Distinctive Characteristics of His Bundle Potentials in Patients with
Atrioventricular Nodal Reentrant Tachycardia
Abstract
Background: We aim to determine the characteristics of the HB potentials
in atrioventricular nodal reentrant tachycardia (AVNRT), and elucidate
whether these can provide clues for identification of patients with slow
pathway (SP). Methods:We studied the electrophysiological findings of
162 consecutive patients with symptomatic AVNRT due to slow-fast or
fast-slow type reentry (n=112) and AV reentrant tachycardia (AVRT)
(n=50). Maximal HB potential (taken as HBmax, which was highest in
amplitude) among HB cloud was recorded for comparison. For AVNRT
patients: (1)The AH interval (A2H2) at the “jump” during programmed
atrial stimulation (taken as a reflection of slow-pathway conduction
time); (2)The distance from HBmax to the successful SP ablation site
(HBmax-ABL) and from HBmax to the ostium of coronary sinus (HBmax-CSO).
Results: HBmax was 0.29±0.10mV in AVNRT patients, whereas it was
0.17±0.05 mV in AVRT group (p<0.0001). Likewise, the HBmax
duration was 22±5 ms in the AVNRT group and 16±3 ms in the AVRT
group(p<0.0001). The area under the ROC curve of HBmax
amplitude in AVNRT patients was 0.86 and the optimal HBmax cut-off to
predict AVNRT was≥0.22 mV with a sensitivity of 0.78 and specificity of
0.84. HBmax-CSO was positively correlated with HBmax-ABL, and HBmax-ABL
was positively correlated with A2H2. Conclusions: HBmax amplitudes were
higher and durations longer in patients with AVNRT, as compared to those
with AVRT. Moreover, the distance between HBmax and successful ablation
site was positively correlated with the SP conduction time and with the
distance from HBmax to the CS ostium.