Abstract 10961: QRS Duration and Left Bundle Branch Block Do Not Deter Assessment of Low Voltage in Cardiac Amyloidosis

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Brett W Sperry ◽  
Michael N Vranian ◽  
Hariom Joshi ◽  
Rory Hachamovitch ◽  
Mazen Hanna
Keyword(s):  
Left Bundle Branch Block ◽  
Cardiac Amyloidosis ◽  
Low Voltage ◽  
Left Ventricular ◽  
S Wave ◽  
Bundle Branch Block ◽  
Propensity Matching ◽  
History Of ◽  
Ventricular Wall Thickness ◽  
Qrs Duration

Introduction: Left bundle branch block (LBBB) with QRS duration > 120 msec is typically associated with increased ECG voltage without a necessary increase in left ventricular wall thickness. Studies assessing voltage criteria in amyloidosis and other cardiomyopathies have excluded patients with LBBB. We sought to assess the effects of QRS duration and LBBB on voltage criteria in cardiac amyloidosis. Methods: We performed a retrospective analysis of patients with newly diagnosed cardiac amyloidosis at our institution from 2001-2014. Low voltage in the precordial leads was defined by the Sokolow criteria (S wave in V1 plus R wave in V5 or V6 ≤ 15mm). Limb lead voltage was calculated by the sum of the entire QRS complex voltage of leads I, II and III with low voltage being defined as each lead ≤ 5 mm. Patients with left bundle branch block were propensity matched to assess voltage criteria based upon age, sex, history of HTN, amyloid type (AL vs TTR), anteroseptal thickness and BSA to those with QRS < 120msec. Results: In 299 subjects (age 69.6 +/- 11.7 years, male 69%, HTN 53%, AL 53%, IVS 18.1 +/- 4.1 mm, BSA 1.95 +/- 0.26, EF 48 +/- 14%), mean QRS duration was 107 +/- 25 msec with 71 patients (24%) having a QRS duration greater than 120 msec (17 LBBB). The average limb voltage was 15.1 +/- 7.3 mm with low limb lead voltage seen in 62% of patients. Low precordial lead voltage was found in 73% of patients with a mean Sokolow voltage of 12.9 +/- 7.5 mm. After propensity matching the 17 patients with LBBB on a 1:3 basis with patients with a narrow complex QRS, there was no difference in any measure of voltage criteria. Conclusion: LBBB is not associated with higher voltage and does not hinder the ability to detect low voltage in patients with cardiac amyloidosis.

P1242ECG predictors of outcome in non-left bundle branch block cardiac resynchronization therapy patients

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A M W Van Stipdonk ◽  
M Dural ◽  
F Salden ◽  
I A H Ter Horst ◽  
H J G M Crijns ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Patient Selection ◽  
Primary Endpoint ◽  
Left Bundle Branch Block ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Bundle Branch Block ◽  
Qrs Morphology ◽  
Qrs Duration

Abstract Background The effectiveness of cardiac resynchronization therapy (CRT) in patients without left bundle branch block (non-LBBB) QRS morphology is limited, compared to those with LBBB. Still, a substantial part of these patients can benefit from therapy and additional selection criteria are needed to identify these patients. Purpose To evaluate the association of additional baseline 12-lead ECG features; with clinical and echocardiographic outcomes in CRT-treated non-LBBB patients. Methods Pre-implantation 12-lead ECGs from 790 consecutive non-LBBB CRT patients from 3 implanting centres in the Netherlands were evaluated for the presence of predefined ECG parameters. QRS morphology (right bundle branch block and intraventricular conduction delay), QRS duration (≥/<150ms), QRS area (≥/<109μVs), left ventricular activation time ((≥/<125ms), and the presence of fragmented QRS (fQRS). The association with the primary endpoint, the combination of left ventricular assist device implantation, cardiac transplantation and all-cause mortality, was evaluated. Results There was a significantly lower occurrence of the primary endpoint in non-LBBB patients with QRS area ≥109 μVs (p<0.001) and in those without fQRS present (p=0.004) (figure 1). Figure 1 Conclusion A large QRS area and the absence of fQRS are positively associated to event free survival in non-LBBB patients treated with CRT. Whereas currently used patient selection cut-off QRS duration is not associated to outcome in these patients. These data may provide additional value for the non-LBBB patient selection for CRT and warrant prospective evaluation of these ECG features. Acknowledgement/Funding None

Pathological S-wave in lead I in left bundle branch block is associated with MRI scar and reduced left ventricular function

2017 ◽  
Vol 50 (6) ◽  
pp. 868-869 ◽  
Author(s):  
Brett D. Atwater ◽  
Jimmy Axelsson ◽  
Rasmus Borgquist ◽  
Uzma Chaudhry ◽  
Jean-Philippe Couderc ◽  
...  
Keyword(s):  
Left Ventricular Function ◽  
Ventricular Function ◽  
Left Bundle Branch Block ◽  
Left Ventricular ◽  
S Wave ◽  
Bundle Branch Block

scholarly journals Comparison of the Relation Between Left Ventricular Anatomy and QRS Duration in Patients With Cardiomyopathy With Versus Without Left Bundle Branch Block

2014 ◽  
Vol 113 (10) ◽  
pp. 1717-1722 ◽  
Author(s):  
Dulciana D. Chan ◽  
Katherine C. Wu ◽  
Zak Loring ◽  
Loriano Galeotti ◽  
Gary Gerstenblith ◽  
...  
Keyword(s):  
Left Bundle Branch Block ◽  
Left Ventricular ◽  
Bundle Branch Block ◽  
Qrs Duration

Clinical characteristics and outcomes after pulmonary vein isolation in atrial fibrillation patients with complete right bundle branch block

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Yano ◽  
M Nishino ◽  
K Yanagawa ◽  
H Nakamura ◽  
Y Matsuhiro ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Late Recurrence ◽  
Left Ventricular ◽  
Bundle Branch Block ◽  
Intraventricular Conduction ◽  
Echocardiographic Parameters ◽  
History Of ◽  
Qrs Duration ◽  
Cox Analysis

Abstract Background Complete right bundle branch block (CRBBB) is one of the most frequent alterations of the electrocardiogram (ECG). Several studies have shown that CRBBB was a risk factor for cardiovascular diseases and the appearance of CRBBB in patients hospitalized for exacerbated heart failure (HF) was associated with a worse prognosis. Various alternations of ECG such as early repolarization pattern and intraventricular conduction disturbance were associated with high recurrence ratio of atrial fibrillation (AF) after pulmonary vein isolation (PVI). However clinical outcome after PVI in patients with CRBBB remains unclear. Methods We enrolled consecutive AF patients who underwent PVI from September 2014 to November 2018 rom Osaka Rosai Atrial Fibrillation (ORAF) registry. We excluded patients with other wide QRS (left bundle branch block, ventricular pacing and unclassified intraventricular conduction disturbance) and divided into 2 groups; CRBBB (QRS duration ≥120msec) group and no-CRBBB (QRS duration &lt;120) group. We compared the clinical characteristics including age, gender, hypertension, diabetes mellitus, history of heart failure, history of stroke, CHADS2Vasc score, paroxysmal AF (PAF), renal function, plasma brain natriuretic peptide (BNP) level and echocardiographic parameters including left ventricular end-diastolic diameter (LVDd), left ventricular end-systolic diameter (LVDs), left atrial diameter (LAD) and left ventricular ejection fraction (LVEF) between the 2 groups. We also compared the incidence of late recurrence of AF/atrial tachycardia (AT) between the 2 groups. We investigated whether CRBBB was an independent predictor of late recurrence of AF/AT after PVI by multivariate Cox analysis. Results We enrolled 736 consecutive AF patients who underwent PVI. CRBBB patients comprised 55 patients (7.5%). There were no significant differences of age, gender, hypertension, diabetes mellitus, history of heart failure, history of stroke, CHADS2Vasc score, PAF, renal function, plasma BNP level and echocardiographic parameters (LVDd, LVDs, LVEF and LAD) between the 2 groups. Incidence of AF/AT recurrence after PVI was significantly higher in CRBBB group than no-CRBBB group (Figure). CRBBB was an independently and significantly associated with late recurrence of AF/AT after PVI by multivariate Cox analysis (hazard ratio: 1.923, 95% CI: 1.190–2.961, p=0.009) in addition to female (p&lt;0.001), no-PAF (p=0.005) and left atrial diameter (p=0.042). Conclusion CRBBB may be a strong predictor of AF/AT late recurrence after PVI. AF/Ar recurrence after PVI Funding Acknowledgement Type of funding source: None

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