Electrocardiographic features and prevalence of bilateral bundle-branch delay

Leonidas Tzogias, Leonard A. Steinberg, Andrew J. Williams, Kent E. Morris, William Mahlow, Richard I. Fogel, Jeff A. Olson, Eric N. Prystowsky, Benzy J. Padanilam

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background-Definitive diagnosis of bilateral bundle-branch delay/block may be made when catheter-induced right bundlebranch block (RBBB) develops in patients with baseline left bundle-branch (LBB) block. We hypothesized that a RBBB pattern with absent S waves in leads I and aVL will identify bilateral bundle-branch delay/block.Methods and Results-Fifty patients developing transient RBBB pattern in lead V1 during right heart catheterization were studied. Patients were grouped according to whether the baseline ECG demonstrated a normal QRS, left fascicular blocks, or LBB block pattern. The RBBB morphologies in each group were compared. The prevalence of bilateral bundle-branch delay/block pattern was examined in our hospital ECG database. All patients with baseline normal QRS complexes (n=30) or left fascicular blocks (4 anterior, 5 posterior) developed a typical RBBB pattern. Among the 11 patients with a baseline LBB block pattern, 7 developed an atypical RBBB pattern with absent S waves in leads I and aVL and the remaining 4 demonstrated a typical RBBB. The absence of S waves in leads I and aVL during RBBB was 100% specific and 64% sensitive for the presence of pre-existing LBB block. Among the consecutive 2253 hospitalized patients with RBBB, 34 (1.5%) had the bilateral bundle-branch delay/block pattern.Conclusions-An ECG pattern of RBBB in lead V1 with absent S wave in leads I and aVL indicates concomitant LBB delay. Pure RBBB and bifascicular blocks are associated with S waves in leads I and aVL.

Original languageEnglish (US)
Pages (from-to)640-644
Number of pages5
JournalCirculation: Arrhythmia and Electrophysiology
Volume7
Issue number4
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

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Bundle-Branch Block
Electrocardiography
Patient Rights
Cardiac Catheterization
Catheters
Databases

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Tzogias, L., Steinberg, L. A., Williams, A. J., Morris, K. E., Mahlow, W., Fogel, R. I., ... Padanilam, B. J. (2014). Electrocardiographic features and prevalence of bilateral bundle-branch delay. Circulation: Arrhythmia and Electrophysiology, 7(4), 640-644. https://doi.org/10.1161/CIRCEP.113.000999

Electrocardiographic features and prevalence of bilateral bundle-branch delay. / Tzogias, Leonidas; Steinberg, Leonard A.; Williams, Andrew J.; Morris, Kent E.; Mahlow, William; Fogel, Richard I.; Olson, Jeff A.; Prystowsky, Eric N.; Padanilam, Benzy J.

In: Circulation: Arrhythmia and Electrophysiology, Vol. 7, No. 4, 01.01.2014, p. 640-644.

Research output: Contribution to journalArticle

Tzogias, L, Steinberg, LA, Williams, AJ, Morris, KE, Mahlow, W, Fogel, RI, Olson, JA, Prystowsky, EN & Padanilam, BJ 2014, 'Electrocardiographic features and prevalence of bilateral bundle-branch delay', Circulation: Arrhythmia and Electrophysiology, vol. 7, no. 4, pp. 640-644. https://doi.org/10.1161/CIRCEP.113.000999
Tzogias, Leonidas ; Steinberg, Leonard A. ; Williams, Andrew J. ; Morris, Kent E. ; Mahlow, William ; Fogel, Richard I. ; Olson, Jeff A. ; Prystowsky, Eric N. ; Padanilam, Benzy J. / Electrocardiographic features and prevalence of bilateral bundle-branch delay. In: Circulation: Arrhythmia and Electrophysiology. 2014 ; Vol. 7, No. 4. pp. 640-644.
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AU - Mahlow, William

AU - Fogel, Richard I.

AU - Olson, Jeff A.

AU - Prystowsky, Eric N.

AU - Padanilam, Benzy J.

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