Delivering premature HIS complexe maneuver in differentiating between paroxysmal supraventicular tachycardias

Abstract

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.