JACC. Clinical electrophysiology · 2025
His-LBB Twig: The Origin for Premature Ventricular Complexes With Morphology Almost Identical to Sinus Rhythm.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Chen Yifan, Zheng Cheng, Li Chenyang, Li Xiaowei, Zhou Zhixiang, Li Jia, Li Jin, Lin Yuannan, Lin Yunlu, He Ruilin, D'Angelo Lucia, James Shea Michaela, Po Sunny S, Lin Jiafeng
Аннотация
BACKGROUND: Premature ventricular complexes with a QRS morphology almost identical to the sinus rhythm (PVC-iSR) are scarce and have been insufficiently investigated.
OBJECTIVES: The purpose of this study was to explore the electrophysiology characteristics, true origin, and ablation strategy for PVC-iSR.
METHODS: Among 3,804 patients referred for PVC ablation, 20 patients with PVC-iSR were identified. Detailed mapping, ablation, and analysis were performed.
RESULTS: The earliest activation site (EAS) of PVC-iSR consistently recorded a sharp Purkinje potential with a Purkinje-ventricular interval of 46.65 ± 4.43 milliseconds. By targeting the EAS of PVC-iSR, successful ablation was achieved without incurring atrioventricular block or bundle branch block in 17 of 20 cases. These findings indicate that PVC-iSR may originate from a discrete branch of the His bundle or proximal left bundle branch (LBB); we labeled this "His-LBB twig." His-LBB twig was located anterosuperior to the His-LBB trunk and underneath the right coronary cusp (RCC). The distance was 8.96 ± 2.32 mm between the EAS and left-sided His bundle, and 5.55 ± 2.31 mm between EAS and RCC. Ablation was successful in the RCC in 45%, beneath the RCC in 40%, and aborted for high risk of atrioventricular nodal injury in 15% of patients, with the distance between the EAS and RCC being shortest, moderate, and longest, respectively. The R/S index >1.0 in lead II was a good predictor of successful ablation in RCC.
CONCLUSIONS: PVC-iSR was caused by a His-LBB twig that could be successfully ablated in or underneath the RCC without injury to the conduction system.
OBJECTIVES: The purpose of this study was to explore the electrophysiology characteristics, true origin, and ablation strategy for PVC-iSR.
METHODS: Among 3,804 patients referred for PVC ablation, 20 patients with PVC-iSR were identified. Detailed mapping, ablation, and analysis were performed.
RESULTS: The earliest activation site (EAS) of PVC-iSR consistently recorded a sharp Purkinje potential with a Purkinje-ventricular interval of 46.65 ± 4.43 milliseconds. By targeting the EAS of PVC-iSR, successful ablation was achieved without incurring atrioventricular block or bundle branch block in 17 of 20 cases. These findings indicate that PVC-iSR may originate from a discrete branch of the His bundle or proximal left bundle branch (LBB); we labeled this "His-LBB twig." His-LBB twig was located anterosuperior to the His-LBB trunk and underneath the right coronary cusp (RCC). The distance was 8.96 ± 2.32 mm between the EAS and left-sided His bundle, and 5.55 ± 2.31 mm between EAS and RCC. Ablation was successful in the RCC in 45%, beneath the RCC in 40%, and aborted for high risk of atrioventricular nodal injury in 15% of patients, with the distance between the EAS and RCC being shortest, moderate, and longest, respectively. The R/S index >1.0 in lead II was a good predictor of successful ablation in RCC.
CONCLUSIONS: PVC-iSR was caused by a His-LBB twig that could be successfully ablated in or underneath the RCC without injury to the conduction system.