Electrocardiographic diagnosis of left ventricular hypertrophy in the presence of bundle branch block

Effect of Right Bundle Branch Block on Electrocardiographic Amplitudes, Including Combined Voltage Criteria Used for the Detection of Left Ventricular Hypertrophy

“…15 More recent studies using echocardiography as the gold standard for LVH also have demonstrated reduced sensitivity of ECG voltage criteria in the presence of RBBB. 4,[6][7][8] Our findings quantify the reduction in leftward and posterior mid-QRS amplitudes during RBBB that explain these observations. In our population, both Sokolow-Lyon and Cornell voltage combinations were greatly reduced (5-7 mm, 500-700 μV) in the presence of RBBB.…”

“…5 It is generally recognized that RBBB alters ECG amplitudes to reduce the already poor sensitivity of standard voltage criteria for the detection of left ventricular hypertrophy (LVH). [4][5][6][7][8][9] However, the magnitude of QRS voltage changes caused by RBBB in the standard leads of the routine ECG has not been quantified in patients and subjects who are in a temporally and physiologically constant state. The present study examined the effect of RBBB on QRS amplitudes and voltage criteria used for the detection of LVH in a consecutive series of patients with intermittent bundle branch block and normal (i.e., nonRBBB) intraventricular conduction during simultaneous lead recording of a single 10-second ECG.…”

Usefulness of ECG criteria to rule out left ventricular hypertrophy in older individuals with true left bundle branch block: an observational study

“…These results question the usefulness of the LVH electrocardiographic criteria in patient with LBBB. Although some reports have yielded high sensitivity [17][18][19][20][21], especially when using a computer-assisted diagnostic system [6], other groups have also questioned the use of ECG-based LVH criteria in patients with LBBB [7]. Previous studies testing ECG-based LVH criteria in patients with LBBB were performed prior to the development of the stricter LBBB criteria, and likely enrolled a more heterogeneous population, mixing conduction disease with LVH or LV dilation.…”

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

“…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].…”