Vectorcardiographic and electrocardiographic criteria to distinguish new and old left bundle branch block

Heart Rhythm : the Official Journal of the Heart Rhythm Society
Alexei ShvilkinMark E Josephson

Abstract

There are no established criteria to differentiate new from old left bundle branch block (LBBB). This complicates management of patients with LBBB and suspected acute coronary syndrome. The purpose of this study was to develop electrocardiographic (ECG) criteria to differentiate new and old LBBB. All LBBB tracings (n = 3,706) in a hospital ECG database were retrieved. New (<24 hours, n = 39) and old (>24 hours, n = 1,760) LBBB tracings were identified. QRS and T-wave amplitudes, directions, and durations were measured digitally. Vectorcardiograms were reconstructed from 12-lead ECGs using inverse Dower transform and analyzed with Cardio3KG software. Receiver operator characteristic (ROC) curves were used to develop decision rules to distinguish new and old LBBB. The new LBBB group had larger T-vector magnitude (1.20 +/- 0.07 vs. 0.71 +/- 0.01 mV), smaller QRS vector magnitude (2.13 +/- 0.12 vs. 2.47 +/- 0.02 mV), and a lower QRS/T vector magnitude ratio (QRS/T; 1.79 +/- 0.03 vs. 3.92 +/- 0.04) compared with the old LBBB group (mean +/- standard error of the mean, P <.001). The ratio of deepest S to largest T wave in precordial leads (Max S/T) was significantly smaller in the new compared with in the old LBBB group (1.66 +/- 0.0...Continue Reading

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Citations

May 21, 2015·Biomedizinische Technik. Biomedical Engineering·Muhammad A Hasan, Derek Abbott
Sep 4, 2015·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Alexei ShvilkinMark E Josephson
Aug 15, 2015·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Larisa G TereshchenkoSMART-AV Trial Investigators
Apr 23, 2015·Circulation. Arrhythmia and Electrophysiology·Alexei ShvilkinMark E Josephson
Dec 25, 2016·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Elien B EngelsFrits W Prinzen
May 20, 2020·Arquivos brasileiros de cardiologia·José Nunes de Alencar NetoAngelo Amato Vincenzo de Paola
May 18, 2018·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Uyên Châu NguyênFrits W Prinzen
Apr 22, 2014·American Journal of Physiology. Heart and Circulatory Physiology·Nico H L KuijpersFrits W Prinzen
Apr 20, 2021·Computers in Biology and Medicine·Kazi T HaqLarisa G Tereshchenko

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