Wavelet ECG Analysis in Time-Frequency Domain of the QRS-Complex in Individuals with Left Bundle Branch Block

Introduction. Determination of ventricular and supraventricular arrhythmias with left bundle branch block morphology (LBBB) seems to be one of the most complex diagnostic tasks when P waves are not clearly identifiable on 12-lead ECG. Previously described criteria for differential diagnosis of wide QRS arrhythmias had low accuracy especially for patients from various clinical groups and also those taking antiarrhythmic drugs. When patient’s clinical data, medical history or physical examination results are not available the number of misdiagnosis may increase leading to improper treatment. Therefore, development of new temporal and amplitude based characteristics of wide QRS complex arrhythmias with LBBB morphology in patients of any clinical groups is an important task.Methods. Twenty-eight consecutive patients with wide QRS premature beats and LBBB morphology identified by 24-hour and long-term ECG monitoring (ZAO “INCART”, Russia) were enrolled in the study. Fourteen patients had premature atrial contractions (PAC) and fourteen patients had premature ventricular contractions (PVC) during sinus rhythm. For each patient 10 typical single wide QRS complexes in 12 ECG leads were analyzed. The duration of QRS complexes, time intrinsic deflection (TID) and electrical axis of the heart were determined automatically in 12 leads ECG using KT Result 3 software (ZAO “INCART”, Russia). The experts assessed morphology of the QRS complexes and transition zone location in leads V1-V6. ROC analysis with optimal cut-off value level evaluation as well as calculation of sensitivity (SV), specificity (SP) and diagnostic accuracy (ACC) were performed for qualitative and quantitative assessment of diagnostic value of PAC and PVC amplitude and temporal characteristics. Comparison of diagnostic values of wide QRS complex morphological and temporal criteria was performed based on the AUC difference and the corresponding p-value assessment.Results. The results of study found out that V5, V1 leads were more informative for assessment of QRS complex morphology and duration while V1 and V4 leads were more informative for TID calculation in differential diagnosis of wide QRS complexes arrhythmias with LBBB morphology. PAC with aberrant conduction had the following characteristics: TID < 68 ms in V1 lead and TID < 62 ms in V4 lead; QRS < 136 ms; transition zone in the leads V5, V6; QS, rS or RS complexes (with S> R) with low-amplitude r/R waves in leads V1-V4; electric axis of the heart less than 80° in standard leads. In all cases PVCs were characterized by QRS > 160 ms and TID > 88 ms in V1-V6 leads.Conclusions. New various criteria which can improve differential diagnosis of wide QRS complexes with LBBB morphology were identified in this study. These criteria should be tested in a larger group of patients with various forms of wide QRS complex arrhythmias and different PVC localizations including information of structural heart diseases due to the small sample size in this study.Conflicts of Interest: Viktor M. Tikhonenko - CEO (Director General) of the Institute of Cardiology Technics (INCART), Saint-Petersburg, Russia.

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The Role of Echocardiography in the Optimization of Cardiac Resynchronization Therapy: Current Evidence and Future Perspectives

The Open Cardiovascular Medicine Journal ◽

10.2174/1874192401711010133 ◽

2017 ◽

Vol 11 (1) ◽

pp. 133-145 ◽

Cited By ~ 2

Author(s):

Michael Spartalis ◽

Eleni Tzatzaki ◽

Eleftherios Spartalis ◽

Christos Damaskos ◽

Antonios Athanasiou ◽

...

Keyword(s):

Cardiac Resynchronization Therapy ◽

Patient Selection ◽

Left Bundle Branch Block ◽

Cardiac Resynchronization ◽

Qrs Complex ◽

Resynchronization Therapy ◽

Bundle Branch Block ◽

Ischaemic Cardiomyopathy ◽

Lead Placement

Background: Cardiac resynchronization therapy (CRT) has become a mainstay in the management of heart failure. Up to one-third of patients who received resynchronization devices do not experience the full benefits of CRT. The clinical factors influencing the likelihood to respond to the therapy are wide QRS complex, left bundle branch block, female gender, non-ischaemic cardiomyopathy (highest responders), male gender, ischaemic cardiomyopathy (moderate responders) and narrow QRS complex, non-left bundle branch block (lowest, non-responders). Objective: This review provides a conceptual description of the role of echocardiography in the optimization of CRT. Method: A literature survey was performed using PubMed database search to gather information regarding CRT and echocardiography. Results: A total of 70 studies met selection criteria for inclusion in the review. Echocardiography helps in the initial selection of the patients with dyssynchrony, which will benefit the most from optimal biventricular pacing and provides a guide to left ventricular (LV) lead placement during implantation. Different echocardiographic parameters have shown promise and can offer the possibility of patient selection, response prediction, lead placement optimization strategies and optimization of device configurations. Conclusion: LV ejection fraction along with specific electrocardiographic criteria remains the cornerstone of CRT patient selection. Echocardiography is a non-invasive, cost-effective, highly reproducible method with certain limitations and accuracy that is affected by measurement errors. Echocardiography can assist with the identification of the appropriate electromechanical substrate of CRT response and LV lead placement. The targeted approach can improve the haemodynamic response, as also the patient-specific parameters estimation.

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ECG analysis in the Time-Frequency domain

2012 IEEE 12th International Conference on Bioinformatics & Bioengineering (BIBE) ◽

10.1109/bibe.2012.6399711 ◽

2012 ◽

Cited By ~ 1

Author(s):

N. Neophytou ◽

A. Kyriakides ◽

C. Pitris

Keyword(s):

Frequency Domain ◽

Ecg Analysis ◽

Time Frequency

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Results of the randomized studies on cardiac resynchronization therapy and the reevaluation of the cardiac ventricular activation in left bundle branch block

Orvosi Hetilap ◽

10.1556/oh.2013.29596 ◽

2013 ◽

Vol 154 (18) ◽

pp. 688-693 ◽

Cited By ~ 1

Author(s):

István Préda

Keyword(s):

New York ◽

Cardiac Resynchronization Therapy ◽

Left Bundle Branch Block ◽

Heart Association ◽

Left Ventricular ◽

Cardiac Resynchronization ◽

Qrs Complex ◽

Resynchronization Therapy ◽

Bundle Branch Block ◽

New York Heart Association

If New York Heart Association Class II–IV heart failure is present, and ejection fraction ≤35%, electrocardiographic QRS width ≥ 120 ms in the presence of left bundle branch block, cardiac resynchronization therapy is indicated. Reevaluation of the data of cardiac resynchronization trials and electrophysiologic findings in left bundle branch block provided evidence that “true” left bundle branch block requires a QRS width of ≥130 ms (in woman) and ≥140 ms (in man). In “true” left bundle branch block, after the 40th ms of the QRS notched/slurred R waves are characteristic in minimum two of I, aVL, V1, V2, V5 and V6 leads, in addition to a ≥40 ms increase of the QRS complex, as compared to the original QRS complex. In contrast, slowly and continuously widened “left bundle branch block like” QRS patterns are mostly occur in left ventricular hypertrophy or in a metabolic/infiltrative disease. Orv. Hetil., 2013, 154, 688–693.

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QRS Complex Wavelet Analysis Can Distinguish Patients with and without Heart Failure, in the Presence of Left Bundle Branch Block

Journal of Integrative Cardiology Open Access ◽

10.31487/j.jicoa.2020.03.06 ◽

2020 ◽

pp. 1-6

Author(s):

Kalliopi Papathoma ◽

Anastasios Tsarouchas ◽

Dimitrios Mouselimis ◽

Efstratios Theofilogiannakos ◽

Eleni Christaina ◽

...

Keyword(s):

Heart Failure ◽

Wavelet Analysis ◽

Structural Heart Disease ◽

Healthy Controls ◽

Healthy Individuals ◽

Qrs Complex ◽

Bundle Branch Block ◽

Time Frequency ◽

Heart Failure Patients ◽

The Mean

Background: Left bundle branch block (LBBB) in heart failure (HF) patients is a negative predictor of survival. This pattern is occasionally recorded in individuals without structural heart disease. The LBBB morphology has not been previously analyzed in a time-frequency domain using wavelet analysis), and thus the factors distinguish LBBB patients from individuals without structural heart disease remain unexplored. The purpose of this analysis was to investigate the variations and the differences in LBBB morphology between healthy individuals with LBBB and patients with HF and LBBB. Methods: HF patients with LBBB and individuals with LBBB were included in this study. Signal-averaged 90-second Holter monitor recordings were extracted from each subject in orthogonal leads. QRS decomposition in 9 time-frequency bands (TFB) was performed using Complex Morlet wavelets transformation, while the mean and maximum energies of the QRS complexes were calculated for each of the 9 TFBs. The wavelet parameters of HF patients were compared with those of healthy controls. Results: Wavelet analysis was performed on ECG recordings of 69 HF patients and 17 individuals without cardiac disease. The mean and max wavelet energies of the QRS complex in all TFBs were higher for heart failure patients with LBBB, as compared to healthy individuals with LBBB. Differences were statistically significant in TFB4 and TFB7 (max energy, axis X), TFB4 and TFB7 (max energy, axis Y) and TFB4 and TFB7 (mean energy, axis Y). A multivariate logistic regression model, comprising of the aforementioned wavelet parameters, proved reasonably capable of distinguishing between HF patients and healthy controls with LBBB (AUC=0.854, 80.2% sensitivity and 80.3% specificity). Conclusion: QRS wavelet analysis revealed differences in the template of the QRS complex between healthy individuals with LBBB and heart failure patients with LBBB. This feature could be used as part of the diagnostic algorithm, a possibility that should be investigated further.

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