Int J Arrhythm.  2020 Dec;21(4):15. 10.1186/s42444-020-00023-7.

Differentiation of the right versus left outflow tract ventricular arrhythmias using local activation time at the His bundle electrogram

  • 1Division of Cardiology, Department of Internal Medicine, Sejong General Hospital, Bucheon, Republic of Korea.
  • 2Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital, 101 Daehak‑ro, Jongno‑gu, Seoul 03080, Republic of Korea.


Although multiple algorithms based on surface electrocardiographic criteria have been introduced to localize idiopathic ventricular arrhythmia (VA) origins from the outflow tract (OT), their diagnostic accuracy and clini‑ cal usefulness remain limited. We evaluated whether local activation time of the His bundle region could differentiate left and right ventricular OT VA origins in the early stage of electrophysiology study.
We studied 30 patients who underwent catheter ablation for OT VAs with a left bundle branch block pat‑ tern and inferior axis QRS morphology. The interval between the local V signal on the mapping catheter placed in the RVOT and His bundle region (V(RVOT)-V(HB) interval) and the interval from QRS complex onset to the local V signal on the His bundle region (QRS-V(HB) interval) were measured during VAs.
The V(RVOT)-V(HB) and QRS-V(HB) intervals were significantly shorter in patients with LVOT VAs. The area under the curve (AUC) for the V(RVOT)-V(HB) interval by receiver operating characteristic analysis was 0.865. A cutoff value of ≤ 50 ms predicted an LVOT origin of VA with sensitivity, specificity, and positive and negative predictive values of 100%, 62.5%, 40%, and 100%, respectively. The QRS-V(HB) interval showed similar diagnostic accuracy (AUC, 0.840), and a cutoff value of ≤ 15 ms predicted an LVOT origin of VA with a sensitivity, specificity, and positive and negative predictive values of 100%, 70.8%, 45.2%, and 100%, respectively.
The V(RVOT)-V(HB) and QRS-V(HB) intervals could differentiate left from right OT origins of VA with high sensitivity and negative predictive values.


Idiopathic ventricular tachycardia; Premature ventricular contraction; Right ventricular outflow tract; Left ventricular outflow tract; Radiofrequency catheter ablation
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