Right bundle branch block–type wide QRS complex tachycardia with a reversed R/S complex in lead V6: Development and validation of electrocardiographic differentiation criteria

Heart Rhythm ◽  
2020 ◽  
Author(s):  
Minsu Kim ◽  
Chang Hee Kwon ◽  
Ji Hyun Lee ◽  
Ki Won Hwang ◽  
Hyung Oh Choi ◽  
...  
Keyword(s):  
Right Bundle Branch Block ◽  
Block Type ◽  
Qrs Complex ◽  
Bundle Branch Block ◽  
Development And Validation

Abstract P64: Right Ventricular Outflow Septal Pacing as Cardiac Resynchronization Therapy in Patients with Right Bundle-Branch Block: Results in 62 Patients

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Phillip E Schrumpf ◽  
Michael Giudici ◽  
Deborah Paul ◽  
Roselyn Krupa ◽  
Cynthia Meirbachtol
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Right Ventricular ◽  
Right Bundle Branch Block ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Qrs Complex ◽  
Resynchronization Therapy ◽  
Ventricular Performance ◽  
Bundle Branch Block ◽  
Qrs Duration

Background: Cardiac resynchronization therapy has been shown to improve left ventricular performance in patients with left ventricular dysfunction and a left-sided interventricular conduction delay. This is performed by placing a pacing lead on the lateral left ventricular wall to stimulate the area normally stimulated by the left bundle branch. In patients with right bundle branch block (RBBB), pacing the right bundle branch could also result in resynchronization. Previous studies have shown that right ventricular outflow septal (RVOS) pacing does, in fact, utilize the native conduction system. Methods: 62 consecutive patients, 46 male/16 female, aged 75 +/− 10.5 yr, with RBBB and indications for pacing, underwent RVOS lead placement using commercially available pacing systems. The patients subsequently underwent bedside A-V optimization to achieve the narrowest QRS duration and most “normal” QRS complex. Echocardiography was performed to evaluate changes in wall motion comparing baseline with optimal pacing. Results: Baseline mean QRS duration 146 +/− 20.9 ms Optimized mean QRS duration 111 +/− 20.5 ms Average decrease in QRS duration -35 +/− 21.5 ms p < 0.001 Echocardiography demonstrated improvement in septal contraction abnormalities. Conclusions: 1) RVOS pacing in RBBB patients can significantly narrow the QRS complex on ECG. 2) Septal contraction abnormalities due to RBBB can be improved with RVOS pacing and optimal A-V timing. 3) Further studies are warranted to evaluate this therapy in a heart failure population.

Abstract 16382: The Surface ECG May Provide Information About Left Ventricular Systolic Function in Patients With Right Bundle Branch Block

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Anshul Gupta ◽  
Behzad B Pavri
Keyword(s):  
Right Bundle Branch Block ◽  
Visual Recognition ◽  
Visual Analysis ◽  
Systolic Function ◽  
Left Ventricular ◽  
Lv Function ◽  
Qrs Complex ◽  
Bundle Branch Block ◽  
Transition Group ◽  
Surface Ecg

Introduction: In patients (pts) with right bundle branch block (RBBB) and heart failure, assessment of left ventricular (LV) function is vital to management, but echocardiograms (ECHO) may not always be readily available. We studied the utility of using the Superimposed Median Format (available on digital ECG systems) in assessing LV function. This format allows visual recognition of change in dV/dT when rapid initial impulse propagation over the left bundle branch (LBB) and LV Purkinje network transitions to slower muscle-to-muscle propagation to the right ventricle (RV) in the setting of RBBB. Hypothesis: With a normal LBB and healthy LV myocardium, the transition from rapid forces to slower depolarization would occur in the 1 st half of the QRS complex ( Early Transition Group - ET) whereas in patients with abnormal LV function, this transition would occur in the 2 nd half (Late Transition Group - LT) of the QRS complex. Methods: Digital superimposed median format ECGs of 108 pts with RBBB were analyzed. Pts were divided into 2 groups: ET or LT. See figure. LVEFs were obtained from ECHO. LVEF ≥ 50% was considered normal. Results: ET: n = 69. LT: n = 39. Mean QRS durations were not different in the 2 groups. ET pts were more likely to have normal LVEF (p < 0.01). See figure. PPV of ET in predicting LVEF ≥50% = 90%; NPV = 71%. Accuracy = 82%. Conclusions: These data, if confirmed, suggest that in pts with RBBB, visual analysis of the QRS complex from the surface ECG using the superimposed median format may provide valuable clues about LV systolic function, and may be clinically useful when ECHO are not readily available.

scholarly journals The Apparent and the Effective PR Interval, Insights for Cardiac Pacing

2011 ◽  
Vol 4 ◽  
pp. CCRep.S8227
Author(s):  
Antoine Kossaify
Keyword(s):  
Right Ventricular ◽  
Male Patient ◽  
Right Bundle Branch Block ◽  
Cardiac Pacing ◽  
Qrs Complex ◽  
Dual Chamber ◽  
Bundle Branch Block ◽  
Dual Chamber Pacemaker ◽  
Pr Interval ◽  
Av Delay

A 75-year-old-male patient with dual chamber pacemaker presented with a bizarre EKG showing a unique spike within the QRS complex. Apparent PR interval was 160 ms and effective atrio- right ventricular delay was 210 ms due to right bundle branch block. Sensed AV delay was set at 180 ms causing pseudofusions. Insights regarding cardiac pacing are presented.

scholarly journals Right Bundle Branch Block: Current Considerations

2020 ◽  
Vol 16 ◽  
Author(s):  
Takanori Ikeda
Keyword(s):  
Differential Diagnosis ◽  
Clinical Practice ◽  
Electrical Activity ◽  
Right Bundle Branch Block ◽  
Qrs Complex ◽  
Bundle Branch Block ◽  
S Waves ◽  
Characteristic Appearance ◽  
Normal Sequence ◽  
Purkinje System

: RBBB, a pattern seen on the 12-lead ECG, results when normal electrical activity in the His-Purkinje system is interrupted by some reason. The normal sequence of activation is altered in RBBB, with a resultant characteristic appearance on the ECG manifest by a widened QRS complex and changes in the directional vectors of the R and S waves. This ECG pattern is often seen in clinical practice and generally regarded as benign. The anatomy, epidemiology, causes, symptoms, ECG findings and diagnosis, differential diagnosis in ECG, treatment, complications, prognosis, with respect to RBBB is outlined here, demonstrating some typical ECGs of RBBB.

scholarly journals Wide QRS complex tachycardia with alternating right bundle branch block morphologies: What is the mechanism?

2020 ◽  
Vol 6 (9) ◽  
pp. 564-567
Author(s):  
Isaiah C. Lugtu ◽  
Yenn-Jiang Lin ◽  
Pi-Chang Lee ◽  
Fa-Po Chung ◽  
Shih-Ann Chen
Keyword(s):  
Right Bundle Branch Block ◽  
Qrs Complex ◽  
Bundle Branch Block

scholarly journals Approach to the wide QRS-complex tachycardia

2018 ◽  
Vol 146 (11-12) ◽  
pp. 663-667
Author(s):  
Miloje Tomasevic ◽  
Srdjan Aleksandric ◽  
Jelena Rakocevic ◽  
Vladimir Miloradovic ◽  
Miodrag Sreckovic
Keyword(s):  
Chest Pain ◽  
Right Bundle Branch Block ◽  
Treatment Algorithm ◽  
Oxygen Demand ◽  
Myocardial Oxygen Demand ◽  
Qrs Complex ◽  
Bundle Branch Block ◽  
Intraventricular Conduction ◽  
Arterial Blood ◽  
Intravenous Amiodarone

Introduction. Patients presenting with tachycardia most often complain of palpitation and dizziness, but can also report episodes of chest pain due to increased myocardial oxygen demand. The aim of this case article was to emphasize the importance of differential diagnosis between different types of supraventricular (SVT) or ventricular tachycardia (VT) according to ECG findings, and highlight the treatment algorithm for wide QRS-complex tachycardia. Case Outline. We present a 34-years old female patient which was admitted to our hospital due to palpitations and chest pain that occurred at rest about two hours before hospital admission. Cardiac auscultation showed the presence of irregular heartbeats with tachycardia, whereas arterial blood pressure was 100/60 mmHg. Initial ECG recording demonstrated wide complex tachycardia (WCT) with irregular heart rate of approximately 180 beats per minute with right bundle branch block-like morphology of QRS complexes. After administration of intravenous amiodarone, patient was converted to sinus rhythm, with short PR interval (< 120 ms) and narrow QRS complexes (< 120 ms) with visible delta waves, indicating the presence of Wolff?Parkinson?White syndrome type A as the underlying cause of atrial fibrillation with right bundle branch block-like morphology of QRS complexes. Conclusion. The ability to differentiate between VT and SVT with a wide QRS complex due to aberrant intraventricular conduction or preexcitation is critical because the treatment of each is different, and inadequate therapy may potentially have lethal consequences.

Diagnosis and Ablation of Fascicular Tachycardia

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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