Shunsuke Uetake MD, William G. Stevenson MD, FHRS, Travis D. Richardson MD, Arvindh N. Kanagasundram MD, FHRS, Kanae Hasegawa MD, Masaaki Kurata MD, Daisuke Togashi MD, Salah H. Alahwany MD, Tiffany Hu MD, Giovanni E. Davogustto MD, Zachary T. Yoneda MD, Sharon T. Shen MD, Jay A. Montgomery MD, Harikrishna Tandri MD, FHRS
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引用次数: 0
Abstract
Background
Ventricular tachycardia (VT) with a 1:1 V-His relation can be seen in bundle branch reentry or with passive retrograde activation from scar-related VT or reentry using left ventricular Purkinje fascicles.
Objective
This study aimed to review the frequency with which 1:1 V-His relation occurs and to identify differentiating characteristics of these arrhythmias, including new measures obtained during right ventricular (RV) pacing based on orthodromic His–proximal right bundle potential (HisRB) capture and the stimulus to HisRB (S-HisRB) interval approximating RV electrogram to His interval (Egm-HisRBVT).
Methods
This was a retrospective review of induced VTs that had a HisRB potential recorded while pacing from the distal right ventricle.
Results
From 147 patients, 158 VTs were analyzed. A 1:1 V to HisRB was observed in 86 VTs (54%): 18 bundle branch reentrant VTs (BBR-VTs), 8 LV fascicular/Purkinje-related reentrant VTs (FPVTs), and 60 scar-related reentrant VTs (SRR-VTs). The HisRB-QRSVT was >135 ms, falling within the QRS in 87% of SRR-VTs, and 30–135 ms in all BBR-VTs (P < .001). With RV pacing, the HisRB remained 1:1 in 100% of BBR-VTs and 23 (69.7%) of 33 SRR-VTs. An S-HisRB of >135 ms combined with S-HisRB – Egm-HisRBVT difference <30 ms was specific for BBR-VT. In FPVTs, the HisRB-QRS timing was more variable, and RV pacing was helpful in distinguishing these from BBR-VTs.
Conclusion
Retrograde HisRB activation is common in all forms of VT. HisRB timing and new features based on consideration of orthodromic HisRB activation during RV pacing can help distinguish BBR-VT, SRR-VT, and FPVT.
期刊介绍:
HeartRhythm, the official Journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, is a unique journal for fundamental discovery and clinical applicability.
HeartRhythm integrates the entire cardiac electrophysiology (EP) community from basic and clinical academic researchers, private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our EP community.
The Heart Rhythm Society is the international leader in science, education, and advocacy for cardiac arrhythmia professionals and patients, and the primary information resource on heart rhythm disorders. Its mission is to improve the care of patients by promoting research, education, and optimal health care policies and standards.