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Measurement of the AH and HV interval and His bundle duration: interobserver and intraobserver variation
Insights
Intracardiac electrophysiology testing reliability varies. AH and HV intervals show moderate reliability for clinical decisions, but His bundle duration measurements are unreliable.
Area of Science:
- Electrophysiology
- Cardiology
- Medical Measurement
Background:
- Conduction system intervals are crucial for clinical decisions during electrophysiologic testing.
- Variability in measurements can impact patient management.
- Assessing the reliability of these measurements is essential.
Purpose of the Study:
- To evaluate the interobserver and intraobserver reliability of AH interval, HV interval, and His bundle duration measurements.
- To determine if these measurements are reliable enough for clinical decision-making.
Main Methods:
- Fifty patients undergoing intracardiac electrophysiologic testing were included.
- Three investigators measured AH interval, HV interval, and His bundle duration.
- The square of the correlation coefficient (r2) was used to assess measurement reliability.
Main Results:
- AH interval interobserver r2 ranged from 0.55-0.68; intraobserver r2 ranged from 0.60-0.88.
- HV interval interobserver r2 ranged from 0.42-0.63; intraobserver r2 ranged from 0.489-0.73.
- His bundle duration showed lower reliability (interobserver r2: 0.42-0.52; intraobserver r2: 0.19-0.52).
Conclusions:
- AH and HV intervals demonstrate sufficient reliability for clinical use alongside patient history and ECG.
- His bundle duration measurements lack reliability with standard techniques and should not guide clinical decisions.
Abstract:
Conduction system intervals measured during intracardiac electrophysiologic testing influence clinical decisions. To evaluate measurement reliability, interobserver and intraobserver variation for AH, HV, and His bundle duration measurements from 50 patients were evaluated. The square of the correlation coefficient (r2) was used as the index for measurement reliability. Three investigators performed the measurements. The r2 for interobserver variation of the AH interval ranged from 0.55 to 0.68 and for intraobserver variability from 0.60 to 0.88. The standard error of measurement based on intraobserver measurements ranged from 10.2 to 18.0 ms. The r2 for interobserver variation of the HV interval ranged from 0.42 to 0.63 and for intraobserver variation from 0.489 to 0.73. The standard error of measurement was 6.2 to 9.9 ms. For the His bundle duration, the r2 for interobserver variation ranged from 0.42 to 0.52 and for intraobserver variation from 0.19 to 0.52. The standard error of measurement was 3.1 to 5.2 ms. Although there is measurement variation for AH and HV intervals, their use in conjunction with the history and the surface electrocardiogram to make clinical decisions is appropriate. His bundle duration cannot be measured reliably using the standard recording technique and should not be used for clinical decision making.