Electrocardiogram identification method to distinguish ventricular arrhythmias originating from HIS bundle area and adjacent locations

AIM To propose an ECG diagnostic method to distinguish ventricular arrhythmias originating from HIS bundle area (HIS), posterior right ventricular outflow tract (pRVOT) and anterolateral of tricuspid annulus (TA-AL).

METHODS Seventy-five consecutive patients with ventricular arrhythmias (VA) that were successfully ablated from HIS (n=18), pRVOT (n=42) or TA-AL (n=15) were enrolled in this study. The measurements of ECG parameters showed highest diagnostic performance were used to develop the diagnostic criterion.

RESULTS Among the ECG parameters, R wave amplitude in lead Ⅰ and QRS duration were found to have the best diagnostic performance in distinguishing these different origins. The best ECG identification method was the combination of R wave amplitude in lead Ⅰ and QRS duration: HIS, R wave amplitude in lead Ⅰ>0.49 mV and QRS duration≤125.5 ms (sensitivity 72.2%, specificity 100%); pRVOT, R-wave amplitude in lead Ⅰ≤0.49 mV and QRS duration >125.5 ms (sensitivity 88.1%, specificity 81.8%) and TA-AL, R-wave amplitude in lead I > 0.49 mV and QRS duration >125.5 ms (sensitivity 66.7%, specificity 95.0%). The overall accuracy of these diagnostic criteria in determining the site of origin of VA was 88.9%.

CONCLUSION The VAs originating near HIS usually show positive R wave in lead Ⅰ and short QRS duration. The combined application of R wave amplitude in lead Ⅰ and QRS duration can be used to distinguish VAs originating from HIS, pRVOT or TA-AL.