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Distinctive characteristics of His bundle potentials in patients with atrioventricular nodal reentrant tachycardia

Fu Guan1,2, Ardan M Saguner3, Daniel Hofer3

  • 1Arrhythmia and Electrophysiology Division, Department of Cardiology, University Heart Center, Zurich, Switzerland. fu.guan@usz.ch.

Cardiology Journal
|September 28, 2021
PubMed

Insights

Maximal His bundle (HB) potential amplitude and duration are significantly higher in patients with atrioventricular nodal reentrant tachycardia (AVNRT) compared to atrioventricular reentrant tachycardia (AVRT). These HB characteristics can help identify slow pathways (SP) in AVNRT.

Area of Science:

  • Electrophysiology
  • Cardiac Arrhythmias
  • Cardiology

Background:

  • His bundle (HB) potentials exhibit variable amplitude and duration in patients with and without slow pathways (SP).
  • Understanding HB potential characteristics may aid in identifying SPs.

Purpose of the Study:

  • To characterize His bundle potentials in patients with atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycardia (AVRT).
  • To determine if HB potential characteristics can identify slow pathways (SP) in AVNRT.

Main Methods:

  • Prospective electrophysiological study of 162 patients with symptomatic AVNRT or AVRT.
  • Recorded maximal His bundle potential (HBmax) amplitude and duration.
  • Measured AH interval (A2H2) and distances from HBmax to ablation site (HBmax-ABL) and coronary sinus ostium (HBmax-CSO) in AVNRT patients.

Main Results:

  • HBmax amplitude (0.29 ± 0.10 mV vs 0.17 ± 0.05 mV) and duration (22 ± 5 ms vs 16 ± 3 ms) were significantly higher in AVNRT than AVRT patients (p < 0.0001).
  • Optimal HBmax amplitude cutoff (≥ 0.22 mV) predicted AVNRT with 78% sensitivity and 84% specificity (AUC 0.86).
  • HBmax-ABL positively correlated with A2H2 and HBmax-CSO, indicating HBmax proximity to SP and coronary sinus.

Conclusions:

  • Higher HBmax amplitude and duration distinguish AVNRT from AVRT.
  • HBmax characteristics, particularly its distance to the ablation site and coronary sinus, correlate with slow pathway conduction time, aiding SP identification.
Abstract

Keywords:
His bundleatrioventricular nodal reentrycatheter ablationslow pathwaytachycardia

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