The Differential Morphology of Anomalous Ventricular Complexes of RBBB-Type in Lead V
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Sandler, Israel; Marriotr, Henry J. L.

doi:10.1161/01.cir.31.4.551

Cited by 136 publications

(25 citation statements)

References 4 publications

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“…5 In addition to prematurity, unequal refractoriness of the bundle branches also favors phasic aberrant ventricular conduction. Results of several studies [5][6][7][8][9] in which aberrant ventricular conduction in humans and dogs was investigated have indicated that the right bundle branch is more susceptible to block, most likely because the right bundle branch has a larger diameter and a longer action potential, compared with that of the left bundle branch.…”

Section: Discussionmentioning

confidence: 99%

ECG of the Month

Achen¹,

Saunders²,

Miller³

2008

javma

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A 10-year-old 20-kg (44-lb) spayed female Brittany was examined by a veterinarian because of acute onset of lethargy and inappetence. Tachycardia was detected on physical examination and confirmed via ECG; in all leads, the QRS complexes were wide. Lidocaine hydrochloride (2 mg/kg [0.9 mg/lb]) was administered IV, which slowed the heart rate slightly. The dog was subsequently transferred to a local emergency clinic for supervision overnight. Because of the incomplete response to lidocaine, the dog was referred to the Veterinary Medical Teaching Hospital at Texas A&M University for further evaluation the following morning.The dog was bright and alert at the initial evaluation. Thoracic auscultation revealed an irregularly irregular tachyarrhythmia with associated femoral pulse deficits. No murmurs were detected, and bronchovesicular sounds were considered normal. A history of bird hunting, the last episode of which occurred > 1 year earlier, was reported. Vaccination status was current, and the dog was regularly receiving a heartworm preventative.Diagnostic procedures included thoracic radiography; echocardiography; ECG; systemic blood pressure evaluation; CBC; serum biochemical analyses; titer assessment of serum antibodies against Trypanosoma cruzi via an immunofluorescent antibody test; and measurements of serum concentrations of taurine, thyroid hormones (total thyroxine, free thyroxine [determined via equilibrium dialysis], and thyroid-stimulating hormone), and cardiac troponin I. Findings of thoracic radiography included mild generalized cardiomegaly with a mildly large left atrium, pulmonary venous congestion, and a mild unstructured interstitial pattern in the lungs. Echocardiographic findings included left ventricular internal dimensions indicative of dilatation, left ventricular systolic dysfunction, a mild centrally located jet of mitral valve regurgitation, a moderately large left atrium, and mild low-velocity tricuspid valve regurgitation. The mitral and tricuspid valves appeared normal. Indirect systemic blood pressure measured by use of an oscillometric device was within reference limits. Results of serum biochemical analyses and a CBC were unremarkable. The dog was seronegative for T cruzi; serum taurine and thyroid hormone concentrations were within reference limits. Serum cardiac troponin I concentration was increased at 3.86 ng/mL (reference range, < 0.2 ng/mL). ECG InterpretationElectrocardiographic findings during the initial examination included an irregularly irregular wide and bizarre QRS tachycardia, conducted with a right bundle branch block (RBBB) morphology, and all QRS complexes were conducted with an RS complex morphology (Figure 1). Instantaneous heart rates varied from 55 to 188 beats/min. The RS complex appearance varied depending on heart rate. With heart rates > 97 beats/min, the RS complexes were conducted with an RBBB (RS complex duration, 100 milliseconds). More-narrow (40 milliseconds in duration), upright RS complexes occurred at heart rates < 62 beats/min, suggesting more-n...

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Section: Discussionmentioning

confidence: 99%

ECG of the Month

Achen¹,

Saunders²,

Miller³

2008

javma

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“…Extrasystoles were considered ventricular on the usual criteria (Lipman and Massie, 1965;Talbot, 1973). Differentiation from aberrant conduction was based on the criteria of Marriott (Sandler and Marriott, 1965) but when in doubt the rhythm was considered supraventricular.…”

Section: Methodsmentioning

confidence: 99%

Prognostic importance of ventricular extrasystoles in acute myocardial infarction

Talbot

1977

Postgraduate Medical Journal

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SummaryVentricular arrhythmias were recorded in 233 patients in a prospective study of patients with acute myocardial infarction. In over 95°o of patients antiarrhythmic therapy was not given until the onset of ventricular tachycardia, ventricular fibrillation, or persistent idioventricular rhythm. There was a mortality of 18%y during the patients' stay in hospital. The most important features of ventricular ectopic activity, which preceded these severe ventricular arrhythmias in the first 48 hr, were multiformity, variation of coupling intervals of >01 sec, the R-on-T phenomenon, double ventricular extrasystoles and ventricular bigeminy. The number of single ventricular extrasystoles per minute was related to the probability of these severe ventricular arrhythmias but to a lesser degree. It was found that if all the patients with the first two prognostic features were removed, the number of single ventricular extrasystoles was not of significant import and the other features were less important.Three-quarters of the severe arrhythmias occurred in the first 24 hr and during this period 60%y were preceded by either multiform ventricular extrasystoles or extrasystoles with variable coupling. The importance of these findings in relation to prophylactic therapy is discussed.

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“…By combining the information from programmed electrical stimulation of the heart and cardiac mapping with the 12-lead electrocardiogram during the tachycardia, it became possible to identify the different types of supraventricular tachycardias [17] . Using the same approach in patients with ventricular tachycardia, Sandler and Marriott suggested [18] ways of differentiating supraventricular tachycardia with bundle branch block from ventricular tachycardia. These fruitful suggestions were followed by new observations using the width, the frontal plane axis and configurational characteristics of the QRS complex [19] .…”

Section: -1977: the Decade Of Discoverymentioning

confidence: 99%

1967–1997: Thirty years of cardiac arrhythmias

Wellens¹

1998

European Heart Journal

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The Differential Morphology of Anomalous Ventricular Complexes of RBBB-Type in Lead V ₁

Cited by 136 publications

References 4 publications

ECG of the Month

ECG of the Month

Prognostic importance of ventricular extrasystoles in acute myocardial infarction

1967–1997: Thirty years of cardiac arrhythmias

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The Differential Morphology of Anomalous Ventricular Complexes of RBBB-Type in Lead V 1

Cited by 136 publications

References 4 publications

ECG of the Month

ECG of the Month

Prognostic importance of ventricular extrasystoles in acute myocardial infarction

1967–1997: Thirty years of cardiac arrhythmias

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The Differential Morphology of Anomalous Ventricular Complexes of RBBB-Type in Lead V ₁