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

    Linlin Wang, Lei Wang,Hailei Liu,Nan Wu,Kuan Cheng,Yunlong Wang,Yuegang Wang,Fangyi Xiao,Ruhong Jiang, Xuefeng Zhu, Jingcheng Chen, Jinfeng Wang, Rongbin Yu,Weizhu Ju,Minglong Chen

    The Canadian journal of cardiology（2025）

    Division of Cardiology | Department of Cardiology

    Cited 0|Views4
    Abstract
    BACKGROUND:The choice between left- and right-sided ablation for outflow tract premature ventricular complexes (OT-PVCs) during procedures remains a topic of ongoing discussion. In this study we aim to elucidate the value of the QRS-VHis interval in distinguishing between left and right origins in left bundle branch block (LBBB)-type OT-PVCs, thereby optimizing the ablation process. METHODS:The QRS-VHis interval was measured in consecutive patients with LBBB-type OT-PVCs. The performance of this interval was compared with traditional electrocardiographic (ECG) algorithms and prospectively validated in a cohort from 8 centers. Based on the interval, we developed an algorithm to assess its efficacy in optimizing the ablation process. RESULTS:A total of 166 patients were enrolled in the development cohort, and 53 patients in the validation cohort. The QRS-VHis interval demonstrated greater accuracy than ECG algorithms among 153 patients with typical endocardial origins (area under the curve = 0.962). At a cutoff of 30 ms, the QRS-VHis interval showed a sensitivity of 71.8% and a specificity of 98.2% for identifying left-sided locations. A flowchart was developed based on the QRS-VHis interval, indicating that a QRS-VHis value of < 30 ms necessitated left-sided ablation with a 94% likelihood, leading to an 88% success rate. Conversely, when the QRS-VHis value was ≥ 30 ms, the likelihood of requiring left-sided ablation dropped to only 16%. The accuracy of the flowchart was validated in the independent cohort. CONCLUSIONS:The QRS-VHis interval is superior for distinguishing between left and right ventricular outflow tract origins in LBBB-type OT-PVCs and has proven valuable in optimizing the intraprocedural process.
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    【要点】：研究提出了一种基于QRS-VHis间隔的算法，用于区分左心室流出道（LVOT）和右心室流出道（RVOT）起源的左束支传导阻滞型室性早搏（LBBB-type OT-PVCs），从而优化消融过程。
    

    【方法】：通过测量LBBB型OT-PVCs患者的QRS-VHis间隔，并将其与传统的ECG算法进行比较，前瞻性验证了算法在8个中心的队列中的效果。
    

    【实验】：共招募了166名患者作为开发队列，53名患者作为验证队列。QRS-VHis间隔在153名具有典型心内膜起源的患者中显示出比ECG算法更高的准确性（AUC = 0.962）。在30ms的截断值下，QRS-VHis间隔对识别左侧位置的敏感性为71.8%，特异性为98.2%。基于QRS-VHis间隔的流程图显示，当QRS-VHis值小于30ms时，进行左侧消融的可能性为94%，成功率为88%。而当QRS-VHis值大于或等于30ms时，进行左侧消融的可能性降至16%。该流程图的准确性在独立队列中得到了验证。