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

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

Main Methods:

• Measured the QRS-V_His 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-V_His interval showed high accuracy (AUC=0.962) in distinguishing origins, outperforming ECG algorithms.
• A QRS-V_His 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-V_His 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.