Fragmented left sided QRS in absence of bundle branch block: sign of left ventricular aneurysm.

Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc
Chatla V R ReddyMithilesh Kumar Das

Abstract

A left ventricular aneurysm (LVA) occurs between 3.5% and 9.4% of all cases of acute myocardial infarction. A fragmented left sided QRS (RSR; pattern or its variant RSr;, rSR;, or rSr;) without evidence of bundle branch block (QRS duration <or=120 ms) on the ECG may be associated with a significant myocardial scar, which is the characteristic of a LVA. We, therefore, postulate that fragmented QRS (RSR; pattern or its variant) in the left sided leads (I, aVL, V(3) to V(6)) may be a useful sign of LVA. ECGs of 110 consecutive patients with LVA documented by left ventricular angiography (30 degrees right anterior oblique view) was compared with 220 patients without LVA (110 patients with and 110 patients without coronary artery disease (CAD)), who were evaluated for CAD by symptoms and signs. The sensitivity of the fragmented QRS for identification of LVA was 50% (55 of 110 patients) and specificity was 94.6% (209 of 220). Within the study population, the positive predictive value of the fragmented QRS for LVA was 83.3% (55 of 66) and the negative predictive value was 79.2% (209 of 264). Based on the range of prevalence of LVA in postmyocardial infarction population (3.5-9.4%) and on observed sensitivity and specificity, the posit...Continue Reading

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Citations

Aug 1, 2012·Medizinische Klinik, Intensivmedizin und Notfallmedizin·S H Recke
Jun 9, 2007·Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology·Jo MahenthiranMithilesh K Das
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