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. 2019 Feb 15;35(2):252-261.
doi: 10.1002/joa3.12167. eCollection 2019 Apr.

Radiofrequency catheter ablation of premature ventricular contractions from near the His-bundle

Atsushi Tanaka  1 , Masao Takemoto  1 , Akihiro Masumoto  2 , Honsa Kang  1 , Takahiro Mito  1 , Hiroshi Kumeda  2 , Ryota Aoki  1 , Satoko Kinoshita  1 , Yoshibumi Antoku  1 , Atsutoshi Matsuo  1 , Satoru Hida  1 , Teiji Okazaki  1 , Kei-Ichiro Tayama  1 , Ken-Ichi Kosuga  1
Affiliations

Radiofrequency catheter ablation of premature ventricular contractions from near the His-bundle

Atsushi Tanaka et al. J Arrhythm. .

Abstract

Objective: This study aimed to investigate the effects of radiofrequency catheter ablation (RFCA) and clinical and electrophysiological characteristics in symptomatic patients with premature ventricular contractions (PVCs) from near the His-bundle (His-PVCs).

Methods: The patient characteristics, prevalence of complications with any life style related disease (ALSRD) including hypertension, dyslipidemia, or diabetes mellitus, and/or cardiovascular disease (CVD) including coronary artery disease, cerebrovascular disease, renal dysfunction, or cardiomyopathy, clinical status, frequency of PVCs evaluated by 24hour Holter monitoring, echocardiography including the left ventricular diastolic dysfunction (LVDD) parameters, and electrophysiological findings were evaluated in 14 consecutive symptomatic patients with His-PVCs.

Results: The prevalence of males, being elderly and/or slightly obese, current and/or history of smoking, ALSRD or CVD related complications, and LVDD probably resulting from ALSRD and/or CVD complications were higher in patients with His-PVCs. RFCA of His-PVCs steadily decreased the PVC frequency and improved the systolic function, LV dilation, and clinical status, but not the LVDD. There was a significant relationship between the accordance rate of the QRS polarity between sinus rhythm and His-PVCs and the distance between the successful ablation site and His-bundle.

Conclusion: The analysis of the QRS duration and accordance rate of the QRS polarity between sinus rhythm and His-PVCs before the RFCA may help to determine the distance between the origin of the PVCs and His-bundle. Further, the appropriate ablation catheter may be selected during the RFCA procedure. Finally, RFCA may be one of the most effective, feasible, and safest therapies for symptomatic patients with His-PVCs.

Keywords: His‐bundle; catheter ablation; clinical characteristics; clinical status; premature ventricular contraction.

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Conflict of interest statement

Authors declare no conflict of interests for this article.

Figures

Figure 1
Figure 1
The 12‐lead electrocardiograms and the QRS polarities in patients of His‐PVC (A) and RIS‐PVC (B) groups, respectively. The accordance rate of QRS polarities was 100% (A) and 83% (B), respectively. The successful ablation sites of the premature ventricular contractions from near the His‐bundle are demonstrated in (C). The bars indicate 10 millimeters. The scatter plot analysis shows a significant strong relationship between the accordance rate of the QRS polarity between sinus rhythm and His‐PVCs and the distance between the successful ablation site and His‐bundle (P < 0.001, r = 0.876) (D), but not between the accordance rate of the QRS polarity between sinus rhythm and the QRS duration of the His‐PVCs and QRS duration of the His‐PVCs (P = 0.159) (E). The red and blue circles indicate the His‐PVC group (n = 6) and RIS‐PVC group (n = 8), respectively. CS; coronary sinus, IVC; inferior vena cava, RVOT; right ventricular outflow tract, TA; tricuspid annulus
See this image and copyright information in PMC

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