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Heart Rhythm. 2019 Mar;16(3):380-387. doi: 10.1016/j.hrthm.2018.09.015. Epub 2018 Sep 21.

Catheter ablation of right-sided para-Hisian ventricular arrhythmias using a simple pacing strategy.

Author information

1
Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
2
Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China; Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China. Electronic address: gdzxz@163.com.
3
Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China; Askepios Klinik St. Georg, Hamburg, Germany.
4
Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China; Guangdong Provincial Key Laboratory of Clinical Pharmacology, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, China.
5
The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.

Abstract

BACKGROUND:

Ablation of para-Hisian ventricular arrhythmias (PH-VAs) is challenging because of the close relationship of the origin site and His bundle. Using pacing techniques to differentiate the near-field from far-field His activations, thereby avoiding atrioventricular block, has been reported in patients with para-Hisian accessory pathways.

OBJECTIVES:

We applied the same pacing technique and 3-dimensional mapping to guide radiofrequency (RF) ablation in patients with right-sided PH-VAs and investigated the clinical outcome of such cases.

METHODS:

Fourteen patients with right-sided PH-VAs were included in this study. The earliest activation sites were confirmed in the right ventricle on the 3-dimensional map. Pacing with different outputs was performed at the largest His potential site (P1) and the earliest activation site (P2). If the minimum His bundle-right bundle branch-captured output at P2 was higher than that at P1, RF ablation was performed at the site.

RESULTS:

All the patients in this study had monomorphic premature ventricular contractions (PVCs) with a mean QRS duration of 118.3 ± 8.1 ms. A His-right bundle branch potential with an amplitude of 0.05 ± 0.02 mV was recorded at P2, with a mean distance of 5.97 ± 1.84 mm away from P1. PVCs were successfully eliminated in 13 of 14 patients (92.9%). One patient exhibited persistent right bundle branch block after ablation, and 1 recurrence of ablated PVCs occurred during a median follow-up period of 15 months.

CONCLUSION:

Using a simple pacing technique to evaluate the safety of RF energy application led to a high success rate of RF catheter ablation of right-sided PH-VAs without atrioventricular block.

KEYWORDS:

Catheter ablation; His bundle; Mapping; Para-Hisian region; Right ventricle; Ventricular arrhythmias

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