How to map and ablate parahisian ventricular arrhythmias

Ventricular tachycardia (VT) and premature ventricular contractions (PVCs) originating in the vicinity of the His-bundle region represent 3%–9% of all idiopathic ventricular arrhythmias (VAs). 1 Ban J. Chen Y. Park H. Kim D. Lee D. Park Y. Choi J. Lim H. Park S. Kim Y. Idiopathic ventricular arrhythmia originating from the para-Hisian area: Prevalence, electrocardiographic and electrophysiological characteristics. J Arrhythm. 2014; 30: 48-54 Crossref Scopus (12) Google Scholar , 2 Yamada T. McElderry H.T. Doppalapudi H. Kay G.N. Catheter ablation of ventricular arrhythmias originating in the vicinity of the His bundle: significance of mapping the aortic sinus cusp. Heart Rhythm. 2008; 5: 37-42 Abstract Full Text Full Text PDF PubMed Scopus (77) Google Scholar In addition, patients with cardiomyopathies and scar-related VT may exhibit septal arrhythmogenic substrate involving the parahisian region. 3 Kumar S. Barbhaiya C. Nagashima K. et al. Ventricular tachycardia in cardiac sarcoidosis: characterization of ventricular substrate and outcomes of catheter ablation. Circ Arrhythm Electrophysiol. 2015; 8: 87-93 Crossref PubMed Scopus (142) Google Scholar Catheter ablation of these arrhythmias poses particular challenges because of the risk of inadvertent atrioventricular (AV) block, and a systematic approach is important to improve outcomes and minimize complications.