| The surface electrocardiogram predicts risk of heart block during right heart catheterization in patients with preexisting left bundle branch block: implications for the definition of complete left bundle branch block. | |
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MedLine Citation:
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PMID: 20132380 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Patients with left bundle branch block (LBBB) undergoing right heart catheterization can develop complete heart block (CHB) or right bundle branch block (RBBB) in response to right bundle branch (RBB) trauma. We hypothesized that LBBB patients with an initial r wave (>or=1 mm) in lead V1 have intact left to right ventricular septal (VS) activation suggesting persistent conduction over the left bundle branch. Trauma to the RBB should result in RBBB pattern rather than CHB in such patients. METHODS: Between January 2002 and February 2007, we prospectively evaluated 27 consecutive patients with LBBB developing either CHB or RBBB during right heart catheterization. The prevalence of an r wave >or=1 mm in lead V1 was determined using 118 serial LBBB electrocardiographs (ECGs) from our hospital database. RESULTS: Catheter trauma to the RBB resulted in CHB in 18 patients and RBBB in 9 patients. All 6 patients with >or=1 mm r wave in V1 developed RBBB. Among these 6 patients q wave in lead I, V5, or V6 were present in 3. Four patients (3 in CHB group and 1 in RBBB group) developed spontaneous CHB during a median follow-up of 61 months. V1 q wave >or=1 mm was present in 28% of hospitalized complete LBBB patients. CONCLUSIONS: An initial r wave of >or=1 mm in lead V1 suggests intact left to right VS activation and identifies LBBB patients at low risk of CHB during right heart catheterization. These preliminary findings indicate that an initial r wave of >or=1 mm in lead V1, present in approximately 28% of ECGs with classically defined LBBB, may constitute a new exclusion criterion when defining complete LBBB. |
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Authors:
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Benzy J Padanilam; Kent E Morris; Jeff A Olson; Janet S Rippy; Mary Norine Walsh; Natrajan Subramanian; Alex Vidal; Eric N Prystowsky; Leonard A Steinberg |
Publication Detail:
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Type: Journal Article Date: 2010-02-01 |
Journal Detail:
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Title: Journal of cardiovascular electrophysiology Volume: 21 ISSN: 1540-8167 ISO Abbreviation: J. Cardiovasc. Electrophysiol. Publication Date: 2010 Jul |
Date Detail:
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Created Date: 2010-07-26 Completed Date: 2010-11-02 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9010756 Medline TA: J Cardiovasc Electrophysiol Country: United States |
Other Details:
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Languages: eng Pagination: 781-5 Citation Subset: IM |
Affiliation:
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The Care Group, LLC, Indianapolis, Indiana, USA. bpadanil@thecaregroup.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aged, 80 and over Bundle of His / injuries*, physiopathology Bundle-Branch Block / complications, diagnosis*, physiopathology Electrocardiography* Electrophysiologic Techniques, Cardiac* Female Heart Block / etiology*, physiopathology Heart Catheterization / adverse effects* Humans Indiana Male Middle Aged Predictive Value of Tests Prospective Studies Risk Assessment Risk Factors |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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