Left-posterior hemiblock. Clinical and vectorcardiographic study of twenty cases

Lopes, Vírginia M.; Miguel, José Pereira; Reis, Dario D. dos; Costa, Braz C. Bruto Da; Pádua, Fernando de

doi:10.1016/s0022-0736(74)80031-2

Cited by 15 publications

(6 citation statements)

References 22 publications

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“…There were 15 male and 3 female patients whose ages varied from 7 to 91 years. As seen in the study of Lopes et al (1974), the mean age was lower in group A (41.8) than in group B (52.9). The clinical and pathological findings, and the electrocardiographic diagnoses are listed in Tables 1 and 2.…”

Section: Description Of Cases Selectedsupporting

confidence: 59%

“…In 3 cases, though the vectorcardiogram was characteristic for left posterior fascicular block, the mean QRS axis was not located in the right inferior quadrant of the frontal plane: it was, respectively, at +600, +800, and undetermined (around -140°). This is not surprising since there is not always a good correlation between the orientation of the maximal spatial QRS vector and the angle of the maximal vector in frontal plane (Lopes et al, 1974). Moreover, since the range of normality is different between the mean QRS axis of the electrocardiogram and the angle of the maximal QRS vector in the frontal plane, the criteria for left posterior fascicular block based on these two values should necessarily be different (Poblete et al, 1974).…”

Section: Criterion B: Main Part Of Qrs Loopmentioning

confidence: 99%

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Spatial Frank vectorcardiogram in left posterior fascicular block. Criteria and correlation with clinical and electrocardiographic data.

Brohet¹,

Arnaud²

1977

Heart

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Computer processing of spatial QRS parameters (Frank vectorcardiogram) was used to study left posterior fascicular block. The best set of vectorcardiographic criteria was sought in order to characterise the classic pattern of left posterior fascicular block. Using these criteria, 18 cases were selected from a group of 4600 patients and 340 healthy subjects; isolated left posterior fascicular block was seen in 10 cases, and was associated with right bundle-branch block in 8 cases. It is shown that some external factors can influence the aspect of the spatial QRS loop in left posterior fascicular block: cardiomegaly tends to produce a superior displacement of the main QRS forces: right bundle-branch block enhances the superior displacement of the initial forces and shifts the main QRS forces more anteriorly and to the right. The 'masquerading effect' of the left posterior fascicular block on a concomitant inferior myocardial infarct was also shown. The most important diagnostic feature was the opposite direction of the initial forces (left anterosuperior) and the maximal vector (right postero-inferior): the angle between these two vectors averaged 152 degrees. Other criteria, such as the direction of rotation or the axis of the frontal loop, the vertical direction of the spatial loop, the presence of a Q wave in leads II, III, and aVF of the electrocardiogram, are not mandatory for the diagnosis of left posterior fascicular block.

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Section: Description Of Cases Selectedsupporting

confidence: 59%

Section: Criterion B: Main Part Of Qrs Loopmentioning

confidence: 99%

Spatial Frank vectorcardiogram in left posterior fascicular block. Criteria and correlation with clinical and electrocardiographic data.

Brohet¹,

Arnaud²

1977

Heart

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“… Horizontal Plane: QRS loop very similar to RVH of type C [50]; QRS loop of CCW rotation. The rotation could be in “eight”; initial 10–20 ms vector heading to the front and the right or left; greater area of QRS loop located in the left posterior quadrant; maximal vector of QRS around −60 to −110°; final portions with delay (60–100 ms) and located in the right posterior quadrant; 20% or more of the QRS loop area located in the right posterior quadrant; T loop located to the front and the left (+60°) and CW rotation.…”

Section: Epidemiologymentioning

confidence: 99%

Left posterior fascicular block, state-of-the-art review: A 2018 update

Pérez‐Riera

Barbosa‐Barros

Daminello‐Raimundo

et al. 2018

Indian Pacing and Electrophysiology Journal

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We conducted a review of the literature regarding epidemiology, clinical, electrocardiographic and vectorcardiographic aspects, classification, and differential diagnosis of left posterior fascicular block.Isolated left posterior fascicular block (LPFB) is an extremely rare finding both in the general population and in specific patient groups. In isolated LPFB 20% of the vectorcardiographic (VCG) QRS loop is located in the right inferior quadrant and when associated with right bundle branch block (RBBB) ≥40%.The diagnosis of LPFB should always consider the clinical aspects, because a definite diagnosis cannot be made in the presence of right ventricular hypertrophy (RVH) (chronic obstructive pulmonary disease (COPD)/emphysema), extensive lateral myocardial infarction (MI) or extremely vertical heart.Intermittent LPFBs are never complete blocks (transient or second degree LPFB) and even in the permanent ones, one cannot be sure that they are complete. When LPFB is associated with RBBB and acute inferior MI, PR interval prolongation is very frequent.

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“…In their original description, Rosenbaum et al [8,9] diagnosed LPHB when an axis of 120° was reached. Nevertheless, several investigators [9][10][11][12] have utilized lesser degrees of RAD as requirement for this diagnosis. Rosenbaum et al [9] also expressed the opinion that LPHB may occur with a lesser degree of RAD which probably represents an incomplete form of LPHB.…”

Section: Rad Versus Lphbmentioning

confidence: 99%

Significance of Rightward Axis Shift in Anterior Acute Myocardial Infarction

Sagie¹,

Sclarovsky²,

Strasberg³

et al. 1991

Am J Noninvas Cardiol

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The purpose of this study was to assess the significance of two types of rightward axis shift appearing during anterior acute myocardial infarction. Of 731 consecutive patients admitted with evidence of anterior acute myocardial infarction, 72 (10%) developed acute rightward axis shift and were divided into two groups according to electrocardiographic criteria: group A consisted of 27 patients with rightward axis shift and an electrocardiographic pattern characteristic of left posterior hemiblock, and group B consisted of 45 patients with rightward axis shift without the electrocardiographic pattern of left posterior hemiblock. A comparison between their electrocardiographic patterns, clinical course, prognosis, and échocardiographie findings was made. There was no significant difference in the average shift of the axis to the right between the groups (60 vs. 62°). The average mean axes of the first (<0.04 ms) and second (>0.04 ms) vector in group A were 2 and 107°, respectively, as compared with 68 and 52° in group B (p < 0.001). The Killip class on admission was worse in group A (26 vs. 2% for Killip III and IV). The patients in group A had a significantly higher incidence of in-hospital morbidity such as congestive heart failure (63 vs. 24%) and cardiogenic shock (74 vs. 7%). The in-hospital mortality rate in group A was very high (70%) as compared with group B (9%; p < 0.001). The echocardiogram of group A patients showed severe general hypokinesia as compared with group B patients in whom there was a better left ventricular function with normal inferior wall motion and lateral base wall compensatory hyperkinesia. The right axis deviation in group A is attributed to different degrees of left posterior hemiblock, while in group B the rightward axis shift is attributed to the cancellation of electrical forces from the anterolateral wall as a result of the infarction and the upsurge of the right electrical forces from the posterior wall. In conclusion, it is very important to differentiate between patients with these two electrocardiographic patterns of rightward axis shift during anterior acute myocardial infarction because they are completely different in their electrocardiographic characteristics, clinical course, and prognosis.

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Left-posterior hemiblock. Clinical and vectorcardiographic study of twenty cases

Cited by 15 publications

References 22 publications

Spatial Frank vectorcardiogram in left posterior fascicular block. Criteria and correlation with clinical and electrocardiographic data.

Spatial Frank vectorcardiogram in left posterior fascicular block. Criteria and correlation with clinical and electrocardiographic data.

Left posterior fascicular block, state-of-the-art review: A 2018 update

Significance of Rightward Axis Shift in Anterior Acute Myocardial Infarction

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