No relevant mechanical leg axis deviation in the frontal and sagittal planes is to be expected after subtrochanteric or supracondylar femoral rotational or derotational osteotomy

Background: Derotational osteotomy of the distal femur allows the anatomic treatment of patellofemoral maltracking due to increased femoral antetorsion. However, such rotational osteotomy procedures have a high potential of intended/unintended changes of frontal alignment. Purpose/Hypothesis: The purpose of this study was to perform derotational osteotomy of the distal femur and to demonstrate the utility of a novel trigonometric approach to address 3-dimensional (3D) changes on 2-dimensional imaging (axial computed tomography [CT] and frontal-plane radiography). The hypothesis was that 1-step single-cut osteotomy can simultaneously correct torsion and frontal alignment based on preoperatively calculated cutting angles. Study Design: Controlled laboratory study. Methods: Eight human cadaveric whole legs (4 lower limb torsos) underwent derotational osteotomy of the distal femur of 20°. A straight leg axis, determined as a mechanical femorotibial angle (mFTA) of 0°, was chosen as a goal for postoperative frontal alignment. The inclination of the cutting angle from the lateral view was calculated individually for each cadaveric leg and was represented by a simple 3D-printed cutting guide for surgery. Specimens underwent CT for the measurement of torsion, while the frontal leg axis was determined on an upright radiograph preoperatively and postoperatively. Preoperative and postoperative angles were compared with the mathematical prediction model. Results: The preoperative mFTA ranged from –3.9° (valgus) to +3.4° (varus) (mean, –0.2° ± 2.6°). A postoperative mean mFTA of 0.37° ± 0.69° (95% CI, –0.22° to 0.95°) was achieved ( P = .01). Derotation showed a mean of 19.1° ± 2.1° (95% CI, 17.3°-20.8°). The oblique cutting plane for the correction of valgus legs showed a mean of 5.9° ± 6.8° and, for the correction of varus legs, a mean of –10.0° ± 4.5° projected on the perpendicular plane to the virtual anatomic shaft axis from the sagittal view. Conclusion: Single-cut distal femoral osteotomy can be performed to simultaneously address rotational as well as frontal alignment using a preoperatively defined oblique cut, as determined by the presented reproducible calculation model. Clinical Relevance: This study adds important knowledge to the technique of derotational osteotomy. This approach provides an individual, oblique single cut for the correction of torsion and frontal axis within a clinically insignificant margin. Simplified tables for calculation and a surgical reference make this model reproducible and safe.

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Mal-angulation of femoral rotational osteotomies causes more postoperative sagittal mechanical leg axis deviation in supracondylar than in subtrochanteric procedures

Journal of Experimental Orthopaedics ◽

10.1186/s40634-020-00262-6 ◽

2020 ◽

Vol 7 (1) ◽

Author(s):

Lukas Jud ◽

Octavian Andronic ◽

Lazaros Vlachopoulos ◽

Sandro F. Fucentese ◽

Patrick O. Zingg

Keyword(s):

Axis Deviation ◽

Leg Axis

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Diagnosis and Ablation of Fascicular Tachycardia

Asia Pacific Cardiology ◽

10.15420/apc.2011:3:1:67 ◽

2011 ◽

Vol 3 (1) ◽

pp. 67

Author(s):

Akihiko Nogami ◽

Keyword(s):

Ventricular Tachycardia ◽

Right Bundle Branch Block ◽

Axis Deviation ◽

Exit Site ◽

Rare Form ◽

Bundle Branch Block ◽

Diagnosis And Therapy ◽

Narrow Qrs ◽

Left Posterior ◽

Qrs Morphology

Verapamil-sensitive fascicular ventricular tachycardia (VT) is the most common form of idiopathic left VT. According to the QRS morphology and the successful ablation site, left fascicular VT can be classified into three subgroups: left posterior fascicular VT, whose QRS morphology shows right bundle branch block (RBBB) configuration and superior axis (common form); left anterior fascicular VT, whose QRS morphology shows RBBB configuration and right-axis deviation (uncommon form), and upper septal fascicular VT, whose QRS morphology shows narrow QRS configuration and normal or right-axis deviation (rare form). Posterior and anterior fascicular VT can be successfully ablated at the posterior or anterior mid-septum with a diastolic Purkinje potential during VT or at the VT exit site with a fused pre-systolic Purkinje potential. Upper septal fascicular VT can also be ablated at the site with diastolic Purkinje potential at the upper septum. Recognition of the heterogeneity of this VT and its unique characteristics should facilitate appropriate diagnosis and therapy.

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Left axis deviation as an electrocardiographic manifestation of acute pulmonary embolism

Journal of Electrocardiology ◽

10.1016/s0022-0736(71)80053-5 ◽

1971 ◽

Vol 4 (1) ◽

pp. 67-69 ◽

Cited By ~ 4

Author(s):

Paul D. Stein ◽

Thomas A. Bruce

Keyword(s):

Pulmonary Embolism ◽

Acute Pulmonary Embolism ◽

Axis Deviation

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Natural history of the electrical axis during the first four weeks of life

European Heart Journal ◽

10.1093/ehjci/ehaa946.3199 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M Paerregaard ◽

J Kock ◽

C Pihl ◽

A Pietersen ◽

K.K Iversen ◽

...

Keyword(s):

Heart Disease ◽

Heart Diseases ◽

Structural Heart Disease ◽

Funding Source ◽

Axis Deviation ◽

General Population Study ◽

Gestation Age ◽

History Of ◽

The Right ◽

Heart Foundation

Abstract Background The QRS axis represents the sum of the amplitudes and orientation of the ventricular depolarization. In newborns, the QRS axis is generally directed downward and to the right and left axis deviation (LAD) may be associated with heart disease. Accurate interpretation of abnormalities in the QRS axis may facilitate early diagnosis of heart diseases in newborns. Purpose To describe the evolution of the QRS axis during the first four weeks of life and provide updated, digitalized, normal values from healthy newborns. Methods Electrocardiograms from 12,317 newborns (age 0–28 days) included in a regional, prospective, general population study from 2016–2018 were analyzed. Electrocardiograms were obtained and analyzed with a computerized algorithm with manual validation. The algorithm calculated the QRS mean axis using the net amplitudes of three leads I, II, and III. The four main QRS axis classifications were: “adult normal” axis (+1° to +90°), left axis deviation (LAD, 0° to −90°), right axis deviation (RAD, +91° to +180°), and extreme axis deviation (EAD, +181° to +270°). Echocardiograms were performed according to standard guidelines. Only newborns with an echocardiography excluding structural heart disease were included. Results Electrocardiograms from 12,317 newborns with a median age at examination of 12 days (52% boys) were included. The median QRS axis was 119° at the ages 0–7 days and shifted leftwards to 102° at the ages 22–28 days (p<0.001). We found that girls had significant less pronounced right axis deviation than boys (111° vs 117°, p<0.001) and that increasing gestational age was associated with more pronounced right axis deviation (104° vs 116°, p<0.05). Infant size did not affect the axis (p>0.05). Only 0.5% had LAD (0° to −90°) and 1.1% had an axis within the interval +240° to +30° indicating that a QRS axis in this expanded interval is unusual in healthy newborns. Conclusion The QRS axis showed a gradual leftward-shift during the first four weeks of life and was affected by sex and gestation age but unaffected by infant size. LAD occurred in only 0.5% of the newborns. Our data serve as updated reference values, which may facilitate clinical handling of newborns. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): This work was supported by the Danish Children Heart Foundation, Snedkermester Sophus Jacobsen and wife Astrid Jacobsen's foundation (Grant 19-R112-A5248-26048), the Research Council at Herlev-Gentofte Hospital and Toyota-Fonden, Denmark.

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Left Axis Deviation in Brugada Syndrome: Vectorcardiographic Evaluation during Ajmaline Provocation Testing Reveals Additional Depolarization Abnormalities

International Journal of Molecular Sciences ◽

10.3390/ijms22020484 ◽

2021 ◽

Vol 22 (2) ◽

pp. 484

Author(s):

Martijn H. van der Ree ◽

Jeroen Vendrik ◽

Jan A. Kors ◽

Ahmad S. Amin ◽

Arthur A. M. Wilde ◽

...

Keyword(s):

Sodium Channel ◽

Brugada Syndrome ◽

Right Ventricular Outflow Tract ◽

Ventricular Outflow Tract ◽

Conduction Delay ◽

Channel Blockers ◽

Axis Deviation ◽

Provocation Testing ◽

The Right

Patients with Brugada syndrome (BrS) can show a leftward deviation of the frontal QRS-axis upon provocation with sodium channel blockers. The cause of this axis change is unclear. In this study, we aimed to determine (1) the prevalence of this left axis deviation and (2) to evaluate its cause, using the insights that could be derived from vectorcardiograms. Hence, from a large cohort of patients who underwent ajmaline provocation testing (n = 1430), we selected patients in whom a type-1 BrS-ECG was evoked (n = 345). Depolarization and repolarization parameters were analyzed for reconstructed vectorcardiograms and were compared between patients with and without a >30° leftward axis shift. We found (1) that the prevalence of a left axis deviation during provocation testing was 18% and (2) that this left axis deviation was not explained by terminal conduction slowing in the right ventricular outflow tract (4th QRS-loop quartile: +17 ± 14 ms versus +13 ± 15 ms, nonsignificant) but was associated with a more proximal conduction slowing (1st QRS-loop quartile: +12[8;18] ms versus +8[4;12] ms, p < 0.001 and 3rd QRS-loop quartile: +12 ± 10 ms versus +5 ± 7 ms, p < 0.001). There was no important heterogeneity of the action potential morphology (no difference in the ventricular gradient), but a left axis deviation did result in a discordant repolarization (spatial QRS-T angle: 122[59;147]° versus 44[25;91]°, p < 0.001). Thus, although the development of the type-1 BrS-ECG is characterized by a terminal conduction delay in the right ventricle, BrS-patients with a left axis deviation upon sodium channel blocker provocation have an additional proximal conduction slowing, which is associated with a subsequent discordant repolarization. Whether this has implications for risk stratification is still undetermined.

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A single premature stimulation from the para-Hisian region unmasked negative involvement of the left anterior fascicle in the verapamil-sensitive ventricular tachycardia with a right bundle branch block and right-axis deviation

Journal of Electrocardiology ◽

10.1016/j.jelectrocard.2021.07.011 ◽

2021 ◽

Author(s):

Masahiro Toba ◽

Toshihiro Nasu ◽

Nobuyoshi Nekomiya ◽

Ryo Itasaka ◽

Takao Makino ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Right Bundle Branch Block ◽

Axis Deviation ◽

Bundle Branch Block

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Clinical impact of left and right axis deviations with narrow QRS complex on 3-year outcomes in a hospital-based population in Japan

Scientific Reports ◽

10.1038/s41598-021-88259-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yuta Seko ◽

Takao Kato ◽

Yuhei Yamaji ◽

Yoshisumi Haruna ◽

Eisaku Nakane ◽

...

Keyword(s):

Cardiovascular Events ◽

Primary Outcome ◽

Outcome Measure ◽

Conduction Block ◽

Primary Outcome Measure ◽

Excess Risk ◽

Major Adverse Cardiovascular Events ◽

Prognostic Impact ◽

Axis Deviation ◽

The Right

AbstractWhile the prognostic impact of QRS axis deviation has been assessed, it has never been investigated in patients without conduction block. Thus, we evaluated the prognostic impact of QRS-axis deviation in patients without conduction block. We retrospectively analyzed 3353 patients who had undergone both scheduled transthoracic echocardiography and electrocardiography in 2013 in a hospital-based population, after excluding patients with a QRS duration of ≥ 110 ms, pacemaker placement, and an QRS-axis − 90° to − 180° (northwest axis). The study population was categorized into three groups depending on the mean frontal plane QRS axis as follows: patients with left axis deviation (N = 171), those with right axis deviation (N = 94), and those with normal axis (N = 3088). The primary outcome was a composite of all-cause death and major adverse cardiovascular events. The cumulative 3-year incidence of the primary outcome measure was significantly higher in the left axis deviation group (26.4% in the left axis deviation, 22.7% in the right axis deviation, and 18.4% in the normal axis groups, log-rank P = 0.004). After adjusting for confounders, the excess risk of primary outcome measure remained significant in the left axis deviation group (hazard ratio [HR] 1.44; 95% confidence interval [CI] 1.07–1.95; P = 0.02), while the excess risk of primary outcome measure was not significant in the right axis deviation group (HR 1.22; 95% CI 0.76–1.96; P = 0.41). Left axis deviation was associated with a higher risk of a composite of all-cause death and major adverse cardiovascular events in hospital-based patients without conduction block in Japan.

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