Novel method for the prediction of para‐Hisian premature ventricular complexes from the electrocardiogram

BACKGROUND: Catheter ablation of para‐Hisian (PH) premature ventricular complexes (PVCs) has a high risk of heart block. This study aimed to find the electrocardiographic (ECG) predictors of PH‐PVCs. METHODS: We enrolled 47 patients who underwent an electrophysiologic study for catheter ablation of PVCs and analyzed the ECG characteristics, retrospectively. RESULTS: The PVC locations were the PH in 14, right ventricular (RV) outflow tract (OT) in 11, left ventricular (LV) OT in 16, LV septum in 5, and LV summit in 1. The QRS width of the PH‐PVCs was significantly narrower than that of the rest of PVCs (140.9 ± 17.1 ms vs. 158.9 ± 19.4 ms, P = 0.004). Precordial transition of the PH‐PVCs related to sinus rhythm was not helpful in predicting the location. Lead I had monophasic R waves in 100% and lead aVR QS waves in 100%. In aVL, 13 of 14 patients had monophasic R waves, and 1 had biphasic (rS) waves with an initial positive polarity. Among the study cohort, 15 patients had a QS in aVR and R in aVL, including 13 PH‐PVCs and 2 PVCs coming from the RVOT septum and LVOT septum, respectively. The QS in aVR and monophasic R in aVL had a sensitivity of 92.8%, specificity of 93.9%, positive predictive value of 86.7%, and negative predictive value of 96.9% for localizing PH‐PVCs. CONCLUSIONS: A PVC morphology with a QS in aVR and monophasic R in aVL and QRS width <143 msec, could be used as a reliable parameter for predicting the PH location.