AHA/ACCF/HRS Recommendations for the Standardization and Interpretation of the Electrocardiogram

Surawicz, Borys; Childers, Rory; Deal, Barbara J.; Gettes, Leonard S.

doi:10.1016/j.jacc.2008.12.013

Cited by 1,120 publications

(179 citation statements)

References 20 publications

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“…QRS duration was automatically detected and visually controlled. QRS morphology was defined according to current definitions 14. QRS duration and morphology were both categorized into <150 vs. ≥150 ms and LBBB vs. non‐LBBB, respectively.…”

Section: Methodsmentioning

confidence: 99%

QRS duration versus morphology and survival after cardiac resynchronization therapy

et al. 2016

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AimsThe prognostic implications of QRS duration and morphology in heart failure patients treated with cardiac resynchronization therapy (CRT) remains debated. The present evaluation investigated the association between QRS duration (<150 vs. ≥150 ms) and QRS morphology (left bundle brand block [LBBB] vs. non‐LBBB) and long‐term prognosis of a large cohort of unselected heart failure patients treated with CRT according to contemporary guidelines.Methods and resultsOf 973 heart failure patients treated with CRT (mean age 66.1 ± 9.8 years, 76% male), 658 patients (68%) showed QRS duration ≥150 ms, and 772 patients (79%) had LBBB configuration. Compared with patients with QRS duration <150 ms, patients with QRS duration ≥150 ms had less frequently ischaemic cardiomyopathy and atrial fibrillation and showed larger left ventricular volumes and lower left ventricular ejection fraction. Compared with patients with non‐LBBB configuration, patients with LBBB morphology were younger, less often males and less often had ischaemic cardiomyopathy and atrial fibrillation. On multivariable analysis, after correcting for relevant clinical and echocardiographic variables, LBBB morphology was significantly associated with better survival [hazard ratio (HR) 0.737; 95% confidence interval (CI) 0.584–0.931; P = 0.010], whereas there was no statistically significant association between QRS duration ≥150 ms and survival (HR 0.889; 95% CI 0.726–1.088; P = 0.252).ConclusionsIn this large population of heart failure patients treated with CRT, QRS morphology was independently associated with long‐term survival. The association between QRS duration and long‐term survival was not statistically significant.

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Section: Methodsmentioning

confidence: 99%

QRS duration versus morphology and survival after cardiac resynchronization therapy

et al. 2016

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“…using digital calipers and verified by the other (R.B.). LBBB was diagnosed using the most recent published criteria [7]: -QRS duration ≥ 120 ms; -board, notched or slurred R wave in leads I, aVL, V5 and V6; -absent q waves in leads I, V5, V6; -R peak time > 60 ms in leads V5 and V6 but normal in V1, V2, V3; -ST and T waves usually opposite in direction to QRS. The separation between LBBB and QRS prolongation due to LVH is a well known problem in electrocardiology.…”

Section: Electrocardiographymentioning

confidence: 99%

“…The highest values (area under curve > 0.8) were noted for parameters that included S wave amplitude: S in V2, V3 i.e. RaVL+SV3, SV2+SV3, autopsy or echocardiographic study [7][8][9][10][11][12][13][14]. The most frequently cited ECG criterion for LVH in patients with LBBB (S in V2+RV6 > 45 mm) was reported with maximal 86% sensitivity and 100% specificity [15].…”

Section: Predictive Value Of Ecg For Lvh In Lbbbmentioning

confidence: 99%

Electrocardiographic diagnosis of the left ventricular hypertrophy in patients with left bundle branch block: Is it necessary to verify old criteria?

Baranowski

Małek²,

Prokopowicz³

et al. 2012

Cardiol J

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“…The QRS interval was measured from the onset of the Q wave, or R wave if no Q wave was visible, to the J point. The diagnosis of intraventricular conduction abnormalities was based on recommendations from the American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society for the standardization and interpretation of ECGs 13. The QT interval was measured from the onset of the QRS to the end of the T wave 14.…”

Section: Methodsmentioning

confidence: 99%

Relationship Between QT Interval and Outcome in Low‐Flow Low‐Gradient Aortic Stenosis With Low Left Ventricular Ejection Fraction

Dahou

Toubal

Clavel

et al. 2016

JAHA

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Background QT interval has been shown to be associated with cardiovascular events. There is no data regarding the association between QT interval and left ventricular (LV) function and prognosis in patients with low LV ejection fraction (LVEF), low‐flow, low‐gradient aortic stenosis (LF‐LG AS). We aimed to examine the relationship between corrected QT interval (QT c) and LV function and outcome in these patients.Methods and ResultsNinety‐three patients (73±10 years; 74% men) with LF‐LG AS (mean gradient <40 mm Hg and indexed aortic valve area ≤0.6 cm2/m2) and reduced LVEF (≤40%) were prospectively included in this analysis and 63 of them underwent aortic valve replacement within 3 months following inclusion. Prolonged QT c was defined as QT c >450 ms in men and >470 ms in women. LV global longitudinal strain was measured by speckle tracking and expressed in absolute value |%|. QT c correlated with the following: global longitudinal strain (r=−0.40, P=0.005), LVEF (r=−0.27, P=0.02), stroke volume (r=−0.35, P=0.007), and B‐type natriuretic peptide (r=0.45, P=0.0006). During a median follow‐up of 2.0 years, 49 patients died. Prolonged QT c was associated with a 2‐fold increase in all‐cause mortality (hazard ratio=2.05; P=0.01) and cardiovascular mortality (hazard ratio=1.89; P=0.04). In multivariable analysis adjusted for EuroSCORE, aortic valve replacement, previous myocardial infarction, LVEF, and ß‐blocker medication, prolonged QT c was independently associated with all‐cause mortality (hazard ratio=2.56; P=0.008) and cardiovascular mortality (hazard ratio=2.50; P=0.02).ConclusionsIn patients with LF‐LG AS and reduced LVEF, longer QT c interval was associated with worse LV function and increased risk of death. Assessment of QT c may provide a simple and inexpensive tool to enhance risk stratification in LF‐LG AS patients.Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT 01835028.

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AHA/ACCF/HRS Recommendations for the Standardization and Interpretation of the Electrocardiogram

Cited by 1,120 publications

References 20 publications

QRS duration versus morphology and survival after cardiac resynchronization therapy

QRS duration versus morphology and survival after cardiac resynchronization therapy

Electrocardiographic diagnosis of the left ventricular hypertrophy in patients with left bundle branch block: Is it necessary to verify old criteria?

Relationship Between QT Interval and Outcome in Low‐Flow Low‐Gradient Aortic Stenosis With Low Left Ventricular Ejection Fraction

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