Electrocardiographic diagnosis of left ventricular hypertrophy in the presence of left bundle branch block

Electrocardiographic diagnosis of the left ventricular hypertrophy in patients with left bundle branch block: Is it necessary to verify old criteria?

“…However as authors commented the association of LVH and LBBB was probably less pronounced in living patients. In 1984 Klein et al [15] based on the echocardiographic verification proposed the following parametersum of the S amplitude in V2 and R wave amplitude in V6 above 45 mm. The reported sensitivity achieved 86%, specificity 100%.…”

“…RaVL+SV3, SV2+SV3, autopsy or echocardiographic study [7][8][9][10][11][12][13][14]. The most frequently cited ECG criterion for LVH in patients with LBBB (S in V2+RV6 > 45 mm) was reported with maximal 86% sensitivity and 100% specificity [15]. Now the results of CMRI are more accurate and reproducible in LV mass quantification.…”

AHA/ACCF/HRS Recommendations for the Standardization and Interpretation of the Electrocardiogram

“…[32][33][34] Left Bundle-Branch Block Studies of the electrocardiographic diagnosis of LVH in the presence of complete left bundle-branch block (LBBB) have yielded conflicting results. [35][36][37][38][39][40][41] Some have concluded that the diagnosis should not be attempted in this setting, [35][36][37] whereas others believe that the diagnosis can be made. 38 -41 Estimations of specificity are affected by the relatively high prevalence of anatomic LVH in patients with LBBB, especially in autopsy series, where it may be 90% or more.…”

“…Because "complete" LBBB may often be not truly complete, and because the QRS duration in LVH can probably be greater than 120 ms without a localized lesion in the left bundle, the distinction between these two entities may be difficult to define. 43 A left atrial P-wave abnormality 38,39,41 and a QRS duration greater than approximately 155 ms, as well as precordial lead voltage criteria, 35,38 -42 tend to have relatively high specificity for LVH in the presence of LBBB. In patients meeting these specific criteria, it is reasonable to diagnose LVH, even though the sensitivity is low.…”

Atrial fibrillation with left bundle branch block and intermittent right axis deviation during acute myocardial infarction

“…The diagnosis of left ventricular hypertrophy is possible in cases of LBBB by using the criteria of QRS amplitude in the left precordial leads [1]. The diagnosis of myocardial infarction is more difficult, the criteria being very specific but having a sensitivity b 50% [2].…”