High-density mapping of his-ventricular intervals: impact of recording site and sex-specific differences

Q: What are the key findings of this study?

Proximal His-ventricular interval measurements were significantly longer than distal recordings (51 vs 46 ms), and women had consistently shorter intervals than men across all measurement sites.

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Atrial fibrillation (n=67). Intervention: Proximal high-density mapping catheter recording vs. Distal recording. Primary outcome: His-ventricular (HV) interval duration (MD 5.1 ms, 95% CI 4.4-5.8, p=<0.001).

Q: What does this research mean for the field?

Proximal His-ventricular (HV) interval measurements are significantly longer than distal recordings, and women systematically exhibit shorter HV intervals than men across all recording sites. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the impact of catheter measurement location and sex on His-ventricular (HV) interval values using high-density mapping in patients undergoing atrial fibrillation ablation.

Teodor Serban; Jeanne du Fay de Lavallaz; Sven Knecht; David Spreen; Behnam Subin; Reto Stump; Philipp Krisai; Nicolas Schärli; Beat Schär; Felix Mahfoud; Christian Sticherling; Michael Kühne; Patrick Badertscher

doi:10.1007/s10840-026-02438-z

September 18, 2026Journal of Interventional Cardiac ElectrophysiologyOpen Access

High-density mapping of his-ventricular intervals: impact of recording site and sex-specific differences

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Key result

Proximal HV interval measurements average ~5 ms longer than distal recordings, with shorter intervals in women.

MD +5.1 ms
95% CI 4.4-5.8
P<0.001
n=67

Figures

Why the study?

The influence of recording site and sex on His–ventricular interval values is not well defined, impacting diagnosis of infranodal conduction disease.

Does measurement location and sex impact the values of His-ventricular (HV) intervals recorded using high-density mapping catheters in patients undergoing atrial fibrillation ablation?

Key Points

To evaluate the impact of catheter measurement location and sex on His-ventricular (HV) interval values using high-density mapping in patients undergoing atrial fibrillation ablation.
Prospective study of 67 patients (mean age 64 ± 10 years, 33% women) in sinus rhythm undergoing atrial fibrillation ablation.
HV intervals were measured at the end of the procedure using a standard decapolar catheter and a high-density mapping catheter categorized into proximal (HV prox), distal (HV dis), and right bundle (HV RB) locations.
Conduction velocities and sex-specific differences were analyzed using multivariable linear mixed-effects models and correlation analyses.
HV prox was significantly longer than HV dis (51 ± 10 ms vs. 46 ± 10 ms, p < 0.001) and HV RB (37 ± 10 ms, p < 0.001), with abnormal HV intervals (> 55 ms) identified in 28% of patients proximally compared to 12% distally and 5% over the right bundle.
Clinical HV interval was shorter in women than men (40 ms vs. 47 ms, p < 0.001), with high-density intervals remaining shorter in women across all sites: HV prox (48 ± 9 ms vs. 53 ± 10 ms, p = 0.034), HV dis (42 ± 8 ms vs. 48 ± 10 ms, p = 0.005), and HV RB (33 ± 8 ms vs. 40 ± 10 ms, p = 0.002).
Overall propagation velocity from proximal His to right bundle was 1.5 ± 0.6 m/s without sex differences (women: 1.4 ± 0.6 m/s vs. men: 1.5 ± 0.6 m/s, p = 0.6) and correlated weakly with surface electrocardiogram parameters.

Study Design

Type

Cross-Sectional (n=67)

Multicenter

No

Structured PICO

Does measurement location and sex impact the values of His-ventricular (HV) intervals recorded using high-density mapping catheters in patients undergoing atrial fibrillation ablation?

P

Population

67 patients with atrial fibrillation (33% women, mean age 64) undergoing catheter ablation who had His-ventricular intervals mapped in sinus rhythm at the end of the procedure.

E

Exposure

His-ventricular (HV) interval measurement using a multipolar high-density (HD) mapping catheter (assessing proximal, distal, and right-bundle locations) at the end of the ablation procedure.

C

Comparator

Clinical HV interval measurement using a conventional decapolar catheter.

O

Outcome

Differences in HV interval values and detection of abnormal HV intervals (> 55 ms) based on measurement location and sex.surrogate

Main Result

Mean Difference: 5.1 (95% CI 4.4–5.8)

Absolute Event Rate: 51% vs 46%

p-value: p=<0.001

HV intervals vary significantly based on the exact recording site and patient sex, suggesting that current universal cutoffs for diagnosing infranodal conduction delay may miss clinically relevant delays in distal measurements and in women.

Limitations

Included only patients undergoing catheter ablation for atrial fibrillation, which may limit generalizability
Propagation speed calculations relied on estimated distances and did not fully account for the 3D anatomy of Koch's triangle
No pharmacological or pacing stress protocols were applied to assess dynamic changes in conduction
Low number of female patients limits the power of some sex-specific analyses
Included only patients undergoing catheter ablation for atrial fibrillation, which may limit generalizability to the general population
Low number of females in the study may limit the power of some sex-specific analyses and may lead to model overfitting

Implication

HV intervals differ by site and sex; leaves open whether adjusted thresholds improve conduction delay diagnosis.

Abstract

Background Accurate assessment of the His–ventricular (HV) interval is essential to diagnosing infranodal conduction disease, but the influence of recording site and sex on HV values is not well defined. Objective To evaluate the impact of measurement location and sex on HV interval values using high-density (HD) mapping catheters in patients undergoing atrial fibrillation (AF) ablation. Methods We prospectively studied patients in sinus rhythm undergoing AF ablation. HV intervals were measured with a decapolar catheter and a HD mapping catheter at the end of the procedure. HD-based HV intervals were classified as proximal (HV prox ), distal (HV dis ), and right bundle (HV RB ) recordings. Conduction velocities and sex-specific differences were analyzed. Results A total of 67 patients (mean age 64 ± 10 years, 33%women) were evaluated. The clinical HV interval was 45 ± 9 ms and shorter in women (40 ms vs. 47 ms, p < 0.001). HV prox was longer than HV dis (51 ± 10 ms vs. 46 ± 10 ms, p < 0.001) and HV RB (37 ± 10 ms; p < 0.001). Abnormal HV intervals (> 55 ms) were more often detected using HV prox than HV dis or HV RB . Conduction velocities did not differ by sex and correlated poorly with surface ECG parameters. Conclusion HV interval measurements vary significantly by recording site and sex. Proximal measurements reveal longer HV intervals and detect more conduction delays, while women have systematically shorter HV intervals. Anatomical precision and sex-specific interpretation are important for accurate diagnosis of infranodal conduction delay. Graphical Abstract Abbreviations: Dis: Distal His-Ventricle measurement, Prox: Proximal His-Ventricle measurement, RB: His-ventricle measurement over the right bundle.

Discussion

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Cite This Study

Serban et al. (2026) conducted a cross-sectional in Atrial fibrillation (n=67). Proximal high-density mapping catheter recording vs. Distal recording was evaluated on His-ventricular (HV) interval duration (MD 5.1 ms, 95% CI 4.4-5.8, p=<0.001). Proximal His-ventricular interval measurements were significantly longer than distal recordings (51 vs 46 ms), and women had consistently shorter intervals than men across all measurement sites.

synapsesocial.com/papers/6ad0fd4715427f6a84040630 https://doi.org/10.1007/s10840-026-02438-z

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High-density mapping of his-ventricular intervals: impact of recording site and sex-specific differences

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

High-density mapping of his-ventricular intervals: impact of recording site and sex-specific differences

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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