The Canadian journal of cardiology · 2025
Using the QRS-VHis Interval-based Algorithm to Optimize the Ablation Process of Outflow Tract Premature Ventricular Complexes.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Wang Linlin, Wang Lei, Liu Hailei, Wu Nan, Cheng Kuan, Wang Yunlong, Wang Yuegang, Xiao Fangyi, Jiang Ruhong, Zhu Xuefeng, Chen Jingcheng, Wang Jinfeng, Yu Rongbin, Ju Weizhu, Chen Minglong
Аннотация
BACKGROUND: The choice between left- and right-sided ablation for outflow tract premature ventricular complexes (OT-PVCs) during procedures remains a topic of ongoing discussion. In this study we aim to elucidate the value of the QRS-VHis interval in distinguishing between left and right origins in left bundle branch block (LBBB)-type OT-PVCs, thereby optimizing the ablation process.
METHODS: The QRS-VHis interval was measured in consecutive patients with LBBB-type OT-PVCs. The performance of this interval was compared with traditional electrocardiographic (ECG) algorithms and prospectively validated in a cohort from 8 centers. Based on the interval, we developed an algorithm to assess its efficacy in optimizing the ablation process.
RESULTS: A total of 166 patients were enrolled in the development cohort, and 53 patients in the validation cohort. The QRS-VHis interval demonstrated greater accuracy than ECG algorithms among 153 patients with typical endocardial origins (area under the curve = 0.962). At a cutoff of 30 ms, the QRS-VHis interval showed a sensitivity of 71.8% and a specificity of 98.2% for identifying left-sided locations. A flowchart was developed based on the QRS-VHis interval, indicating that a QRS-VHis value of < 30 ms necessitated left-sided ablation with a 94% likelihood, leading to an 88% success rate. Conversely, when the QRS-VHis value was ≥ 30 ms, the likelihood of requiring left-sided ablation dropped to only 16%. The accuracy of the flowchart was validated in the independent cohort.
CONCLUSIONS: The QRS-VHis interval is superior for distinguishing between left and right ventricular outflow tract origins in LBBB-type OT-PVCs and has proven valuable in optimizing the intraprocedural process.
METHODS: The QRS-VHis interval was measured in consecutive patients with LBBB-type OT-PVCs. The performance of this interval was compared with traditional electrocardiographic (ECG) algorithms and prospectively validated in a cohort from 8 centers. Based on the interval, we developed an algorithm to assess its efficacy in optimizing the ablation process.
RESULTS: A total of 166 patients were enrolled in the development cohort, and 53 patients in the validation cohort. The QRS-VHis interval demonstrated greater accuracy than ECG algorithms among 153 patients with typical endocardial origins (area under the curve = 0.962). At a cutoff of 30 ms, the QRS-VHis interval showed a sensitivity of 71.8% and a specificity of 98.2% for identifying left-sided locations. A flowchart was developed based on the QRS-VHis interval, indicating that a QRS-VHis value of < 30 ms necessitated left-sided ablation with a 94% likelihood, leading to an 88% success rate. Conversely, when the QRS-VHis value was ≥ 30 ms, the likelihood of requiring left-sided ablation dropped to only 16%. The accuracy of the flowchart was validated in the independent cohort.
CONCLUSIONS: The QRS-VHis interval is superior for distinguishing between left and right ventricular outflow tract origins in LBBB-type OT-PVCs and has proven valuable in optimizing the intraprocedural process.