scholarly journals New ECG criteria for differential diagnosis of wide QRS complex tachycardias with right bundle branch block pattern

2019 ◽  
Vol 91 (4) ◽  
pp. 83-89 ◽  
Author(s):  
N B Shlevkov ◽  
H F Salami ◽  
V G Kiktev ◽  
S F Sokolov
Keyword(s):  
Differential Diagnosis ◽  
Right Bundle Branch Block ◽  
S Wave ◽  
Bundle Branch Block ◽  
Prognostic Accuracy ◽  
Electrophysiological Studies ◽  
Block Pattern ◽  
Ecg Criteria ◽  
Ventricular Tachycardias ◽  
Supraventricular Tachycardias

Aim. To evaluate standard 12-lead ECG indices for the differential diagnosis of wide QRS tachycardias with right bundle branch block (RBBB) pattern. Materials and methods. Study analyses the 244 ECG indices in 111 patients (79 males and 32 females, age 53±17 years) with RBBB tachycardias, who underwent electrophysiological studies. First step includes retrospective analysis of QRS characteristics in 20 patients with ventricular tachycardias (VT), 24 pts with aberrant supraventricular tachycardias (SVT+RBBB) and 14 pts with antidromic SVTs (WPW). ROC- and multifactorial analyses were performed to develop diagnostic ECG algorithms. The prognostic accuracy of the algorithms was subsequently evaluated on a prospective group of patients with RBBB tachycardias (n=53). Results and discussion. ECG criteria of RBBB VTs were: 1) the presence Q-wave in lead II, 2) the duration interval R(peak)-S(end) >100 ms in lead V5. ECG criteria for antidromic SVTs with RBBB were: 1) the duration of the R wave in lead I ≥80 ms, 2) the absence of split (M-sharp) R-waves in lead V2, 3) the absence notch in ascending S wave in lead aVL. The accuracy of the algorhythm for diagnostic of VTs with RBBB was 83% (sensitivity 100%, specificity 73%). The accuracy of the algorhythm for diagnostic of antidromic SVTs with RBBB was 91% (sensitivity 85%, specificity 96%). Conclusion. The proposed algorithms are based on new ECG criteria for the differential diagnosis of wide QRS complexes tachycardias with RBBB pattern, unlike the previous algorithms.

scholarly journals NEW ELECTROCARDIOGRAPHIC CRITERIA FOR DIFFERENTIAL DIAGNOSIS OF TACHYCARDIAS WITH ADVANCED QRS COMPLEXES ACCORDING TO THE TYPE OF BLOCKADE OF LEFT BUNDLE OF HIS

2019 ◽  
Vol 34 (1) ◽  
pp. 98-106
Author(s):  
H. F. Salami ◽  
N. B. Shlevkov ◽  
P. S. Novikov ◽  
N. Yu. Mironov ◽  
A. V. Pevzner
Keyword(s):  
Differential Diagnosis ◽  
Electrophysiological Study ◽  
S Wave ◽  
Bundle Branch Block ◽  
Prognostic Accuracy ◽  
Sensitivity Rate ◽  
Ventricular Tachycardias ◽  
Supraventricular Tachycardias ◽  
Electrocardiogram Ecg ◽  
Specificity Rate

Aim. To evaluate standard 12-lead electrocardiogram (ECG) indices for the differential diagnosis of left bundle branch block (LBBB) tachycardias.Material and Methods. The study analyses 244 ECG indices in 63 retrospective patients (85 males and 39 females aged 50±12 years) with LBBB type tachycardias. The electrophysiological study identified ventricular tachycardias (VT) (VT group, n=20), supraventricular tachycardias (SVT) with LBBB (SVT+LBBB group, n=23) or antidromic SVTs (WPW group, n=20). Unifactorial, multifactorial, and ROC analyses were performed to develop diagnostic ECG algorithms. The prognostic accuracy of the algorithms was subsequently evaluated in a prospective group of patients with LBBB tachycardias (n=57).Results. ECG signs of LBBB VTs were as follows: 1) the presence of the initial R wave in the lead aVL; 2) the absence of a split (M-shaped) R wave in the lead I; and 3) the S wave duration in the lead V1≤100 ms. For antidromic LBBB tachycardias, the ECG signs were as follows: 1) the duration of the R waves in the lead V2≥45 ms; 2) the absence of a split R waves (M-shaped) in the lead I; and 3) the duration of the R wave in the lead aVL>30 ms. The accuracy of the algorithm for diagnosis of VT with LBBB was 95% (sensitivity of 97%, specificity of 92%). The accuracy of the algorithm for diagnosis of antidromic tachycardias was 84% (sensitivity rate of 65%, specificity rate of 100%).Conclusion. Our data showed new very powerful criteria for differential diagnosis between various LBBB tachycardias even in comparison with well-known ECG algorithms of Wellens, Brugada, Griffith, Scheinman, Vereckei, Sasaki, et al.

scholarly journals NEW ELECTROCARDIOGRAPHIC CRITERIA FOR DIFFERENTIAL DIAGNOSIS OF TACHYCARDIAS WITH ADVANCED QRS COMPLEXES ACCORDING TO THE TYPE OF BLOCKADE OF LEFT BUNDLE OF HIS

2019 ◽  
Vol 34 (1) ◽  
pp. 98-106 ◽  
Author(s):  
H. F. Salami ◽  
N. B. Shlevkov ◽  
P. S. Novikov ◽  
N. Yu. Mironov ◽  
A. V. Pevzner
Keyword(s):  
Differential Diagnosis ◽  
Electrophysiological Study ◽  
S Wave ◽  
Bundle Branch Block ◽  
Prognostic Accuracy ◽  
Sensitivity Rate ◽  
Ventricular Tachycardias ◽  
Supraventricular Tachycardias ◽  
Electrocardiogram Ecg ◽  
Specificity Rate

Aim. To evaluate standard 12-lead electrocardiogram (ECG) indices for the differential diagnosis of left bundle branch block (LBBB) tachycardias.Material and Methods. The study analyses 244 ECG indices in 63 retrospective patients (85 males and 39 females aged 50±12 years) with LBBB type tachycardias. The electrophysiological study identified ventricular tachycardias (VT) (VT group, n=20), supraventricular tachycardias (SVT) with LBBB (SVT+LBBB group, n=23) or antidromic SVTs (WPW group, n=20). Unifactorial, multifactorial, and ROC analyses were performed to develop diagnostic ECG algorithms. The prognostic accuracy of the algorithms was subsequently evaluated in a prospective group of patients with LBBB tachycardias (n=57).Results. ECG signs of LBBB VTs were as follows: 1) the presence of the initial R wave in the lead aVL; 2) the absence of a split (M-shaped) R wave in the lead I; and 3) the S wave duration in the lead V1≤100 ms. For antidromic LBBB tachycardias, the ECG signs were as follows: 1) the duration of the R waves in the lead V2≥45 ms; 2) the absence of a split R waves (M-shaped) in the lead I; and 3) the duration of the R wave in the lead aVL>30 ms. The accuracy of the algorithm for diagnosis of VT with LBBB was 95% (sensitivity of 97%, specificity of 92%). The accuracy of the algorithm for diagnosis of antidromic tachycardias was 84% (sensitivity rate of 65%, specificity rate of 100%).Conclusion. Our data showed new very powerful criteria for differential diagnosis between various LBBB tachycardias even in comparison with well-known ECG algorithms of Wellens, Brugada, Griffith, Scheinman, Vereckei, Sasaki, et al.

scholarly journals Electrocardiography changes and their significance during treatment of patients with intermediate-high and high-risk pulmonary embolism

2019 ◽  
Vol 9 (4) ◽  
pp. 271-278
Author(s):  
Natasha Novicic ◽  
Boris Dzudovic ◽  
Bojana Subotic ◽  
Sonja Shalinger-Martinovic ◽  
Slobodan Obradovic
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Right Ventricular ◽  
Right Bundle Branch Block ◽  
Systolic Pressure ◽  
S Wave ◽  
Right Ventricular Systolic Pressure ◽  
Bundle Branch Block ◽  
Ventricular Systolic Pressure ◽  
Block Pattern

Background: Electrocardiography (ECG) signs, typical or acute pulmonary embolism, and their changes can be used for the prediction of clinical and haemodynamic outcomes. Purpose: To study the predictive value of the resolution of admission ECG signs in higher risk pulmonary embolism patients for 30-day survival and for the decrease in right ventricular systolic pressure. Methods: We analysed the 12-lead ECGs at admission and daily for the first 5 days after hospitalisation in 110 intermediate-high and high-risk pulmonary embolism patients admitted to the intensive care unit of a single tertiary centre. The predictive value of the resolution of four ECG signs were analysed for 30-day survival and for the changes in right ventricular systolic pressure during hospitalisation: S-wave in the first standard lead, right bundle branch block pattern, S-wave in the aVL lead and negative T-waves in precordial leads. Results: ECG recordings showed the existence of S-wave in the I lead in 71 (64.5%), S-wave in the aVL in 77 (70%), right bundle branch block pattern in 30 (27.3%) and negative T-waves in 66 (60%) patients. All-cause 30-day in-hospital mortality was 13.6%. Among the ECG signs, only the presence of right bundle branch block at admission was significantly associated with 30-day all-cause mortality (hazard ratio (HR) adjusted for age, gender and right ventricular systolic pressure at admission was 7.7, 95% confidence interval (CI) 2.1–27.9; P=0.002). The resolution of three ECG signs during the first 5 days of hospitalisation, S-wave in the I lead (HR 26.4, 95% CI 3.1–226.6; P=0.003), S-wave in the aVL (HR 21.5, 95% CI 2.6–175.3; P=0.004) and right bundle branch block configuration (HR 5.2, 95% CI 1.3–20.8; P=0.020) were associated with 30-day survival. The intermediate-high and high-risk pulmonary embolism patients with S-wave resolution in lead aVL had 0.0% and 7.1% 30-day all-cause mortality, respectively. The patients with resolution of the S-wave in the first lead and in aVL as well as right bundle branch block had more pronounced changes in right ventricular systolic pressure at discharge (27±13 vs. 13±15 mmHg; P=0.011 for S-wave in I lead resolution, 27±12 vs. 15±17 mmHg; P=0.004 for S-wave in aVL resolution and 23±14 vs. 9±14 mmHg; P=0.040 for right bundle branch block resolution) than patients without resolution. Conclusion: Resolution of S-waves and right bundle branch block in ECG correlates with lower all-cause 30-day mortality in intermediate-high and high-risk pulmonary embolism patients. Resolution of S-waves in the first lead and in aVL and right bundle branch block correlates with a decrease of right ventricular systolic pressure.

scholarly journals A rare complication of implantable cardiac defibrillator placement

2020 ◽  
Author(s):  
João Ferreira ◽  
Célia Marques Domingues ◽  
Susana Isabel Costa ◽  
Maria Fátima Franco Silva ◽  
Lino Manuel Martins Gonçalves
Keyword(s):  
Heart Failure ◽  
Right Bundle Branch Block ◽  
Left Ventricular Systolic Dysfunction ◽  
Rare Complication ◽  
Systolic Dysfunction ◽  
Lateral Wall ◽  
Left Ventricular ◽  
Refractory Ascites ◽  
Bundle Branch Block ◽  
Block Pattern

Abstract Background Implantable cardiac defibrillators (ICD) are a popular and effective option in heart failure with left ventricular systolic dysfunction patients. Although frequently underdiagnosed, inadvertent malposition can lead to endocardial damage and thrombotic events. As ICD implants tend to increase in the following years, the recognition of their complications is critical. Case presentation The authors present a case of a 64-year-old woman with advanced heart failure and ICD malposition. This accidental discovery was denounced by the presence of a right bundle branch block pattern and later confirmed by echocardiography which showed the lead tip in contact with the mid segment of the left ventricular antero-lateral wall. As the patient hospitalisation was complicated with refractory ascites and cardiogenic shock, she underwent cardiac transplantation, with no recurrence of heart failure symptoms. Conclusions An electrocardiogram showing a right bundle branch block pattern during VVI pacing should arise the suspicion of inadvertent placement of a pacing/ICD lead. The many facets of echocardiography should be used for the diagnosis of this complication, as they were paramount in this case, as highlighted.

scholarly journals Right bundle branch block pattern in right ventricular endocardial pacing: A needless concern?

Heart India ◽  
2013 ◽  
Vol 1 (2) ◽  
pp. 57
Author(s):  
MangalachulliPottammal Ranjith ◽  
Kalathingathodika Sajeer ◽  
ChakanalilGovindan Sajeev ◽  
Cicy Bastian ◽  
Vellani Haridasan ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Right Bundle Branch Block ◽  
Bundle Branch Block ◽  
Block Pattern ◽  
Endocardial Pacing

The Electrocardiogram in Nonsystemic Ventricular Pacing in a Patient with Congenitally Corrected Transposition of the Great Arteries and Dextrocardia

2021 ◽  
Vol 4 (11) ◽  
pp. 01-05
Author(s):  
Roy Norris
Keyword(s):  
Right Bundle Branch Block ◽  
P Wave ◽  
Ventricular Pacing ◽  
Bundle Branch Block ◽  
High Incidence ◽  
Situs Solitus ◽  
Block Pattern ◽  
Congenitally Corrected Transposition ◽  
Third Degree Atrioventricular Block ◽  
Corrected Transposition

Congenitally corrected transposition of the great arteries (CCTGA) has a high incidence of dextrocardia and complete heart block. We describe a 34 year-old male with CCTGA, dextrocardia, and third degree atrioventricular block status-post dual chamber pacemaker that presented with acute heart failure syndrome. Cardiac CT Angiography confirmed CCTGA with situs solitus and dextrocardia. EKG with standard frontal leads showed a normal P wave axis and right-sided precordial leads showed a right bundle branch block pattern. With situs solitus there is a normal P wave axis on standard frontal leads. With nonsystemic ventricular pacing in CCTGA with dextrocardia left- and right-sided precordial leads show a left bundle branch block pattern and right bundle branch block pattern respectively. This case highlights electrocardiographic patterns seen with dextrocardia and morphologic reversal of ventricles. Subject Terms List: Dextrocardia, Electrocardiogram, Pacemaker, Transposition of the Great Arteries

Posterior fascicular block obscuring the right bundle branch block pattern

2012 ◽  
Vol 159 (3) ◽  
pp. e51-e52
Author(s):  
Paolo Alboni ◽  
Lorella Gianfranchi ◽  
Sabrina Bressan
Keyword(s):  
Right Bundle Branch Block ◽  
Bundle Branch Block ◽  
Block Pattern ◽  
The Right
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