Can the QRS morphology of outflow tract ventricular arrhythmia change when right bundle branch block emerges during sinus rhythm?

IF 1.7 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pace-Pacing and Clinical Electrophysiology Pub Date : 2024-11-01 Epub Date: 2024-08-19 DOI:10.1111/pace.15063

Satoshi Hara, Naoyuki Miwa, Shigeki Kusa, Yoshikazu Sato, Junichi Doi, Tadanori Nakata, Hidenori Hirano, Taiki Ishizawa, Tetsuo Sasano, Hitoshi Hachiya

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Abstract

Background: QRS morphology can change during ventricular arrhythmias (VAs) with the appearance of bundle branch block (BBB).

Methods: We retrospectively investigated 195 consecutive patients who underwent an initial ablation of VA. The study inclusion criteria were VAs that were successfully ablated in the outflow tract (OT) and in whom right bundle branch block (RBBB) was induced by catheter manipulation close to the His bundle area during sinus rhythm, before any radiofrequency application. We analyzed the QRS morphology of the VAs with and without RBBB during sinus beats.

Results: Twenty-four patients (age 59 ± 17 years, female 14) developed RBBB at some point during their procedure. The successful ablation sites of the VAs were the right ventricular outflow tract (RVOT) in 12 patients, pulmonary artery in one, left coronary cusp in five, right coronary cusp in three, right-left cusp junction in two, and great cardiac vein in two. QRS-morphology change was observed in five (20%) cases. The successful ablation sites in that group were the left coronary cusp in three cases, right coronary cusp in one, and RVOT septum in one. The QRS duration of the VAs increased during RBBB.

Conclusions: There are some cases of OT-VAs in which the QRS waveform changes with the appearance of catheter induced RBBB. We need to be aware that when QRS morphology changes during an OT-VA ablation, it does not necessarily mean that the origin or exit of the VA has changed.

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窦性心律期间出现右束支传导阻滞时，流出道室性心律失常的 QRS 形态会发生变化吗？

背景：室性心律失常（VAs）时 QRS 形态会随着束支传导阻滞（BBB）的出现而改变：室性心律失常（VAs）时，QRS 形态会随着束支传导阻滞（BBB）的出现而改变：我们回顾性研究了 195 例连续接受 VA 首次消融术的患者。纳入研究的标准是在流出道（OT）成功消融的 VA，以及在窦性心律时通过在 His 束区附近操作导管诱发右束支传导阻滞（RBBB）的患者。我们分析了窦性心律时有RBBB和没有RBBB的VAs的QRS形态：24名患者（年龄59±17岁，女性14人）在手术过程中的某个阶段出现了RBBB。12名患者成功消融的VAs部位为右室流出道（RVOT），1名患者成功消融的部位为肺动脉，5名患者成功消融的部位为左冠状动脉尖，3名患者成功消融的部位为右冠状动脉尖，2名患者成功消融的部位为右左冠状动脉尖交界处，2名患者成功消融的部位为心脏大静脉。有 5 例（20%）观察到 QRS 形态改变。这组病例中成功消融的部位分别是左冠状动脉尖 3 例、右冠状动脉尖 1 例和 RVOT 间隔 1 例。在RBBB期间，VAs的QRS持续时间延长：结论：在一些 OT-VA 病例中，QRS 波形会随着导管诱导的 RBBB 的出现而改变。我们需要注意的是，当 OT-VA 消融过程中 QRS 波形发生变化时，并不一定意味着 VA 的起源或出口发生了变化。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pace-Pacing and Clinical Electrophysiology 医学-工程：生物医学

CiteScore

2.70

自引率

5.60%

发文量

209

审稿时长

2-4 weeks

期刊介绍： Pacing and Clinical Electrophysiology (PACE) is the foremost peer-reviewed journal in the field of pacing and implantable cardioversion defibrillation, publishing over 50% of all English language articles in its field, featuring original, review, and didactic papers, and case reports related to daily practice. Articles also include editorials, book reviews, Musings on humane topics relevant to medical practice, electrophysiology (EP) rounds, device rounds, and information concerning the quality of devices used in the practice of the specialty.

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