Key result
Radiofrequency catheter ablation of para-Hisian ventricular arrhythmias successfully reduced premature ventricular contraction burden in three patients, despite shifts in exit sites during the procedure.
Why the study?
Catheter ablation of idiopathic ventricular arrhythmias originating in the para-Hisian region carries a risk of atrioventricular block, and uncommon exit site shifts during ablation may require different ablation approaches.
Case Report (n=3)
No
Radiofrequency catheter ablation of para-Hisian ventricular arrhythmias is feasible but may involve shifts in exit sites requiring extensive mapping, and delayed reduction in PVC burden can occur after initially unsuccessful attempts.
Answers are grounded in this paper and cite their sources.
Exit site shifts in para-Hisian VA ablation may require adaptive strategies; case reports leave open optimal techniques to minimize AV block risk.
INTRODUCTION: Radiofrequency catheter ablation of idiopathic ventricular arrhythmias originating in the para-Hisian region could be challenging because of a potential risk of iatrogenic atrioventricular block. Uncommonly, shift of the exit site during the ablation can be observed. Consequently, different approaches of radiofrequency catheter ablation of para-Hisian ventricular foci can be needed. CASE SERIES PRESENTATION: Three patients (2 males) underwent electroanatomical mapping and catheter ablation for idiopathic premature ventricular contractions originating near the His bundle. Patients underwent 24-h ECG Holter monitoring during follow-up. All patients had premature ventricular contractions with left bundle branch block morphology and inferior or horizontal axis. However, change of QRS morphology during ablation was observed, due to a change in the exit site. In two patients there was reduction of the arrhythmia burden after initially unsuccessful procedure. Mapping and ablation in the aortic root were needed in one patient. There were no complications. DISCUSSION: Radiofrequency catheter ablation of para-Hisian ventricular arrhythmias is feasible and safe when performed cautiously. A change in the premature ventricular contractions’ morphology and exit site during ablation may ensue; therefore, extensive mapping on both sides of the interventricular septum as well as in the aortic root may be warranted.
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Dzhinsov et al. (2020) conducted a case report in Idiopathic ventricular arrhythmias originating from the para-Hisian area (n=3). Radiofrequency catheter ablation was evaluated on Reduction of premature ventricular contraction burden. Radiofrequency catheter ablation of para-Hisian ventricular arrhythmias successfully reduced premature ventricular contraction burden in three patients, despite shifts in exit sites during the procedure.
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