Intraventricular Block

Rosenman, Ray H.

doi:10.1001/archinte.1950.00230140032005

Cited by 39 publications

(2 citation statements)

References 159 publications

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“…First, it may be due to anatomical and pathological severance as demonstrated by early animal experiments and confirmed by histological studies in man (Rosenman, Pick., and Katz, 1950;Lev, 1960). Secondly it may be due to ventricular enlargement and strain with dilatation of the appropriate chamber.…”

Section: Discussionmentioning

confidence: 90%

Bundle-Branch Block Under Voluntary Control

Bauer¹

1964

Heart

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Section: Discussionmentioning

confidence: 90%

Bundle-Branch Block Under Voluntary Control

Bauer¹

1964

Heart

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“…Surface electrocardiography (ECG) criteria derived from this early canine work notably resulted in an accidental reversal of LBBB and right bundle branch block (RBBB) criteria in humans due to differences in anatomic orientation of the canine heart compared with the human heart, a misperception that persisted for decades. Perhaps surprisingly, these original criteria continued to inform multiple iterations of LBBB ECG criteria, culminating in the modern American College of Cardiology (ACC)/American Heart Association (AHA)/Heart Rhythm Society (HRS) ECG criteria for LBBB (QRS duration ≥120 milliseconds; a broad notched or slurred R wave in leads I, aVL, V 5 , and V 6 ; absence of Q waves in leads I, V 5 , and V 6 ; R-wave peak time >60 milliseconds in leads V 5 and V 6 ; and ST and T waves usually opposite in direction to the QRS complex) . One limitation of these criteria is that they possess poor specificity for LBBB.…”

Section: Introductionmentioning

confidence: 99%

A Revised Definition of Left Bundle Branch Block Using Time to Notch in Lead I

Treger,

Allaw,

Razminia

et al. 2024

JAMA Cardiol

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ImportanceCurrent left bundle branch block (LBBB) criteria are based on animal experiments or mathematical models of cardiac tissue conduction and may misclassify patients. Improved criteria would impact referral decisions and device type for cardiac resynchronization therapy.ObjectiveTo develop a simple new criterion for LBBB based on electrophysiological studies of human patients, and then to validate this criterion in an independent population.Design, Setting, and ParticipantsIn this diagnostic study, the derivation cohort was from a single-center, prospective study of patients undergoing electrophysiological study from March 2016 through November 2019. The validation cohort was assembled by retrospectively reviewing medical records for patients from the same center who underwent transcatheter aortic valve replacement (TAVR) from October 2015 through May 2022.ExposuresPatients were classified as having LBBB or intraventricular conduction delay (IVCD) as assessed by intracardiac recording.Main Outcomes and MeasuresSensitivity and specificity of the electrocardiography (ECG) criteria assessed in patients with LBBB or IVCD.ResultsA total of 75 patients (median [IQR] age, 63 [53-70.5] years; 21 [28.0%] female) with baseline LBBB on 12-lead ECG underwent intracardiac recording of the left ventricular septum: 48 demonstrated complete conduction block (CCB) and 27 demonstrated intact Purkinje activation (IPA). Analysis of surface ECGs revealed that late notches in the QRS complexes of lateral leads were associated with CCB (40 of 48 patients [83.3%] with CCB vs 13 of 27 patients [48.1%] with IPA had a notch or slur in lead I; P = .003). Receiver operating characteristic curves for all septal and lateral leads were constructed, and lead I displayed the best performance with a time to notch longer than 75 milliseconds. Used in conjunction with the criteria for LBBB from the American College of Cardiology/American Heart Association/Heart Rhythm Society, this criterion had a sensitivity of 71% (95% CI, 56%-83%) and specificity of 74% (95% CI, 54%-89%) in the derivation population, contrasting with a sensitivity of 96% (95% CI, 86%-99%) and specificity of 33% (95% CI, 17%-54%) for the Strauss criteria. In an independent validation cohort of 46 patients (median [IQR] age, 78.5 [70-84] years; 21 [45.7%] female) undergoing TAVR with interval development of new LBBB, the time-to-notch criterion demonstrated a sensitivity of 87% (95% CI, 74%-95%). In the subset of 10 patients with preprocedural IVCD, the criterion correctly distinguished IVCD from LBBB in all cases. Application of the Strauss criteria performed similarly in the validation cohort.Conclusions and RelevanceThe findings suggest that time to notch longer than 75 milliseconds in lead I is a simple ECG criterion that, when used in conjunction with standard LBBB criteria, may improve specificity for identifying patients with LBBB from conduction block. This may help inform patient selection for cardiac resynchronization or conduction system pacing.

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Intermittent Bundle-Branch Block

Shearn¹

1953

AMA Arch Intern Med

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INTERMITTENT bundle-branch block, a not uncommon electrocardiographic finding, is encountered mainly in elderly people or patients with organic heart disease.1 Rarely it is found in a person with an otherwise normal heart,2 though its mere presence is taken by some 3 to be evidence of heart disease. The rarity of this condition in the absence of heart disease was borne out by the study of Comeau, Hamilton, and White 3 wherein they found only 6 patients of a total of 77 with intermittent bundle-branch block in whom myocardial disease could not be implicated. In reviewing the pertinent medical literature since Comeau's analysis, Sandberg and co-workers 4 reached a similar conclusion ; they found that only 6 patients of a total of 82 with intermittent bundle-branch block had no apparent heart disease.Because of the underlying disease in patients with this condition, the conducting system becomes so modified that a point is reached where even minor influences on conduction are attended by a change in the form of the ventricular complex. When such a delicate balance exists, anoxemia, tachycardia, or metabolic abnormalities may supply the additional burden to the compromised conduction system and cause bundle branch-block to appear ; anything which then affects conduction in a salutary manner may result in the return of normal intraventricular conduction.The present report deals with that form of bundle-branch block which is char¬ acterized by the appearance of both normal and bundle-branch block complexes in a single electrocardiogram, with fluctuations back and forth between the normal and the abnormal conduction patterns. This form of conduction disturbance has been

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Intraventricular Block

Cited by 39 publications

References 159 publications

Bundle-Branch Block Under Voluntary Control

Bundle-Branch Block Under Voluntary Control

A Revised Definition of Left Bundle Branch Block Using Time to Notch in Lead I

Intermittent Bundle-Branch Block

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