PVC on His Maneuver

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Useful to attack narrow complex tachycardias including concentric ORT, Atrial Tachycardia, slowly conducting BT.

How to Perform

  • Deliver PVC 35 to 55 msec prior to His electrogram closest to the site of earliest atrial activation. If
    • Atria not advanced and ventricle advances 30ms without modification of tachycardia cycle length excludes a bypass tract. In a long RP tachyacrdia advancement by 60 ms must be demonstrated.
    • If you Advance the A then
      • AP present if the atrial sequence unchanged and tachycardia resets
      • If atrial sequence changed then bystander AP
      • If you then advance the following a then this proves participation
    • Tachycardia breaks without an A proves participation of bypass tract
    • Prolonging the A means there is a decremental pathway and it is part of the circuit
    • Septal BT can be demonstrated by simultaneous atrial activation over the AV and BT. You must demonstrate an A followed by a retrograde his by prolonging V-H with progressive prematures while maintaining constant V-A

Calculate PEI

  1. Calculate the Pre-Excitation Index
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