Electrocardiographic Characteristics and Ablation Outcomes Associated With Para-Hisian Ventricular Arrhythmias

JACC. Asia Pub Date : 2025-02-01 DOI:10.1016/j.jacasi.2024.11.012

Anugrah Nair DM , Jenish P. Shroff DM , Lukah Q. Tuan BSc , Adriana Tokich BSc , Deep Chandh Raja DM , Abhinav Mehta BSc , Walter P. Abhayaratna MBBS, PhD , Prashanthan Sanders MBBS, PhD , Francis E. Marchlinski MD , Kalyanam Shivkumar MD, PhD , Rajeev K. Pathak MBBS, PhD

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Abstract

Background

Ventricular arrhythmias (VAs) near the His-bundle comprise 9% of unexplained VAs and present challenges for ablation caused by the risk of atrioventricular block.

Objectives

The authors studied the electrocardiographic (ECG) and electrophysiological characteristics of Para-Hisian (PH) VAs, comparing them with septal right ventricular outflow tract VAs.

Methods

From 210 patients with VAs between 2018 and 2024, 31 (14.7%) with PH-VAs and 23 (10.9%) with septal right ventricular outflow tract VAs were included. ECG characteristics of both were compared, and features differentiating left and right PH and supra- and infra-Hisian VAs were identified.

Results

Of 31 patients, 15 had VAs from the right PH site and 16 from the left. Median follow-up was 15 months (Q1-Q3: 14-21 months) for left infra-Hisian, 16 months (Q1-Q3: 14-20 months) for left supra-Hisian, and 14 months (Q1-Q3: 14-16 months) for right infra-Hisian and right supra-Hisian VAs (Q1-Q3: 14-15 months). PH-VAs had narrower QRS complexes (134 ± 19.6 ms vs 169 ± 24 ms; P < 0.05), R-wave in lead aVL (100% [31 of 31] vs 4.3% [1 of 23]; P < 0.001), and earlier R-wave transition at or before lead V₃ (80.6% [25 of 31] vs 47.8% [11 of 23]; P < 0.05). Left PH-VAs had earlier R-wave transition at lead V₂ (50% [8 of 16] vs 20% [3 of 15]; P = 0.036). Right PH VAs had deeper S-wave relative to the preceding sinus beat in lead V₁ (73.3% [11 of 15] vs 37.5% [6 of 16]; P = 0.04) and lead aVR (80% [12 of 15] vs 56.3% [9 of 16]; P = 0.01). Postprocedure heart block occurred in 1 patient.

Conclusions

PH-VAs exhibit unique ECG features based on their origins, and can be effectively treated without affecting atrioventricular conduction.

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与旁心性室性心律失常相关的心电图特征和消融结果

背景：his束附近的室性心律失常（VAs）占无法解释的室性心律失常（VAs）的9%，并且由于房室传导阻滞的风险对消融提出了挑战。目的研究旁hisia (PH) VAs的心电图和电生理特征，并与室间隔右心室流出道VAs进行比较。方法纳入2018 - 2024年210例VAs患者，其中PH-VAs 31例（14.7%），室间隔右心室流出道VAs 23例（10.9%）。比较两者的心电图特征，鉴别左、右PH值和上、下hisian VAs的特征。结果31例患者中，15例在右侧PH区有VAs， 16例在左侧PH区有VAs。中位随访时间为15个月（Q1-Q3: 14-21个月），左侧上希sian VAs为16个月（Q1-Q3: 14-20个月），右侧下希sian VAs和右侧上希sian VAs为14个月（Q1-Q3: 14-16个月）（Q1-Q3: 14-15个月）。PH-VAs的QRS复合物较窄（134±19.6 ms vs 169±24 ms）；P & lt;0.05)， aVL导联r波(100% [31 / 31]vs 4.3% [23 / 1]；P & lt;0.001)，在V3导联处或之前的r波转换较早(80.6%[31人中的25人]vs 47.8%[23人中的11人]；P & lt;0.05)。左侧PH-VAs在V2导联处有更早的r波转换(50% [16 / 8]vs 20% [15 / 3]；P = 0.036)。右PH VAs相对于V1导联前窦性搏动s波更深(73.3% [15 / 11]vs 37.5% [16 / 6]；P = 0.04)和导联aVR (80% [15 / 12] vs 56.3% [16 / 9]；P = 0.01)。1例患者术后发生心脏传导阻滞。结论sph - vas有其独特的心电图特征，可在不影响房室传导的情况下有效治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC. Asia Cardiology and Cardiovascular Medicine

CiteScore

4.00

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0.00%

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