Novel method for the prediction of para‐Hisian premature ventricular complexes from the electrocardiogram

Figures

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  Figure 1. Example of the successful ablation of a para‐Hisian PVC. (A) Left: Baseline 12‐lead electrocardiogram (ECG) showing sinus rhythm with a left bundle branch block. Right: The 12‐lead ECG of a PVC showing a polarity reversal between aVR and aVL. (B) The recording of the electrograms at the successful ablation site. During sinus rhythm, a far‐field His bundle signal was observed in the distal ablation catheter recording. During the PVC, a local ventricular potential preceding the QRS onset by 40 ms was observed on the same catheter. (C, D) RAO and LAO fluoroscopic images of the catheter positions. The ablation catheter was positioned at the right coronary cusp toward the His bundle catheter. PVC: premature ventricular complex, ECG: electrocardiogram, ABL d, ablation catheter distal electrogram; ABL p, ablation catheter proximal electrogram; His p/m/d, His bundle recording catheter proximal/middle/distal electrogram; A, atrial potential; His, His bundle potential; V, ventricular potential; RAO, right anterior oblique; LAO, left anterior oblique; ABL, ablation catheter; HB, His bundle catheter; CS, coronary sinus catheter

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  Figure 2. Comparison of the QRS width of para‐Hisian (PH) premature ventricular complexes (PVCs) versus other PVCs. (A) The box and whisker plots of the two groups. (B) Receiver operating characteristics curve analysis of the QRS width in predicting PH‐PVCs. The AUC (area under curve) is 0.779. A QRS width of 143 mm serves as the best cutoff value. It predicts PH‐PVCs with a sensitivity of 78.6% and specificity of 81.8%

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  Figure 3. Representative 12‐lead electrocardiographic (ECG) of the para‐Hisian (PH) premature ventricular complexes (PVCs) in our study patients. Lead aVL had a predominant positive polarity and lead aVR a QS pattern, which we referred to as an “aVR‐aVL polarity reversal sign.” This characteristic ECG finding was observed in most of the PH‐PVC patients

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  Figure 4. Representative 12‐lead electrocardiographic (ECG) of the premature ventricular complexes (PVCs) according to the site of origin. From the left, a PVC from the para‐Hisian region (PH‐PVC), left coronary cusp (LCC), right coronary cusp region (RCC), left ventricular (LV) posteroseptum region, LV summit, right ventricular outflow tract (RVOT) posteroseptum (PS), and RVOT lateral wall (L) region. The average QRS width increases from left to right