Delivering premature HIS complexe maneuver in differentiating between paroxysmal supraventicular tachycardias

Do Duc Thinh, Nguyen Tran Thuy, Tran Van Dong


Tóm tắt

Background: It is difficult to differentiate between paroxysmal supraventricular tachycardias in some circumstances. Delivering premature His complexes (PHC), a new maneuver, has been recently introduced. The study aimed to describe and evaluate initially the value of this maneuver.

Methods: From 12/2021 to 05/2022, 30 patients who underwent electrophysiological studies were diagnosed with AVRT or AVNRT, and successful RF ablations. The PHC maneuver was performed when making differential diagnoses.

Results: 12 AVRT cases and 18 AVNRT cases underwent the premature His complex maneuver. Delivering PHCs disturbed all AVRTs in both early PHCs (∆A1A2 = 21,33 ms) and late PHCs (∆A1A2 = 44,43ms). Late PHCs (∆PHC < 20ms) did not disturb the AVNRT circuit (∆A1A2 = 0ms). Early PHCs (∆PHC ≥ 20ms) with mean ∆PHC = 38,9ms would advance the next atrial potential of ∆A1A2 = 15,85ms, but it was significantly shorter than the atrial advancement of ∆A1A2 = 44,43ms in AVRT (p<0,05). In comparison with the prematurity of PHC, the advancement of the next atrial potential ∆A1A2 in AVRT was greater than or equal to it (∆A1A2-∆PHC ≥ 0ms, however in  AVNRT was always shorter (∆A1A2-∆PHC  ≤ -5ms). This maneuver had accurate results in all cases with a sensitivity and specificity of 100%.

Conclusions: This initial evaluation suggested that this maneuver had highly accurate in differentiating AVNRT and AVRT. Premature His complexes will absolutely disturb the AVRT circuit. Delivering late PHCs could not disturb the AVNRT circuit, and early PHCs would advance the next atrial potential with an amount shorter than the prematurity of PHC. Further studies are necessary to determine the value of the maneuver in clinical practice.


Tài liệu tham khảo

1. Brugada J, Katritsis DG, Arbelo E, Arribas F, Bax JJ, Blomström-Lundqvist C, et al. 2019 ESC Guidelines for the management of patients with supraventricular tachycardia. The Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC). Eur Heart J. 2020 Feb 1;41(5):655–720.
2. Katritsis DG, Josephson ME. Differential diagnosis of regular, narrow-QRS tachycardias. Heart Rhythm. 2015 Jul;12(7):1667–76.
3. Padanilam BJ, Ahmed AS, Clark BA, Gilge JL, Patel PJ, Prystowsky EN, et al. Differentiating Atrioventricular Reentry Tachycardia and Atrioventricular Node Reentry Tachycardia Using Premature His Bundle Complexes. Circ Arrhythm Electrophysiol. 2020 Jan;13(1):e007796.
4. Kay GN, Pressley JC, Packer DL, Pritche-It ELC, German LD, Gilbert MR. Value of the 124ead Electrocardiogram in Discriminating Atrioventricular Nodal Reciprocating Tachycardiafrom Circus Movement Atrioventricular TachycardiaUtilizing a Retrograde AccessoryPathway. Am J Cardiol. 1987;59:5.
5. Mills MF, Motonaga KS, Trela A, Dubin AM, Avasarala K, Ceresnak SR. Is There a Difference in Tachycardia Cycle Length during SVT in Children with AVRT and AVNRT?: AVRT VERSUS AVNRT SVT CYCLE LENGTH. Pacing Clin Electrophysiol. 2016 Nov;39(11):1206–12.
6. Heidbuchel H, Ector H, Werf F. Prospective Evaluation Of The Length Of The Lower Common Pathway In The Differential Diagnoss Of Various Forms Of AV Nodal Reentrant Tachycardia. Pacing Clin Electrophysiol. 1998 Jan;21(1):209–16.
7. Maruyama M, Yamamoto T, Abe J, Yodogawa K, Seino Y, Atarashi H, et al. Number Needed to Entrain: A New Criterion for Entrainment Mapping in Patients With Intra-Atrial Reentrant Tachycardia. Circ Arrhythm Electrophysiol. 2014 Jun;7(3):490–6.