R/S Ratio in Lead III Predicts Successful Ablation of Ventricular Arrhythmias Originating in Para-Hisian Region.

OBJECTIVES: The aim of this study was to investigate the electrocardiographic characteristics of ventricular arrhythmias (VAs) originating near the His bundle (HB) and use the R/S ratio in lead III (RIII/SIII ratio) to predict successful ablation of para-Hisian VAs. BACKGROUND: Catheter ablation for idiopathic VAs near the HB is often challenging, and data are limited. METHODS: The present study included 134 consecutive patients undergoing catheter ablation of para-Hisian VAs. The electrocardiographic characteristics in these patients were retrospectively evaluated with successful ablation and failed ablation. RESULTS: Successful ablation was achieved in 115 (85.8%) of the 134 patients. There was no significant difference in QRS duration between the successful and the failed ablation groups. The ablation success rate was significantly lower for para-Hisian VAs with a predominantly positive R wave in lead III than those with a predominantly negative S wave in lead III. The significant factor associated with successful ablation was the RIII/SIII ratio. The RIII/SIII ratio ≤1.1 predicted the successful ablation of para-Hisian VAs with high sensitivity (80.9%) and specificity (94.7%). The RIII/SIII ratio of >1.2 had high sensitivity (100.0%) and specificity (82.8%) to predict the distance <5 mm from the site of origin of para-Hisian VAs to the site recording the largest HB potential. CONCLUSIONS: The RIII/SIII ratio was a helpful predictor of the successful ablation of VAs originating in the vicinity of the HB. This may be useful for planning ablation of para-Hisian VAs and minimizing the risk of inadvertent atrioventricular block.

Interactions between vitamin D receptor (VDR) gene and Interleukin-6 gene and environment factors on coronary heart disease risk in a Chinese Han population.

AIMS: To investigate the association of several single nucleotide polymorphisms (SNPs) within Interleukin-6 (IL- 6) and vitamin D receptor (VDR) gene, and additional gene- gene and gene- smoking interaction with coronary heart disease (CHD) risk in a Chinese population. METHODS: Hardy-Weinberg equilibrium (HWE) examination was used by SNPstats (http://bioinfo.iconcologia.net/SNPstats). Generalized multifactor dimensionality reduction (GMDR) was used to screen the best interaction combination among SNPs and smoking. Stratified analysis for gene- smoking interaction was investigated by logistic regression. RESULTS: CHD risk was significantly higher in carriers with the C allele of rs1800796 within IL-6 gene than those with GG genotype (GC+ CC versus GG), adjusted OR (95%CI) =1.62 (1.19-2.23); CHD risk was also higher in carriers with the T allele of rs2228570 within VDR gene than those with CC genotype (CT+ TT versus CC), adjusted OR (95%CI) = 1.68 (1.26-2.17). However, we did not find any direct associations of the others SNPs in IL- 6 and VDR gene with CHD risk. We also found a significant interaction between rs1800796 and smoking, the cross-validation consistency of this two- locus model was 10/ 10, and the testing accuracy was 60.11%. Current smokers with rs1800796- GC or CC genotype have the highest CHD risk, compared to never- smokers with rs1800796- GG genotype within IL- 6 gene, OR (95%CI) = 2.57 (1.74 -3.46). CONCLUSIONS: We found that the C allele of rs1800796 within IL-6 and T allele of rs2228570 within VDR gene, interaction between rs1800796 and smoking were all associated with increased CHD risk.