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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).
      • 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.
      • 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.
      In addition, patients with cardiomyopathies and scar-related VT may exhibit septal arrhythmogenic substrate involving the parahisian region.
      • Kumar S.
      • Barbhaiya C.
      • Nagashima K.
      • et al.
      Ventricular tachycardia in cardiac sarcoidosis: characterization of ventricular substrate and outcomes of catheter ablation.
      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.

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