Novel ECG criteria for right ventricular systolic dysfunction in patients with right bundle branch block

Adams, Jonathon C.; Nelson, Matthew R.; Chandrasekaran, Krishnaswamy; Jahangir, Arshad; Srivathsan, Komandoor

doi:10.1016/j.ijcard.2012.04.025

Cited by 7 publications

(9 citation statements)

References 19 publications

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“…Depending on the degree of Purkinje system involvement, conduction across the RV myocardium is expected to become more delayed and presents as prominent QRS and R 0 wave duration prolongation on surface ECG. Recently, Adams et al [9] showed an association between TAPSE and V1 R 0 wave duration in 34 patients with RV dysfunction. However, TAPSE depends on the volume load, which is not suited for the assessment of RV pressure overload in cases of COPD or congenital heart disease.…”

Section: Discussionmentioning

confidence: 99%

“…expected to become delayed and can be detected as R 0 (the later portion of the QRS complex) prolongation on surface ECG. A recent study showed that prolonged R 0 duration in lead V1 was an indicator of RV dysfunction in patients with RBBB [9]. We aimed to investigate the association between R 0 duration in lead V1 and echocardiographic RV functional parameters in patients with RBBB.…”

Section: Introductionmentioning

confidence: 97%

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Association between right ventricular systolic function and electromechanical delay in patients with right bundle branch block

Park

Cho

Kim

et al. 2017

Journal of Cardiology

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

Association between right ventricular systolic function and electromechanical delay in patients with right bundle branch block

Park

Cho

Kim

et al. 2017

Journal of Cardiology

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“…Increased RV pressures and volumes in RV dysfunction can cause myocardial stretching which in turn can lead to stress on the right bundle and purkinje network (13). This can lead to conduction delay across the path of the right bundle branch causing RBBB.…”

Section: Discussionmentioning

confidence: 99%

“…The association of QRS duration in RBBB with RV dysfunction was previously reported mostly in congenital heart disease (24)(25)(26). A previous study, in its novel approach, used echocardiography to define ECG criteria for RV dysfunction (13). However, it was limited by small sample size and the limitations of two dimensional echocardiography as mentioned above.…”

Section: Discussionmentioning

confidence: 99%

“…Right bundle branch block (RBBB), however, has not been proven to be associated with RV dysfunction. A previous study hypothesized R' duration to be independently association with systolic dysfunction by using echocardiography (13). We here try to go one step forward by studying electrocardiographic RBBB features and analyze their association with RV systolic dysfunction using CMRI.…”

Section: Introductionmentioning

confidence: 99%

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Right ventricular failure predicted from right bundle branch block: cardiac magnetic resonance imaging validation

Devarapally

Arora

Ahmad

et al. 2016

Cardiovasc. Diagn. Ther.

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Background: Right ventricular (RV) failure has proven to be independently associated with adverse outcomes. Electrocardiographic parameters assessing RV function are largely unknown, making echocardiography the first line for RV function assessment. It is however, limited by geometrical assumptions and is inferior to cardiac magnetic resonance imaging (CMRI) which is widely regarded as the most accurate tool for assessing RV function. Methods:We seek to determine the correlation of ECG parameters of right bundle branch block (RBBB) with RV ejection fraction (EF) and RV dimensions using the CMRI. QRS duration, R amplitude and R' duration were obtained from precordial lead V1; S duration and amplitude were obtained from lead I and AVL. RV systolic dysfunction was defined as RV EF <40%. RV systolic dysfunction group (mean EF of 24±10%) were compared with normal RV systolic function group which acted as control (mean EF of 48±8%). CMRI and ECG parameters were compared between the two groups. Rank correlations and scatter diagrams between individual CMRI parameters and ECG parameters were done using medcalc for windows, version 12.5. Sensitivity, specificity and area under the curve (AUC) were calculated.Results: RV systolic dysfunction group was found to have larger RV end systolic volumes (90±42 vs. 59±40 mL, P=0.02). ECG evaluation of RV dysfunction group revealed longer R' duration (103±22 vs.84±18 msec, P=0.005) as compared to the control group. The specificity of R' duration >100 msec to detect RV systolic dysfunction was found to be 93%. R' duration was found to have an inverse correlation with RV EF (r=−0.49, P=0.007).Conclusions: Larger RV end systolic volumes seen with RV dysfunction can affect the latter part of right bundle branch leading to prolonged R' duration. We here found prolonged R' duration in lead V1 to have a highly specific inverse correlation to RV systolic function. ECG can be used as an inexpensive tool for RV function assessment and should be used alongside echocardiography to evaluate RV dysfunction when CMRI is not available.

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Does Surgically Induced Right Bundle Branch Block Really Effect Ventricular Function in Children After Ventricular Septal Defect Closure?

et al. 2014

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In this prospective study, we aimed to assess left and right ventricular function in terms of the presence of right bundle branch block (RBBB) in the cases with repaired ventricular septal defect (VSD). Fifty-three patients who had VSD surgery at least 1-year preceding admission and 52 healthy controls were enrolled into the study. All the participants underwent electrocardiographic and echocardiographic examination. The cases with RBBB were determined. The conventional and tissue Doppler echocardiographic measurements of the patients with and without RBBB were compared with each other and healthy controls. Twenty-eight of VSD repair groups were male and 25 were female. Control group consisted of 30 males and 22 females. The mean age of the study and control groups was 7.5 ± 5.0 and 6.9 ± 4.3 years, respectively. RBBB was detected in 20 of 53 (37.7 %) operated patients. The only significant difference between the cases with and without RBBB was decreased right ventricular fractional area change (%) in the former group (33 ± 7 vs. 39 ± 5 p < 0.05). When compared to controls, operated group had statistically lower [corrected] tricuspid annular plane systolic excursion (p < 0.05), lower systolic, early diastolic, and late diastolic myocardial velocities, higher left and right ventricular myocardial performance indices, irrespective of the presence of RBBB. The ratios of mitral or tricuspid inflow to left or right ventricular myocardial in early diastolic velocities measured from lateral annular levels were increased in operated group (all p values <0.05). In conclusion, RBBB in the cases with surgical VSD repair might be associated with right ventricular dysfunction. Biventricular systolic and diastolic dysfunction may develop following VSD repair irrespective of the presence of RBBB. Tissue Doppler-derived myocardial performance indices are useful in detection of those subclinical dysfunctions.

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Novel ECG criteria for right ventricular systolic dysfunction in patients with right bundle branch block

Cited by 7 publications

References 19 publications

Association between right ventricular systolic function and electromechanical delay in patients with right bundle branch block

Association between right ventricular systolic function and electromechanical delay in patients with right bundle branch block

Right ventricular failure predicted from right bundle branch block: cardiac magnetic resonance imaging validation

Does Surgically Induced Right Bundle Branch Block Really Effect Ventricular Function in Children After Ventricular Septal Defect Closure?

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