Abstract 15521: Novel Method For Prediction of Para-Hisian Premature Ventricular Complex by Electrocardiogram
Introduction: The catheter ablation of Para-Hisian (PH) premature ventricular complex (PVC) has a high risk of heart block. The effort to predict the Para-Hisian location of PVC should be pursued before planning an invasive procedure. The purpose of this study was to find the predictor of PH-PVC based on PVC vectors of surface electrocardiogram (ECG).
Methods and Results: We enrolled 55 patients who underwent the electrophysiologic study for catheter ablation of the PVC and analyzed the ECG characteristics, retrospectively. PVC locations were Para-Hisian in 14, right ventricular (RV) outflow tract (OT) in 11, left ventricular (LV) OT in 16, and LV in 14. For PH-PVC, ablation was not attempted or failed in 5 patients due to high risk of heart block, and successful ablation was achieved from septum or coronary cusps in 9 patients. The QRS width of PH-PVC was significantly narrower than the rest of PVCs (140.7±17.1 ms vs. 164.0±21.4 ms, P=0.000). Precordial transition of PH-PVC relating to the transition of sinus rhythm was not helpful to predict the location. Polarity of PVC in limb leads was analyzed to monophasic or biphasic wave with negative or positive deflection in all patients. The inferior leads showed diverse polarity; lead II showed positive in 85%, lead III showed negative in 75%, and lead aVF showed positive in 78%. However, lead I showed monophasic R wave in 100% and lead aVR showed monophasic negative (QS) wave in 100%. In aVL, 13/14 patients had monophasic R wave and 1 patient showed biphasic (rS) wave with initial positive polarity. Among study cohort, 15 patients showed QS in aVR and R in aVL including 13 PH-PVCs and 2 PVCs coming from RVOT septum and LVOT septum, respectively. PVCs of 4 patients showed initial negative biphasic wave (Qr or qR) in aVR and R wave in aVL, which were located in posteroseptum of LV. The QS in aVR and monophasic R in aVL has a sensitivity of 85.8%, a specificity of 95.1%, positive predictive value of 85.8% and a negative predictive value of 95.1% for localizing PH-PVC.
Conclusion: The PVC morphology with QS in aVR and monophasic R in aVL, like normal QRS vectors in sinus rhythm, can be used as a reliable parameter to predict Para-Hisian location. It may help to avoid possible complications and to plan accordingly.
- © 2013 by American Heart Association, Inc.