: A Retrospective Diagnostic Accuracy Study
Background Accurate localization of premature ventricular contraction (PVC) origin from 12-lead electrocardiography (ECG) is important for procedural planning in catheter ablation. Although convolutional neural network (CNN)-based models have shown promising diagnostic performance, they require task-specific training and remain limited in interpretability. We evaluated whether large language model (LLM)-based ECG image interpretation could perform binary left-versus-right PVC origin localization from 12-lead ECG…
Hospital Universitario Doctor Peset, Valencia 01 by 19Tarrestnom65. CC BY-SA 4.0 · https://creativecommons.org/licenses/by-sa/4.0
Researchers tested whether large language models could interpret 12-lead ECG images to distinguish left- versus right-sided origins of premature ventricular contractions in 157 patients who had undergone successful catheter ablation. By August 2026 they reported a staged extraction framework that produced a traceable stepwise process and a continuous score whose discrimination was numerically similar to a CNN baseline.
The finding matters because accurate pre-procedural localization can inform ablation planning, and a traceable LLM approach could address interpretability limits of task-specific CNNs. Uncertainty remains about generalizability, as the high-PPV threshold was set from training data and the authors noted it warrants prospective external validation.
- Retrospective study of 157 patients who underwent successful catheter ablation, classified as RIGHT-origin (n = 103) or LEFT-origin (n = 54) by final ablation site.
- Compared CNN baseline (PPV 0.546 b1 0.058, NPV 0.793 b1 0.047, AUC 0.595 to 0.730) to LLM one-shot and LLM staged extraction with deterministic rule-based integration.
- Staged extraction generated continuous rule-based score with AUC 0.720 b1 0.045 versus CNN 0.712 b1 0.054 across five independent seeds.
LLM-based staged extraction framework localized PVC origin as left versus right from 12-lead ECG images with discrimination comparable to a CNN baseline while providing a traceable stepwise diagnostic process.
The rundown
The authors retrospectively analyzed 12-lead ECG images from 157 patients with successful ablation, labeling each case by ablation site. They evaluated performance using PPV, NPV, recall, and PPV + NPV across five seeds, comparing a CNN baseline to LLM approaches.
The staged extraction approach combined LLM-based feature extraction with deterministic rule-based integration to produce a continuous score and a stricter threshold that increased PPV at the expense of recall, as reported in the results.
Sources
- Peer-reviewedJournal of Cardiovascular Electrophysiology2026-08-01
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