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Updated: May 24, 2025

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Using the QRS-VHis Interval-based Algorithm to Optimize the Ablation Process of Outflow Tract Premature Ventricular

Linlin Wang1, Lei Wang2, Hailei Liu2

  • 1Division of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China; Department of Cardiology, the Fourth Affiliated Hospital of Soochow University, Suzhou, China.

The Canadian Journal of Cardiology
|March 6, 2025
PubMed

Insights

The QRS-VHis interval accurately distinguishes left from right origins of left bundle branch block (LBBB)-type outflow tract premature ventricular complexes (OT-PVCs). This interval optimizes ablation procedures by reliably guiding catheter placement.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Determining the origin of outflow tract premature ventricular complexes (OT-PVCs) is crucial for successful ablation.
  • Left bundle branch block (LBBB)-type OT-PVCs present a challenge in differentiating left from right ventricular origins.

Purpose of the Study:

  • To evaluate the QRS-VHis interval's effectiveness in distinguishing left vs. right ventricular origins of LBBB-type OT-PVCs.
  • To develop and validate an algorithm using the QRS-VHis interval for optimizing ablation site selection.

Main Methods:

  • Measured the QRS-VHis interval in patients with LBBB-type OT-PVCs.
  • Compared the interval's diagnostic performance against traditional electrocardiographic (ECG) algorithms.
  • Developed and prospectively validated a flowchart-based algorithm across multiple centers.

Main Results:

  • The QRS-VHis interval showed high accuracy (AUC=0.962) in distinguishing origins, outperforming ECG algorithms.
  • A QRS-VHis cutoff of 30 ms demonstrated 71.8% sensitivity and 98.2% specificity for left-sided origins.
  • The developed algorithm accurately predicted the need for left-sided ablation, achieving an 88% success rate.

Conclusions:

  • The QRS-VHis interval is a superior metric for differentiating left and right ventricular outflow tract origins in LBBB-type OT-PVCs.
  • This interval significantly aids in optimizing the intraprocedural ablation strategy.
Abstract

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