Electrocardiographic features and ablation outcomes of near-Hisian idiopathic ventricular arrhythmias: Insights from a single-center study in Vietnam

Abstract

Objective To compare the clinical characteristics, electrocardiographic characteristics, and outcomes of radiofrequency catheter ablation in patients with idiopathic right ventricular outflow tract ventricular arrhythmias originating near the Hisian bundle region versus other right ventricular outflow tract regions. Methods A single-center study analyzed 126 patients undergoing radiofrequency catheter ablation for right ventricular outflow tract ventricular arrhythmias from May 2020 to October 2022. Patients were classified into the near-Hisian group (n = 10) and the right ventricular outflow tract group (n = 116) based on the arrhythmia origin. Clinical, electrocardiographic, and procedural characteristics as well as ablation outcomes were compared. Results The near-Hisian group had narrower QRS duration (132.3 ± 24.1 vs. 146.1 ± 28.3 ms), 100% positive QRS in lead I, smaller R-wave ratio in leads III/II (0.65 ± 0.20 vs. 0.97 ± 0.31), smaller Q-wave ratio in leads aVL/aVR (0.31 ± 0.29 vs. 1.03 ± 0.37), and larger R/S ratio in lead V2 (18.8 ± 10.9 vs. 12.0 ± 6.7) (all p < 0.05). Procedural metrics, acute success (90%), and long-term success (80%) were comparable between the two groups, with no major complications reported. Conclusions Right ventricular outflow tract ventricular arrhythmias near the Hisian bundle region have distinct electrocardiographic features. Radiofrequency catheter ablation is safe and effective, emphasizing the need for precise electrocardiogram interpretation and meticulous procedural planning.